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