Aspergillosis Management

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

• 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