Practice Guidelines Published for Aspergillosis Diagnosis and Management

The guidelines-update focuses on earaly diagnosis and new treatments for patients with of the major forms of aspergillosis: allergic, chronic, and invasive, the latter of which kills 40-80% of those with widespread infection. Early diagnosis of invasive aspergillosis remains critical for more effective treatment.

As an airborne mold, aspergillus often is found in air conditioning units, compost piles, and damp or flood-damaged homes or buildings. While generally harmless, it can cause an allergic reaction or chronic lung problems in some people, and serious invasive disease in vulnerable patients. Immunocompromised patients are at highest risk for invasive aspergillosis. While requiring treatment, the allergic and chronic forms of aspergillosis typically are not deadly.

The 2016 guidelines (updated from 2008) were released by the Infectious Diseases Society of America (IDSA; Arlington, VA, USA). “Invasive aspergillosis often is overlooked, but early diagnosis and treatment are key,” said lead author Thomas Patterson, MD, professor, University of Texas Health Science Center at San Antonio (TX, USA) and South Texas Veterans Health Care System (San Antonio, TX, USA), “These are complicated infections with a number of treatment options. Patients really benefit from a multidisciplinary approach, including the expertise of an infectious disease specialist.”

The improved use of diagnostic tools has enhanced the ability to identify the infection early, including with blood tests, cultures, and computed tomography (CT) imaging. Because some methods are invasive (e.g. taking a culture directly from the lungs) physicians often are reluctant to proceed. However, because the infection is so deadly, physicians should be aggressive in diagnosing patients suspected of being infected.

New more-effective and better-tolerated antifungal medications, or versions of existing medications (e.g. extended release) have improved care, including isavuconazole and posaconazole. In some cases, combination therapy with voriconazole and an echinocandin is recommended for certain patients at highest risk. Because invasive aspergillosis is so deadly, the guidelines recommend some patients at highest risk even be treated with antifungals to prevent infection, including those with neutropenia and graft versus host disease (GVHD). Another prevention strategy is the use of special filtration systems for hospitalized immunosuppressed patients.

As with other IDSA guidelines, the aspergillosis guidelines will be available in a smartphone format and a pocket-sized quick-reference edition. The full guidelines are available free on the IDSA website.

As guidelines cannot always account for individual variation among patients, IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician with judgment in the light of each patient's individual circumstances.

The study, by Patterson TF et al, was published June 29, 2016, in IDSA’s journal Clinical Infectious Diseases.

Related Links:
Infectious Diseases Society of America