Abstract
Aspergillus is a fungus that is prevalent in nature and can cause a variety of clinical syndromes in patients. Risk factors for infection are primarily in patients with a compromised immune status, however, newer risk factors, including chronic lung disease and critical illness, have been identified. The diagnosis of invasive aspergillus can be difficult to make but tools for diagnosis that can be helpful include classic radiographic findings on chest CT and serologic testing for fungal proteins including galactomannan. Recent studies for primary treatment of invasive aspergillus have shown improved outcomes with voriconazole as monotherapy over the traditional treatment with liposomal amphotericin. Salvage therapy also includes the addition of echinocandins, such as caspofungin, in those patients failing therapy. Additional treatment can include surgery and reversal of immune dysfunction.
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References
Perfect JR, Cox GM, Lee JY, Kauffman CA, de Repentigny L, Chapman SW, Morrison VA, Pappas P, Hiemenz JW, Stvens DA. The impact of culture isolation of Aspergillus species: a hospital-based survey of aspergillosis. Clin Infect Dis. 2001;33:1824–33.
Patterson TF, Kirkpatrick WR, White M, Hiemenz JW, Wingard JR, Dupont B, Rinaldi MG, Stevens DA, Graybill JR. Invasive aspergillosis: disease spectrum, treatment practices, and outcomes. I3 Aspergillus Study Group. Medicine. 2000;79:250–60.
Soubani AO, Chandrasekar PH. The clinical spectrum of pulmonary aspergillosis. Chest. 2002;121:1988–99.
De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, Pappas PG, Maertens J, Lortholary O, Kauffman CA, Denning DW, Patterson TF, Maschmeyer G, Bille J, Dismukes WE, Herbrecht R, Hope WW, Kibbler CC, Kullberg BJ, Marr KA, Muñoz P, Odds FC, Perfect JR, Restrepo A, Ruhnke M, Segal BH, Sobel JD, Sorrell TC, Viscoli C, Wingard JR, Zaoutis T, Bennett JE. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis. 2008;46(12):1813–821.
Meerseman W, Lagrou K, Maertens J, Van Wijngaerden E. Invasive aspergillosis in the intensive care unit. Clin Infect Dis. 2007;45(2):205–16.
Dutkiewicz R, Hage CA. Aspergillus infections in the critically ill. Proc Am Thorac Soc. 2010;7(3):204–9.
Guinea J, Torres-Narbona M, Gijon P, et al. Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome. Clin Microbiol Infect. 2010;16(7):870–7.
Gustot T, Maillart E, Bocci M, et al. Invasive aspergillosis in patients with severe alcoholic hepatitis. J Hepatol. 2014;60(2):267–74.
Bulpa P, Dive A, Sibille Y. Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease. Eur Respir J. 2007;30(4):782–800.
Samarakoon P, Soubani A. Invasive pulmonary aspergillosis in patients with COPD: a report of five cases and systemic review of the literature. Chron Respir Dis. 2008;5(1):19–27.
Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax. 2014. pii: thoraxjnl-2014-206291. doi:10.1136/thoraxjnl-2014-206291.
Segal BH. Aspergillosis. N Engl J Med. 2009;360(18):1870–84.
Greene RE, Schlamm HT, Oestmann JW, et al. Imaging findings in acute invasive pulmonary aspergillosis: clinical significance of the halo sign. Clin Infect Dis. 2007;44(3):373–9.
Shelhamer JH, Gill VJ, Quinn TC, Crawford SW, Kovacs JA, Masur H, et al. The laboratory evaluation of opportunistic pulmonary infections. Ann Intern Med. 1996;124(6):585–99.
Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical practice guidelines of Infectious Diseases Society of America. Clin Infect Dis. 2008;46:327.
Limper AH, Knox KS, Sarosi GA, et al. An Official American Thoracic Society Statement: treatment of fungal infections in adult pulmonary and critical care patients. Am J Respir Crit Care Med. 2011;183:96–128.
Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, Kern WV, Marr KA, Ribaud P, Lortholary O, et al. Voriconazole versus amphotericin B for primary therapy of invasisve aspergillosis. N Engl J Med. 2002;347:408–15.
Schwartz S, Ruhnke M, Ribaud P, et al. Improved outcome in central nervous system aspergillosis, using voriconazole treatment. Blood. 2005;106:2641.
McLean KJ, Marshall KR, Richmond A, et al. Azole antifungals are potent inhibitors of cytochrome P450 mono-oxygenases and bacterial growth in mycobacteria and stretpomycetes. Microbiology. 2002;148(Pt 10):2937–49.
Limper A. Clinical approach and management fro selected fungal infections in pulmonary and critical care patients. Chest. 2014;146(6):1658–66.
Howard SJ, Lestner JM, Sharp A, et al. Pharmacokinetics and pharmacodynamics of posaconazole for invasive aspergillosis: clinical implications for antifungal therapy. J Infect Dis. 2011;203:1324.
Denning DW, Lee JY, Hostetler S, et al. NIAID Mycoses Study Group Multicenter Trial of oral itraconazole therapy for invasive aspergillosis. Am J Med. 1994;97:135.
Cornely OA, Maertens J, Bresnik M, Ebrahimi R, et al. Liposomal amphotericin B as initial therapy for invasive mold infection: a randomized tiral comparing a high-loading dose regimen with standard dosing (ambiload trial). Clin Infect Dis. 2007;44:1289–97.
McCormack PL, Perry CM. Caspofungin: a review of its use in the treatment of fungal infections. Drugs. 2005;65:2049.
Marr KA, Schlamm HT, Herbrecht R, et al. Combination antifungal therapy for invasive aspergillosi: a randomized trial. Ann Intern Med. 2015;162:81.
Snelders E, van der Lee HA, Kujipers J, et al. Emergence of azole resistance in Aspergillus fumigatus and spread of a single resistance mechanism. PLoS Med. 2008;5, e219.
Verweijj PE, Mellado E, Melchers WJ. Multiple-triazole-resistant aspergillosis. N Engl J Med. 2007;356:1481.
Bueid A, Howard SJ, Moore CB, et al. Azole antifungal resistance in Aspergillus funigatus: 2008 and 2009. J Antimicrob Chemother. 2010;65:2116.
Süslü AE, Oğretmenoğlu O, Süslü N, et al. Acute invasive fungal rhinosinusitis: our experience with 19 patients. Eur Arch Otorhinolaryngol. 2009;266:77.
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Schwartz, E.K. (2017). Invasive Aspergillus. In: Hyzy, R. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-43341-7_54
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DOI: https://doi.org/10.1007/978-3-319-43341-7_54
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