Thursday 7 July 2016

New IDSA guidelines for the management of aspergillosis

New IDSA guidelines for the management of aspergillosis

Dr K K Aggarwal
Early diagnosis and treatment of the major forms of aspergillosis are the focus of a new practice guideline from the Infectious Diseases Society of America (IDSA). Some key recommendations are: • Hospitalized allogeneic hematopoietic stem cell transplant recipients should be placed in a protected environment to reduce mold exposure. These precautions can be reasonably applied to other highly immunocompromised patients at increased risk for invasive aspergillosis (IA), such as patients receiving induction/reinduction regimens for acute leukemia. • Until molecular tools are more widely used in clinical laboratories, tissue and fluid specimens be submitted in adequate quantities for simultaneous histopathologic/cytologic and culture examination. • Serum and BAL galactomannan (GM) is recommended as an accurate marker for the diagnosis of IA in adult and pediatric patients when used in certain patient subpopulations (hematologic malignancy, HSCT). • GM is not recommended for routine blood screening in patients receiving mold-active antifungal therapy or prophylaxis or for screening in solid organ transplant recipients or patients with chronic granulomatous disease (CGD) • A chest CT scan is recommended if there is clinical suspicion of invasive pulmonary aspergillosis (IPA). But routine use of contrast during CT chest is not recommended to screen for IPA. • Voriconazole is recommended for primary treatment of IPA; some high-risk patients may need combination therapy with voriconazole and echinocandin. Antifungal therapy for IPA should continue for at least 6 to 12 weeks. The new guidelines are published online June 29, 2016 in the journal Clinical Infectious Diseases.

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