aspergillosis
ASPERGILLOSIS
Aspergillosis encompasses a variety of clinical syndromes depending on host immunity factors.
It is caused by Aspergillus, an ubiquitous, soil-dwelling, filamentous fungus that grows on soil, food, dead leaves, household dust, etc. It grows best at 37ºC and the small spores are easily inhaled and deposited deep in the lungs.
The most common pathogens are Aspergillus fumigatus, A. flavus, A. niger and A. terreus.
Aspergilloma is a conglomeration of intertwined Aspergillus hyphae, fibrin, mucus and cellular debris within a pulmonary cavity or an ectatic bronchus.

Aspergillosis Management

Prevention

Prophylaxis

Invasive Aspergillosis (IA)

  • Antifungal prophylaxis may be used in patients who are at high risk for invasive aspergillosis (IA)
    • Hematopoietic stem cell transplantation (HSCT) recipients with graft-versus-host disease (GVHD)
    • Patients with acute myelogenous leukemia or myelodysplastic syndrome
  • Posaconazole is the primary agent of choice
  • Voriconazole may also be used as a prophylactic agent in patients at increased risk for IA 
    • May be used for secondary prophylaxis to prevent aspergillosis relapse
  • Itraconazole may be effective but tolerability limits its use
  • Micafungin has in vitro and clinical activity against aspergillosis but breakthrough infections may occur
  • Aerosolized Amphotericin B may be considered in patients with prolonged neutropenia or in lung transplant recipients
  • Recombinant interferon γ have shown prophylactic benefits in individuals with chronic granulomatous disease and can be considered in patients with refractory or severe aspergillosis

Infection Control Measures in the Hospital Setting

  • Educate healthcare personnel regarding infection control procedures tailored to their level of responsibility
  • Monitor severely immunocompromised patients for healthcare-associated pulmonary aspergillosis
  • Surveillance of Aspergillus sp cases
  • Specialized patient care units should be considered for high-risk patients
    • Facilities should have adequate capacity to minimize accumulation and transmission of fungal spores
    • High efficiency particulate air (HEPA) filtration, directed room airflow, positive air pressure in patient’s room in relation to the corridor, well-sealed room, high air exchanges/hour

Infection Control Measures for Outpatient Care

  • Household members should be taught precautions concerning hand washing, safe food handling and preparation, and housekeeping
  • Activities that generate dust should be avoided
  • Air conditioning and air filtering should be kept meticulously clean
  • Home renovations should be postponed
  • Gardening and compost use should be avoided

Prognosis

  • Patients who experience large-volume hemoptysis are especially at high risk of a life-threatening episode

Risk factors that may be associated with poor prognosis

  • Increasing size or number of aspergillomas on chest X-ray
  • Increasing Aspergillus-specific immunoglobulin G (IgG) titers
  • Immunosuppression including use of corticosteroids
  • Severity of underlying lung disease
  • Human immunodeficiency virus (HIV)
  • Underlying sarcoidosis
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