Invasive Aspergillus (IA) - Diagnosis and Management Aspergillus is ubiquitous in nature. Most invasive infections are caused by members of A.fumigatus species complex Classic Risk Factors for IA: • Severe and prolonged neutropenia, Corticosteroid use, Chronically impaired cellular immune responses / severe immunosuppression (eg. allogeneic HSCT, SOT, Advanced HIV/AIDS, CGD) Clinical presentations: • Pulmonary aspergillosis, Tracheobronchitis, Rhinosinusitis, CNS infection, Endophthalmitis, Endocarditis, Cutaneous, Gastrointestinal, Disseminated infection; Fungemia is uncommon Diagnosis and Testing: • Aspergillus Galactomannan sensitivity (sn) 82% in pts with neutropenia (performs best in HM or HSCT; sn lower in SOT pts) • BAL GM can provide additional sn • AspGM can be also positive with Histo, Fusarium, Penicillium • BDG is associated with low sensitivity and low specificity for aspergillosis Aspergillus in tissue: • Non-pigmented (hyaline), septated hyphae, acute angle branching • Ddx of this appearance includes: Fusarium, Scedosporium, Trichoderma, Paecilomyces. Mucorales genera can sometimes have this morphology Treatment: • Drug of choice for IA = Voriconazole - (Tsurvival & Uside effects compared to amphoB) • Combo tx is not routinely recommended but can be considered in certain cases • Endophthalmitis: Intravitreal injection of AmphoB or Vori + systemic vori Infectious Diseases Fellows Network @ID_fellows #Invasive #Aspergillus #IA #Diagnosis #Management #treatment #fungal #infectiousdiseases
