How Do I Manage Refractory Invasive Pulmonary Aspergillosis.
Aspergillosis
Hematopoietic stem cell transplant
Leukemia
invasive fungal infection
invasive mold infection
refractory infection
Journal
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420
Informations de publication
Date de publication:
27 Jan 2024
27 Jan 2024
Historique:
received:
11
08
2023
revised:
06
11
2023
accepted:
20
01
2024
medline:
30
1
2024
pubmed:
30
1
2024
entrez:
29
1
2024
Statut:
aheadofprint
Résumé
Invasive aspergillosis is associated with significant morbidity and mortality in patients with hematologic malignancies and hematopoietic cell transplant recipients. The prognosis is worse among patients who have failed primary antifungal treatment. We aim to provide guidance on the diagnosis and management of refractory invasive pulmonary aspergillosis. Using PubMed we performed a review of original articles, meta-analyses, and systematic reviews. We discuss the diagnostic criteria for invasive pulmonary aspergillosis and the evidence on treatment of primary infection. We outline our diagnostic approach to refractory disease. We propose a treatment algorithm for refractory disease and discuss the role of experimental antifungal agents. For patients with worsening disease while on antifungal therapy, a thorough diagnostic evaluation is required to confirm the diagnosis of aspergillosis and exclude another concomitant infection. Treatment should be individualized. Current options include switching to another triazole, transitioning to a lipid formulation of amphotericin B, or using combination antifungal therapy.
Sections du résumé
BACKGROUND
BACKGROUND
Invasive aspergillosis is associated with significant morbidity and mortality in patients with hematologic malignancies and hematopoietic cell transplant recipients. The prognosis is worse among patients who have failed primary antifungal treatment.
OBJECTIVES
OBJECTIVE
We aim to provide guidance on the diagnosis and management of refractory invasive pulmonary aspergillosis.
SOURCES
METHODS
Using PubMed we performed a review of original articles, meta-analyses, and systematic reviews.
CONTENT
BACKGROUND
We discuss the diagnostic criteria for invasive pulmonary aspergillosis and the evidence on treatment of primary infection. We outline our diagnostic approach to refractory disease. We propose a treatment algorithm for refractory disease and discuss the role of experimental antifungal agents.
IMPLICATIONS
CONCLUSIONS
For patients with worsening disease while on antifungal therapy, a thorough diagnostic evaluation is required to confirm the diagnosis of aspergillosis and exclude another concomitant infection. Treatment should be individualized. Current options include switching to another triazole, transitioning to a lipid formulation of amphotericin B, or using combination antifungal therapy.
Identifiants
pubmed: 38286175
pii: S1198-743X(24)00037-5
doi: 10.1016/j.cmi.2024.01.015
pii:
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024. Published by Elsevier Ltd.