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Invasive Pulmonary Aspergillosis in Hematopoietic Stem Cell Transplantation

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Pulmonary and Critical Care Considerations of Hematopoietic Stem Cell Transplantation

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Abstract

Invasive pulmonary aspergillosis (IPA) remains a cause of high morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients. Changes in transplant practices and use of antifungal prophylaxis have changed the epidemiology of IPA in this population, with many cases now being identified in the late post-engraftment period. Some new risk factors for IPA are emerging such as intensive care unit stay, respiratory viral illnesses, and immunotherapy in addition to previously known risk factors like prolonged neutropenia, graft-versus-host disease (GVHD), corticosteroid administration, and cytomegalovirus (CMV) reactivation. Aspergillus fumigatus remains the predominant species responsible for IPA. Clinical features may include cough, dyspnea, pleuritic chest pain, fever, and hemoptysis. Non-contrast enhanced computed tomography (CT) scan is the preferred imaging modality. Classic radiological features such as halo sign and air-crescent sign may not be present in all patients. Diagnosis is based on a combination of clinical features, host risk factors, radiology, culture, histopathology, and biomarkers such as galactomannan. Management consists of antifungal agents along with withdrawal of immunosuppression and surgical resection in occasional cases. Voriconazole and isavuconazole are the preferred antifungals of choice. Primary prophylaxis with posaconazole has become routine in some high-risk groups. Early recognition, appropriate diagnostic tests, and judicious use of aspergillus-active azoles help improve prevention and management of invasive aspergillosis in the stem cell recipient population.

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Authors and Affiliations

  1. Division of Infectious Diseases, University of California, San Francisco, Fresno, CA, USA

    Geetha Sivasubramanian

  2. Division of Infectious Diseases, Wayne State University, Detroit, MI, USA

    Pranatharthi H. Chandrasekar

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  1. Geetha Sivasubramanian
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  2. Pranatharthi H. Chandrasekar
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Correspondence to Pranatharthi H. Chandrasekar .

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  1. Pulmonary and Critical Care Medicine, Wayne State University, Detroit, MI, USA

    Ayman O. Soubani

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Sivasubramanian, G., Chandrasekar, P.H. (2023). Invasive Pulmonary Aspergillosis in Hematopoietic Stem Cell Transplantation. In: Soubani, A.O. (eds) Pulmonary and Critical Care Considerations of Hematopoietic Stem Cell Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-031-28797-8_8

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  • DOI: https://doi.org/10.1007/978-3-031-28797-8_8

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