Materiały źródłowe

• #1 Aspergillosis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aspergillosis/symptoms-causes/syc-20369619

  Aspergillosis is an infection caused by a type of mold (fungus). The illnesses resulting from aspergillosis infection usually affect the respiratory system, but their signs and severity vary greatly. […] Depending on the type of aspergillosis, treatment may involve observation, antifungal medications or, in rare cases, surgery. […] If you have a weakened immune system and develop an unexplained fever, shortness of breath or a cough that brings up blood, get immediate medical care. In the case of invasive aspergillosis, prompt treatment is crucial. In some cases, treatment with antifungal medication begins as soon as aspergillosis is suspected, even before testing has confirmed the diagnosis. […] It’s nearly impossible to avoid exposure to aspergillus, but if you have had a transplant or are undergoing chemotherapy, try to stay away from places where you’re likely to encounter mold, such as construction sites, compost piles and buildings that store grain. If you have a weakened immune system, your doctor may advise you to wear a face mask to avoid being exposed to aspergillus and other airborne infectious agents.

• #1 Allergic Bronchopulmonary Aspergillosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK542329/

  Allergic bronchopulmonary aspergillosis (ABPA) is a common fungal infection in uncontrolled asthmatics, cystic fibrosis patients, and immunocompromised patients. Early diagnosis and rapid implementation of proper management are critical to prevent complications and/or disease progression. […] This activity describes the etiology, evaluation, and management of allergic bronchopulmonary aspergillosis and highlights the role of the interprofessional team in caring for affected patients. […] The main aim of the treatment of allergic bronchopulmonary aspergillosis is to control episodes of acute inflammation and to limit progressive lung injury. […] Goals of treatment: Controlling symptoms Preventing exacerbations Preserving normal lung function. […] Systemic corticosteroids are the primary therapy for ABPA. The steroids help to relieve the symptoms and decrease airflow obstruction, decrease serum IgE and reduce peripheral blood eosinophils. […] The nurse plays an important role in monitoring the patient for progression or worsening symptoms that must be reported back to the interprofessional team leader. […] This disease is challenging to treat, and only through coordinated interprofessional care will the best outcomes be achieved.

• #2 Aspergillosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482241/

  Aspergillosis is a spectrum of infections caused by fungi from the Aspergillus genus. […] This activity reviews the evaluation and management of aspergillosis, which varies significantly depending on the clinical syndrome and highlights the role of the interprofessional team in managing patients with this spectrum of conditions. […] Identify the role of aspergillus in the etiology of aspergillosis. […] Assess the use of a fungal sputum stain in the evaluation of aspergillosis. […] Evaluate the use of voriconazole as the first-line treatment of aspergillosis. […] Communicate the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by aspergillosis. […] The invasive aspergillosis patient often be critically ill with immunocompromised status.

• #2 Aspergillosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482241/

  The most common initial symptoms of pulmonary infection include fever, worsening dyspnea, increased sputum production, hemoptysis, and pleuritic chest pain. […] Treatment of suspected invasive aspergillosis should be promptly initiated while investigations are ongoing due to the rapidly progressive nature of the infection. […] In most instances, the drug of choice is voriconazole. […] Treatment of patients with chronic pulmonary aspergillosis exhibiting pulmonary symptoms and loss of pulmonary function is accomplished with oral therapy with itraconazole or voriconazole. […] Surgery may be required to remove an aspergilloma and should be considered in cases of hemoptysis. […] Consultations that are typically requested for patients with aspergillosis include: An infectious disease consultation is imperative in invasive aspergillosis and can be helpful in other forms of aspergillosis to manage antifungal therapy.

• #3 Aspergillosis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482241/

  The best way to decrease morbidity and mortality from aspergillosis is to place hospitalized patients at risk of invasive aspergillosis in private rooms with HEPA filtration, lowering fungi concentration. […] When aspergillosis is suspected, remembering the following pearls is helpful: Send all tissue and fluid for cytology, culture, and histopathology. […] An interprofessional team should include healthcare professionals from various disciplines to assist with care, including infectious diseases clinicians, pulmonologists, otolaryngologists, transplant physicians, pathologists, microbiology laboratory personnel, nurses, pharmacists, and infectious diseases pharmacists.

• #3 Episode 49: Invasive pulmonary aspergillosis with Shmuel Shoham – Critical Care Scenarios

  https://icuscenarios.com/episode-49-invasive-pulmonary-aspergillosis-with-shmuel-shoham/

  Invasive aspergillosis is among the most common diseases identified on autopsy studies of ICU patients that was not recognized prior to death. Not all of these deaths are attributable to the aspergillosis, but some likely were. […] Infection in the ICU patient arises when there are abnormalities in the flow of fluid, anatomical barriers, and/or the immune defenses (particularly neutrophil function). […] Risk factors for invasive fungal infection include any immunosuppression that inhibits neutrophil or T-cell function, ranging from high-dose steroids, DMARDs (mycophenolate, methotrexate), neutropenia (e.g. transplant patients, leukemia), and bronchiectatic disease (cystic fibrosis, COPD, etc), but can include anything from low-dose steroids to general critical illness. […] When considering fungal infection, serum galactomannan and beta-D-glucan levels should be done. If looking at the lungs, bronchoscopy with BAL should be performed, and galactomannan tested on the BAL specimen as well along with both bacterial and fungal stains/cultures.

• #4 Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes | Critical Care | Full Text

  https://ccforum.biomedcentral.com/articles/10.1186/s13054-014-0722-7

  Invasive aspergillosis (IA) is a fungal infection that particularly affects immunocompromised hosts. […] IA among critically ill patients is associated with high mortality. Patients diagnosed with proven or putative IA had greater severity of illness and more frequently needed organ support than those with Aspergillus spp colonization. […] In clinical practice, a diagnosis of IA is frequently suspected when Aspergillus is isolated from non-sterile body sites, particularly tracheal and bronchial aspirates. […] The presence of other risk factors, such as chronic lung and liver disease or general debilitation, may strengthen the likely clinical relevance of a positive Aspergillus culture. […] Patients with putative or proven IA were more likely to have hematologic cancer and to have undergone bone marrow or solid organ transplant than were those with Aspergillus colonization, which likely explains the larger proportion of patients receiving chemotherapy, radiotherapy and immunosuppressive drugs in these groups.

• #5 Management of Invasive Aspergillosis

  https://www.uspharmacist.com/article/management-of-invasive-aspergillosis

  Antifungal treatment remains the mainstay of treatment of IA. In order to prevent complications and poor outcomes, antifungal treatment should be initiated immediately in patients at high risk for IA. The Infectious Diseases Society of America (IDSA) recommends the use of voriconazole for the primary treatment of invasive pulmonary aspergillosis, as well as for other manifestations, such as aspergillosis infections of the sinuses, central nervous system aspergillosis, and chronic necrotizing pulmonary aspergillosis. If primary treatment fails, lipid formulations of amphotericin B (AMB), caspofungin, and itraconazole may be used as salvage therapy. The IDSA guidelines also recommend the use of posaconazole for prophylaxis in neutropenic patients with myelodysplasia and leukemia, as well as in allogeneic HSCT recipients with graft-versus-host disease (GvHD).

• #6 Pulmonary aspergillosis: infection, diagnosis and treatment – MedCrave online

  https://medcraveonline.com/JBMOA/pulmonary-aspergillosis-infection-diagnosis-and-treatment.html

  Additionally, Voriconazole is still the preferred treatment, while isavuconazole and posaconazole have comparable efficacy with reduced toxicity. […] As a treatment for invasive Aspergillosis, there is considerable interest in combination antifungal therapy that combines an echinocandin with either an azole or an amphotericin B formulation. […] In some circumstances, surgical intervention may be required to remove contaminated tissue. […] Early detection and management are critical in reducing the disease’s course and severity. However the prevention of Aspergillosis is always a good option.

• #7 Management of Invasive Aspergillosis

  https://www.uspharmacist.com/article/management-of-invasive-aspergillosis

  The IDSA guidelines do not recommend combination therapy for the initial treatment of IA. Instead, salvage therapy is recommended only if there is no clinical response to initial therapy. Consequently, this may involve adding a second agent or switching to another medication. Posaconazole, itraconazole, AMB, and caspofungin have been studied for use as salvage therapy and are recommended by IDSA guidelines. […] The IDSA guidelines recommend the use of posaconazole for prophylaxis of IA. This recommendation is based on two randomized, controlled, multicenter trials that evaluated the prophylactic use of posaconazole in patients with neutropenia and GvHD.

• #8 Aspergillus and Allergic Bronchopulmonary Aspergillosis | Cystic Fibrosis Foundation

  https://www.cff.org/managing-cf/aspergillus-and-allergic-bronchopulmonary-aspergillosis

  Aspergillus species is a fungus that often lives in the airways of children and adults with cystic fibrosis. When people develop an allergic reaction to Aspergillus, it is called allergic bronchopulmonary aspergillosis. […] Treatment for ABPA involves prevention and treatment of acute episodes, or flare-ups. […] Treatment of ABPA has two parts. Inflammation in the lung is treated with corticosteroids. Fungal colonization is treated with antifungal medicines. […] Oral corticosteroid pills or liquid, such as prednisolone (brand names include Pediapred and Prelone), prednisone tablets, and methylprednisolone (brand names include Medrol) tablets, have anti-inflammatory effects. […] Antifungal medicines like itraconazole (brand names include Sporanox) reduce the amount of fungus in the lungs. This may lower the chance of the disease getting worse over time.

• #9

  https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/aspergillosis

  Antifungal medications. These drugs are the standard treatment for invasive pulmonary aspergillosis. The most effective treatment is a newer antifungal drug, voriconazole (Vfend). Amphotericin B is another option. […] Surgery. Because antifungal medications don’t penetrate an aspergilloma very well, surgery to remove the fungal mass is the first-choice treatment when an aspergilloma causes bleeding in the lungs.

• #10 Aspergillus Infection (Aspergillosis) – Together by St. Jude™

  https://together.stjude.org/en-us/conditions/infectious-diseases/aspergillus-infection.html

  Aspergillosis is a fungal infection caused by breathing in spores of a common type of mold (fungus) called Aspergillus. Most people do not get sick from the fungus. But it can cause a serious infection in people with weak immune systems, lung problems, or other risk factors. […] Aspergillosis does not spread from person to person. […] Your health care provider may prescribe medicines called antifungals. Antifungal medicines used to treat aspergillosis may include: Voriconazole, Itraconazole, Amphotericin B, Posaconazole, Caspofungin. […] Other treatments may include: Steroids such as prednisone (for allergic aspergillosis), Surgery to treat aspergilloma or remove areas of infection. […] If your child has a weak immune system, it is important to take steps to limit their exposure to Aspergillus: Avoid dusty areas like construction sites, Limit contact with soil, dirt, dust, and leaves, Wear an N95 mask when around dust and mold, When outdoors, wear shoes, long pants, and long sleeves, Wash hands after playing outside, Use air filters and keep living areas well-ventilated. […] Aspergillosis is usually treated with antifungal medicines. […] If your child has a weakened immune system and shows symptoms of aspergillosis, call your care team.

• #11 Aspergillosis – UF Health

  https://ufhealth.org/conditions-and-treatments/aspergillosis

  Aspergillosis is an infection or allergic response due to the aspergillus fungus. […] Aspergillosis is caused by a fungus called aspergillus. […] Invasive aspergillosis is treated with several weeks of an antifungal medicine. It can be given by mouth or IV (into a vein). […] Allergic bronchopulmonary aspergillosis is treated with medicines that suppress the immune system (immunosuppressive medicines), such as prednisone, typically in conjunction with antifungals. […] Contact your provider if you develop symptoms of aspergillosis or if you have a weakened immune system and develop a fever. […] Precautions should be taken when using medicines that suppress the immune system.

• #12 Aspergillosis: Symptoms, treatment, and when to seek help

  https://www.medicalnewstoday.com/articles/aspergillosis

  Aspergillosis can cause breathing problems and can sometimes lead to severe lung infections, which may lead to hospitalization in people with weakened immune systems, such as those with HIV, AIDS, or lung disease. […] Supportive care, usually in a hospital setting, may be necessary when someone has a severe infection that is affecting their ability to breathe. For example, people with underlying chronic lung diseases may need additional treatment to manage their condition and reduce their risk of developing another infection. […] A person should seek medical help for new or worsening breathing symptoms if they have a chronic lung disease or a weakened immune system. […] Managing chronic health conditions and seeking immediate care for any new or worsening symptoms of infection is important.

• #13

  https://www.nursingcenter.com/journalarticle?Article_ID=6699858&Journal_ID=54015&Issue_ID=6699342

  ABSTRACT: Aspergillus species are ubiquitous in the environment. Premature neonates are particularly vulnerable to these fungal infections because their immune systems and integument are underdeveloped. Fungal invasion through breaks in the epidermis can lead to the development of primary cutaneous aspergillosis (PCA), a skin infection that is locally destructive and causes tissue necrosis. If left untreated, the fungus can disseminate into deeper tissues, causing significant morbidity and mortality. Treatment options are primarily pharmaceutical with rare indications for surgical debridement. However, concomitant wound care protocols may be beneficial. […] This case highlights the importance of rapid medical management coupled with daily wound care for the successful treatment of PCA with extensive necrosis.

• #14 LIVING WITH ASPERGILLOSIS – Mycology Advocacy, Research & Education (MyCARE)

  https://fightfungus.org/living-with-aspergillosis/

  If you have a chronic form of pulmonary aspergillosis: Its important to diagnose it early. Long-term infection can cause lung tissue to thicken and scar. This makes it more difficult for the lung to exchange gases with the blood supply […] Steroids may be prescribed to reduce or prevent inflammation. Its important to use the dose as prescribed by your healthcare provider […] Antifungals can be used to reduce symptoms, although they often dont get rid of the infection completely. Your provider will try to pick the lowest dose possible to prevent side effects and reduce cost […] You may need antibiotics to treat secondary bacterial infections from time to time. […] If you are a caregiver, get some support for yourself. Keep up with your own health and try to build in time to recharge. […] If you experience these symptoms, its important to get help! For tips on managing post-intensive care syndrome, see guidance from the Society of Critical Care Medicine.

• #15 Aspergillosis : symptoms, treatment, prevention – Institut Pasteur

  https://www.pasteur.fr/en/medical-center/disease-sheets/aspergillosis

  Aspergillosis is a general term for infections caused by a type of mold (fungus) belonging to the genus Aspergillus. […] Invasive pulmonary aspergillosis is the third most common invasive fungal infection in France, with a high case fatality rate of between 50 and 80%. […] Aspergillosis is not contagious between individuals. The disease is transmitted by inhaling Aspergillus spores in the air. […] Invasive aspergillosis mainly affects immunocompromised patients (such as patients with neutropenia or those who have received a bone marrow transplant). […] First-line treatment is an azole antifungal agent such as voriconazole or isavuconazole, to be administered immediately if infection is suspected. […] There is no vaccine for aspergillosis. Prophylaxis is crucial for at-risk patients such as bone marrow transplant recipients, for whom posaconazole is used as a first-line treatment.

• #16 Aspergillosis | Asthma + Lung UK

  https://www.asthmaandlung.org.uk/conditions/aspergillosis

  Aspergillosis is a group of conditions caused by breathing in aspergillus mould. […] Aspergillosis can develop in people with an existing lung condition or a weakened immune system. […] The treatment for aspergillosis depends on the type you have: […] It is important to get treatment as, without treatment, aspergillosis can progress and cause lung damage. […] Antifungal medicines for aspergillosis work by killing the fungus and preventing it from growing again. […] There are things you can do to reduce the risk of catching aspergillosis: […] Always take the full course of antifungal medication as prescribed by your doctors. […] Avoid handling imported plant materials, such as flower bulbs, as these can cause resistance to antifungal medication.

• #17 Aspergillosis: Types, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/14770-aspergillosis

  Corticosteroids (like prednisone, prednisolone and methylprednisolone) reduce inflammation. A provider might prescribe them to treat allergic forms of aspergillosis or skin infections. […] Surgery or antifungals can cure some types of noninvasive aspergillosis. In some cases, it may go away and come back again (recur). Invasive aspergillosis can be very hard to cure. […] If you’re at high risk for infection, talk to your provider about the best ways to protect yourself. Your provider might: Prescribe an antifungal medicine to prevent infection. […] Most people will need follow-up screenings, even if they are successfully treated.

• #18 LIVING WITH ASPERGILLOSIS – Mycology Advocacy, Research & Education (MyCARE)

  https://fightfungus.org/living-with-aspergillosis/

  Your provider should go over the symptoms to expect. For ABPA, the goal is to treat the disease early to protect the lung from damage caused by long-standing inflammation […] Because steroids given by mouth are the primary treatment for ABPA, its important to understand how they work and what the side effects are. This is discussed more in the treatment section […] Expect that some events can cause disease exacerbation […] While ABPA cant be cured, it can go into remission. In remission, the person with ABPA: Has no symptoms of ABPA, Has asthma under control, Has no new suspicious findings on the X-ray or any increases in IgE levels for at least 6 months. […] Some patients will have their disease progress to end-stage ABPA. In this stage, the patients have: Extensive bronchiectasis, Predisposition to pneumonia, Less response to corticosteroids, Lung problems: Bronchiectasis, pulmonary fibrosis, pulmonary hypertension.

• #19 Aspergillosis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aspergillosis/symptoms-causes/syc-20369619

  Aspergillosis is an infection caused by a type of mold (fungus). The illnesses resulting from aspergillosis infection usually affect the respiratory system, but their signs and severity vary greatly. […] Depending on the type of aspergillosis, treatment may involve observation, antifungal medications or, in rare cases, surgery. […] If you have a weakened immune system and develop an unexplained fever, shortness of breath or a cough that brings up blood, get immediate medical care. In the case of invasive aspergillosis, prompt treatment is crucial. In some cases, treatment with antifungal medication begins as soon as aspergillosis is suspected, even before testing has confirmed the diagnosis. […] It’s nearly impossible to avoid exposure to aspergillus, but if you have had a transplant or are undergoing chemotherapy, try to stay away from places where you’re likely to encounter mold, such as construction sites, compost piles and buildings that store grain. If you have a weakened immune system, your doctor may advise you to wear a face mask to avoid being exposed to aspergillus and other airborne infectious agents.

• #20 Reducing Risk for Aspergillosis | Aspergillosis | CDC

  https://www.cdc.gov/aspergillosis/prevention/index.html

  Most people breathe in Aspergillus spores without getting sick. […] People with weakened immune systems can reduce their risk of infection a few ways. […] For people who have weakened immune systems, there may be some ways to lower the chances of developing a severe Aspergillus infection. […] If you are at high risk for developing invasive aspergillosis your healthcare provider may prescribe medication to prevent aspergillosis. […] Some high-risk patients may benefit from blood tests to detect invasive aspergillosis.

• #21 Aspergillosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/aspergillosis/diagnosis-treatment/drc-20369623

  Diagnosing an aspergilloma or invasive aspergillosis can be difficult. […] Your doctor is likely to use one or more of the following tests to pinpoint the cause of your symptoms: […] Aspergillosis treatments vary with the type of disease. Possible treatments include: […] Simple, single aspergillomas often don’t need treatment, and medications aren’t usually effective in treating these fungal masses. […] The goal in treating allergic bronchopulmonary aspergillosis is to prevent existing asthma or cystic fibrosis from worsening. […] These drugs are the standard treatment for invasive pulmonary aspergillosis. […] Because antifungal medications don’t penetrate an aspergilloma very well, surgery to remove the fungal mass is the first-choice treatment when an aspergilloma causes bleeding in the lungs.

• #22 Invasive Aspergillosis – Scynexis

  https://www.scynexis.com/our-science/life-threatening-infections/invasive-aspergillosis/

  Invasive aspergillosis is a serious fungal infection caused by Aspergillus species that kills more than half of a million people each year worldwide. Aspergillus invades the lungs of immunocompromised patients and can spread to the bloodstream and other key organs leading to a high mortality rate of 30 to 80%. […] Current treatment guidelines recommend the use of azoles as the initial first-line therapy. However, patients face unsatisfactory clinical outcomes, with resistance to the standard of care, voriconazole, that can be as high as 20% and require long treatment durations. […] Due to the significant rate of resistance, combination antifungal therapy is recommended as first-line treatment for patients suspected of invasive aspergillosis in some countries. […] We believe that ibrexafungerp’s broad activity against Aspergillus spp., including azole-resistant strains along with its minimal drug-drug interactions and high tissue penetration into the lungs and oral formulation allowing for convenient long-term administration, may make it an ideal candidate for use as combination therapy. Oral ibrexafungerp, if approved in combination with standard of care for the treatment of invasive aspergillosis, would allow patients to receive the required combination treatment of two agents with different mechanisms of action for the full six to twelve weeks of therapy, potentially improving patient outcomes.

• #23 Episode 49: Invasive pulmonary aspergillosis with Shmuel Shoham – Critical Care Scenarios

  https://icuscenarios.com/episode-49-invasive-pulmonary-aspergillosis-with-shmuel-shoham/

  Elevated galactomannan in both BAL and blood, in a patient with reasonable pre-test probability, and imaging consistent with the diagnosis, allows a presumptive diagnosis of probable invasive pulmonary aspergillosis. Most diagnoses are never more certain than this, which would require positive cultures from a sterile site (e.g. blood) or biopsy. Such patients should usually be treated. […] Treatment involves antifungals, usually a mold-active -azole or occasionally amphotericin B, and improving the patients immune substrate, such as removal of immunosuppression. Specific drug toxicities play an important role; infectious disease consultation should be pursued. […] Overall, the key to diagnosis of aspergillosis in the ICU is a reasonable threshold to consider the diagnosis, recognizing the skipping record of a patient who doesn’t fit the normal stereotyped disease scripts (e.g. bacterial infections), intelligent workup particularly with biomarkers (b-d glucan, galactomannan), and multi-disciplinary collaboration.

• #24

  https://link.springer.com/article/10.1007/s00134-019-05789-6

  Invasive pulmonary aspergillosis (IPA) is a dreadful event in patients with hematological malignancies (HM). […] Routine voriconazole and prompt ICU admission are warranted. […] IPA is associated with high mortality rates in critically ill patients with acute respiratory failure.

• #25 Two point-of-care tests for invasive aspergillosis launched – Gaffi

  https://gaffi.org/two-point-of-care-tests-for-invasive-aspergillosis-launched/

  Prompt initiation of antifungal therapy can make the difference between life and death for patients with invasive aspergillosis. […] It is hoped that POC testing will help to reduce the global burden of deaths from invasive aspergillosis, particularly in high-risk settings where patients are immunosuppressed (transplants, cancer, HIV/AIDS) or in critical care wards where patients may deteriorate quickly.

• #26 Allergic Bronchopulmonary Aspergillosis Clinical Care Guidelines | Cystic Fibrosis Foundation

  https://www.cff.org/medical-professionals/allergic-bronchopulmonary-aspergillosis-clinical-care-guidelines

  Allergic bronchopulmonary aspergillosis is a hypersensitivity lung disease that results from exposure to Aspergillus fumigatus and occurs primarily in people with asthma or with cystic fibrosis. […] The diagnosis of ABPA in people with CF is difficult and often delayed because of shared clinical features. ABPA has been associated with accelerated deterioration in lung disease, so timely diagnosis and treatment are imperative. […] First line: systemic steroids — prednisone 0.5-2.0 mg per kg per day, one to two weeks — then attempt to taper within two to three months. […] Second line: antifungal — oral itraconazole 5 mg per kg per day (max 400 mg per day) for three to six months (if slow or poor response to steroids, relapse, or steroid toxicity). […] Bronchodilators, inhaled steroids, antiasthma drugs only if indicated for asthma.

• #27 Aspergillosis Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/296052-treatment

  Invasive aspergillosis is often rapidly progressive and has a high mortality. Therefore, preventive therapy and rapid institution of therapy in patients in whom invasive aspergillosis is suggested may be lifesaving. […] Prophylactic antifungal therapy and the use of laminar airflow (LAF) or high-efficiency particulate air (HEPA) filtration of patient rooms in patients who receive bone marrow transplants and other high-risk patients may prevent invasive aspergillosis. […] Surgical resection may be considered when localized disease fails to respond to antifungal therapy. […] Consultation with a pulmonologist may be helpful for patients suggested to have invasive aspergillosis or chronic necrotizing Aspergillus pneumonia in order to establish a definitive diagnosis. […] Invasive aspergillosis is frequently fatal, and prevention is the best way to decrease its associated morbidity and mortality. […] Serial measurement of the serum IgE level is a useful way to monitor response to therapy and to predict relapse after initial management.

• #28 Aspergillus and Allergic Bronchopulmonary Aspergillosis | Cystic Fibrosis Foundation

  https://www.cff.org/managing-cf/aspergillus-and-allergic-bronchopulmonary-aspergillosis

  Because steroids can have significant side effects and ABPA can be difficult to treat, CF providers may offer a therapy that targets one particular part of the immune system (so-called biologic therapies). One such therapy, omalizumab (Xolair), has been used to target IgE, which is often very elevated in patients with ABPA.

• #29 Treating and Preventing Aspergillosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/aspergillosis/treatment

  In patients with milder forms of the disease who are experiencing fewer symptoms, the infection may not require treatment and eventually clear up on its own. A single fungal ball, for example, may persist unchanged for a long time without treatment. It is recommended that, in these cases, your doctor monitor you to ensure that the disease does not progress. […] If treatment is required, your doctors recommendation will depend on the type that is diagnosed. […] If you are diagnosed with allergic bronchopulmonary aspergillosis, an antifungal medication, such as itraconazole, is the most common course of action. If it is not effective, your doctor may suggest an oral corticosteroid as an alternative medication. […] For chronic pulmonary aspergillosis patients who develop a fungal ball, surgery is the best option if the mass is in a good location to be removed. Though sometimes prescribed, antifungal medications have been found to have little effect.

• #30 National Aspergillosis Centre – Wythenshawe Hospital

  https://mft.nhs.uk/wythenshawe/services/infectious-diseases/national-aspergillosis-centre/

  The National Aspergillosis Centre provides expertise for the diagnosis and management of infections caused by the fungus Aspergillus. […] In 2009 NAC was commissioned by the Department of Health to provide long-term care for patients with chronic pulmonary aspergillosis (CPA). […] Developing research, knowledge, and expertise in this area support the advancements in high-quality clinical care required to contribute to the care of patients with CPA and all other forms of aspergillosis. […] For much more detail on aspergillosis and how it impacts patients and carers health wellbeing, visit the aspergillosis patients and carers website. […] National Aspergillosis Centre: Aspergillosis Advice Guidance and Remote MDT, Physiotherapy, Resources for Clinicians, Aspergillosis Patient Support, Referrals, Getting in Touch with NAC.

• #31 COVID-19-associated invasive pulmonary aspergillosis | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-00686-4

  In our 24-bedded mixed ICU, we have encountered an unexpectedly high number of COVID-19 patients developing invasive pulmonary aspergillosis. […] We believe that a low threshold for screening, prophylaxis and early antifungal treatment is of paramount importance, especially since different immunosuppressive therapies have been suggested to treat patients suffering from this alarming condition.

• #32

  https://link.springer.com/article/10.1007/BF01709544

  To assess the outcome of intensive care treatment in invasive aspergillosis. […] In patients with highly suspected or proven invasive aspergillosis, admission to an ICU and mechanical ventilation should be considered in cases of localized infection and obvious signs of hematologic recovery. In most other circumstances ICU admission for mechanical ventilation does not seem to improve survival.

• #33 Treatment and prevention of invasive aspergillosis – UpToDate

  https://www.uptodate.com/contents/treatment-and-prevention-of-invasive-aspergillosis

  Invasive aspergillosis is the most common mold infection in immunocompromised hosts. This infection is caused by Aspergillus, a hyaline mold that is ubiquitous. The most common risk factors for infection include neutropenia and glucocorticoid use, but other risk factors include hematopoietic cell transplantation, solid organ transplantation (particularly lung transplantation), the use of biologic agents, pulmonary diseases, and critical illness. The effective management of invasive aspergillosis includes strategies to optimize prevention, prompt diagnosis, early antifungal treatment, and, in some cases, immunomodulation and surgery. […] Optimal management involves early and definitive diagnosis as well as early initiation of antifungal therapy. In addition to antifungal therapy, surgery should be considered for patients with certain manifestations. Reduction of immunosuppression, when feasible, is another important component of management.

• #34 Invasive Aspergillosis in Rheumatologic Patients in Tertiary Care Hospital in Mexico – ACR Meeting Abstracts

  https://acrabstracts.org/abstract/invasive-aspergillosis-in-rheumatologic-patients-in-tertiary-care-hospital-in-mexico/

  Fungal infections are an important cause of morbidity and mortality in patients with rheumatic diseases. Invasive aspergillosis (IA) is a fungal infection potentially fatal, which has been primarily described in patients with profound neutropenia such as those with hematologic malignancies. There is limited information in patients with rheumatic diseases. We describe herein clinical characteristics and outcomes of IA diagnosed in patients with rheumatic diseases. […] In this study we found specifics characteristics among the rheumatologic patients. The six week mortality of 27% was lower than has been reported in non neutropenic patients. Finally only thrombocytopenia was found as a risk factor of mortality in this group. It is necessary an increased knowledge of IA characteristics in these group of patients for early diagnosis and treatment.

• #35

  https://www.healthychildren.org/English/health-issues/conditions/infections/Pages/Aspergillosis.aspx

  Aspergillosis is an infection that frequently affects the lungs. […] To diagnose aspergillosis, your pediatrician will evaluate your child’s symptoms. […] Treatment for invasive infection involves the use of antifungal medications such as amphotericin B. Treatment of allergic aspergillosis involves steroids as well as antifungal agents.

• #36 Aspergillosis in Intensive Care Unit (ICU) patients: epidemiology and economic outcomes | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-13-29

  Invasive aspergillosis in ICU patients is associated with high mortality and hospital costs. Antifungal timing impacts economic outcomes. These findings underscore the importance of timely diagnosis, appropriate treatment, and consideration of Aspergillus as a potential etiology in ICU patients. […] A better understanding of IA, its treatment, and economic outcomes in ICU patients are needed. […] Our study indicates a potential impact of antifungal timing on economic outcomes. Multiple regression analyses revealed that delay of antifungal therapy resulted in increased LOS and hospital costs: each 1 hospital day lag of initial antifungal therapy was associated with a 1.28 day LOS increase and a 4% cost increase. […] These findings support the need for better, rapid diagnostic methods for IA in ICU patients and potentially earlier institution of antifungal therapy. A high index of suspicion of IA is warranted in critically ill patients. […] Economic outcomes including LOS and hospital costs are impacted by antifungal therapy and patient co-morbidities. These findings underscore the importance of awareness of potential aspergillosis, timely diagnosis and appropriate, early treatment among ICU patients.

• #37 Pulmonary aspergillosis in the intensive care unit: An underdiagnosed disease? | Medicina Intensiva

  https://www.medintensiva.org/en-pulmonary-aspergillosis-in-intensive-care-articulo-S2173572722001187

  Plato used to say: look for, and you will find, and this is applicable to the diagnosis of pulmonary aspergillosis at the intensive care unit (ICU) setting. […] The diagnosis of pulmonary aspergillosis in the critically ill patient is an unsolved challenge for clinicians. In the first place, because the clinical and radiological criteria can remedy other etiologies. It is essential to have previous suspicion of the disease and lean on a targeted microbiological diagnostic strategy. […] The clinical situation should determine whether antifungal treatment should be started or not. However, in critically ill patients who need invasive ventilation and with gas exchange disorders and hypoxemia we should think of fighting the high mortality rate reported to this date. […] It would be interesting to know whether by implementing these strategies for the active search of pulmonary aspergillosis at the ICU setting the incidence rate of this serious infectious complication changes.

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