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Medicina 2023Invasive aspergillosis (IA) is a serious disease with high mortality. There are several risk factors and in-hospital outbreaks related with construction have been...
Invasive aspergillosis (IA) is a serious disease with high mortality. There are several risk factors and in-hospital outbreaks related with construction have been described. An entity related to COVID-19 infection, known as COVID-19 associated pulmonary aspergillosis (CAPA), has recently appeared. Early and appropriate treatment is of paramount importance, especially in immunocompromised and critically ill patients. Diagnosis is based on recognition of predisposing factors, clinical signs, imaging, direct examination, culture, histopathology, and biomarkers such as galactomannan. The drug of choice is voriconazole, but alternative therapies must be taken into account given the increasing presence of resistant isolates.
Topics: Humans; COVID-19; Aspergillosis; COVID-19 Testing
PubMed: 36774601
DOI: No ID Found -
Medecine Et Maladies Infectieuses Jun 2015Invasive aspergillosis (IA) is a major cause of morbidity and mortality in immunocompromised adults and children, the number of which has been continuously increasing in... (Review)
Review
Invasive aspergillosis (IA) is a major cause of morbidity and mortality in immunocompromised adults and children, the number of which has been continuously increasing in the last decades. The purpose of our review was to provide epidemiological, clinical, and biological data and antifungal treatment options in the pediatric population. Several biological assays (galactomannan enzyme immunoassay, β-D-glucan, detection of Aspergillus spp. DNA) have proven useful adjuncts for the diagnosis of IA in adult studies. However, data on these assays in children is limited by small sample sizes and sometimes conflicting results concerning their sensitivity/specificity. Pediatric treatment recommendations are mainly extrapolated from results of clinical trials performed in adults. It is thus necessary to develop new antifungal formulations specifically adapted to the pediatric population and to evaluate their pharmacokinetic/pharmacodynamic profile, their safety, and their effectiveness in infants and children.
Topics: Adolescent; Antifungal Agents; Antigens, Fungal; Antineoplastic Agents; Aspergillosis; Aspergillus; Child; Child, Preschool; DNA, Fungal; Fungemia; Humans; Immunocompromised Host; Immunosuppressive Agents; Infant; Neoplasms; Postoperative Complications; Practice Guidelines as Topic; Prognosis; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 26026226
DOI: 10.1016/j.medmal.2015.04.006 -
Annals of the New York Academy of... Dec 2012Invasive aspergillosis is a devastating infection affecting severely immunocompromised patients, most frequently with hematologic malignancies. In recent years, a surge... (Review)
Review
Invasive aspergillosis is a devastating infection affecting severely immunocompromised patients, most frequently with hematologic malignancies. In recent years, a surge in the incidence of invasive aspergillosis has been reported in critically ill patients without the classical risk factors. The mortality of the disease is equally high in the group of intensive care unit (ICU) patients, while the clinical signs and symptoms are nonspecific and the diagnosis remains a challenge. New noninvasive diagnostic methods in combination with better tolerated antifungal drugs aim for early diagnosis and improved prognosis of invasive aspergillosis. In this review, we discuss the epidemiology, the diagnostic strategy and algorithms, and the therapeutic choices of this severe infection in critically ill patients.
Topics: Antifungal Agents; Aspergillosis; Critical Illness; Hematologic Neoplasms; Humans; Immunocompromised Host; Intensive Care Units; Risk Factors
PubMed: 23231712
DOI: 10.1111/j.1749-6632.2012.06805.x -
Clinical Infectious Diseases : An... Jan 2012Invasive aspergillosis has emerged as an important cause of morbidity and mortality in immunocompromised children. It remains difficult to diagnose, and outcome depends... (Review)
Review
Invasive aspergillosis has emerged as an important cause of morbidity and mortality in immunocompromised children. It remains difficult to diagnose, and outcome depends on early diagnosis, appropriate treatment, and restoration of host defenses. Pediatric patients represent a unique population in their clinical presentation and epidemiology, particularly in respect to the utility of newer diagnostic tools and the pharmacokinetics of antifungal agents. This article reviews the presentation and epidemiology of invasive aspergillosis in children and adolescents with acquired immunodeficiencies and discusses the value of current diagnostic tools and the options for treatment and prevention in this population.
Topics: Adolescent; Antibiotic Prophylaxis; Antifungal Agents; Aspergillosis; Child; Child, Preschool; Female; Humans; Immunocompromised Host; Immunologic Deficiency Syndromes; Male; Risk Factors
PubMed: 22075793
DOI: 10.1093/cid/cir786 -
Infectious Disease Clinics of North... Sep 2006Infections by Aspergillus species present a particular challenge. The organism, which is ubiquitous in the environment, causes allergic disease in otherwise healthy... (Review)
Review
Infections by Aspergillus species present a particular challenge. The organism, which is ubiquitous in the environment, causes allergic disease in otherwise healthy individuals and devastating disease in the immunosuppressed. This article examines the range of infections caused by Aspergillus species, the challenges of diagnosis, and current treatment options.
Topics: Antifungal Agents; Aspergillosis; Humans
PubMed: 16984868
DOI: 10.1016/j.idc.2006.06.001 -
Journal of Investigative Medicine High... 2023Infection by covers a broad clinical spectrum, including invasive pulmonary aspergillosis (IPA) and its disseminated extrapulmonary form, invasive aspergillosis (IA).... (Review)
Review
Infection by covers a broad clinical spectrum, including invasive pulmonary aspergillosis (IPA) and its disseminated extrapulmonary form, invasive aspergillosis (IA). It typically occurs in severely immunocompromised hosts, but it sometimes affects the immunocompetent population, especially patients with acute diseases being treated at the intensive care unit (ICU) and less often those with chronic conditions. In this article, we report the case of a 50-year-old male, with diabetes mellitus (DM) as the only risk factor, treated for IPA and IA with cardiac and central nervous system (CNS) involvement at a high complexity institution in Cali-Colombia. Clinical presentation and radiological findings are unspecific and require a high level of suspicion. To confirm the case, histological or cytological of the fungus is required; histopathological examination of lung tissue is the gold standard, but it is difficult to perform due to respiratory compromise and high risk of bleeding, so bronchoscopy and bronchoalveolar lavage (BAL) plays an essential role in the diagnostic process. A diagnostic algorithm that includes risk assessment, symptoms, imaging findings, and isolation in cultures is essential to allow the diagnosis and initiation of treatment promptly, which includes a combination of surgery and antifungal medications for long periods, even life-long treatment.
Topics: Male; Humans; Middle Aged; Aspergillosis; Aspergillus; Invasive Pulmonary Aspergillosis; Antifungal Agents; Diabetes Mellitus
PubMed: 37203376
DOI: 10.1177/23247096231175443 -
Revue Medicale de Liege Feb 1991
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Medical Mycology May 2005Primary immunodeficiencies are rare and usually first manifest during childhood. Invasive aspergillosis is the leading cause of mortality in chronic granulomatous... (Review)
Review
Primary immunodeficiencies are rare and usually first manifest during childhood. Invasive aspergillosis is the leading cause of mortality in chronic granulomatous disease (CGD), reflecting the key role of the phagocyte NADPH oxidase in host defense against opportunistic fungi. Despite interferon-gamma prophylaxis, invasive filamentous fungal infections are a persistent problem in CGD. Key principles of management of fungal infections involve early recognition and aggressive treatment and appropriate surgical debridement of localized disease. Because CGD is a disorder of phagocyte stem cells in which the gene defects are well defined, it is a model disease to evaluate immune reconstitution through stem cell transplantation and gene therapy. Patients with the hyper-IgE syndrome with recurrent infections (Job syndrome) are prone to colonization of lung cavities (pneumatoceles) by Aspergillus species leading to local invasion and rarely disseminated infection. Other primary phagocytic disorders, T-cell disorders, and mitochondrial disorders are uncommonly associated with invasive aspergillosis. Taken together, these rare primary immunodeficiencies highlight the complex coordination of both innate and acquired pathways mediating host defense against Aspergillus infection.
Topics: Animals; Aspergillosis; Granulomatous Disease, Chronic; Humans; Immunologic Deficiency Syndromes; Job Syndrome; Mice
PubMed: 16110817
DOI: 10.1080/13693780400025203 -
La Revue Du Praticien Apr 2001Invasive aspergillosis remains a life-threatening complication in immunocompromised patients. The pulmonary involvement by the aspergillosis is the most common setting.... (Comparative Study)
Comparative Study Review
Invasive aspergillosis remains a life-threatening complication in immunocompromised patients. The pulmonary involvement by the aspergillosis is the most common setting. The dissemination of the disease is correlated with the worse prognosis. The overall improvement of the prognosis needs a global diagnostic and therapeutic strategy. In neutropenic patients (mostly at risk of invasive aspergillosis), an early diagnosis can be achieved by systematic use of thoracic CT scan to search halo sign (that seems to be quite specific of the diagnosis in this setting). The early initiation of the antifungal treatment (conventional or liposomal amphotericin or new azole compounds) could be combined with a surgical approach if necessary. This approach could be able to improve the prognosis of aspergillosis. However, the outcome of these patients remains also correlated to the underlying disease.
Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillosis, Allergic Bronchopulmonary; Bronchoalveolar Lavage Fluid; Diagnosis, Differential; Drug Combinations; Humans; Immunosuppression Therapy; Itraconazole; Neuroaspergillosis; Neutropenia; Phosphatidylcholines; Phosphatidylglycerols; Postoperative Complications; Prognosis; Radiography, Thoracic; Risk Factors; Tomography, X-Ray Computed
PubMed: 11387668
DOI: No ID Found -
Current Opinion in Hematology Nov 2008Invasive aspergillosis is a common cause of morbidity and mortality in hematopoietic stem cells transplant recipients. Owing to its intrinsic high mortality rate, early... (Review)
Review
PURPOSE OF REVIEW
Invasive aspergillosis is a common cause of morbidity and mortality in hematopoietic stem cells transplant recipients. Owing to its intrinsic high mortality rate, early diagnosis and treatment are critical. This review will therefore address the most important recent advances in diagnosing, preventing and treating invasive aspergillosis in hematopoietic stem cells transplant.
RECENT FINDINGS
The present review will focus on therapeutic and prophylactic aspects, with particular regard to clinical use of drugs other than voriconazole (which has a well known and consolidated role for first-line therapy), combination therapy and prophylactic regimens, particularly with posaconazole. This review will also briefly deal with the clinical role of diagnostic tests such as the detection of galactomannan in body fluids other than blood, beta-D-glucan in serum and fungal DNA by PCR in body fluids.
SUMMARY
Galactomannan antigen detection is a rather reliable diagnostic test for invasive aspergillosis, particularly when a lower threshold of sensitivity is used. PCR is still to be validated. Liposomal amphotericin B at 3 mg/kg per day showed a similar efficacy in invasive aspergillosis as reported for voriconazole. Therapeutic drug monitoring of Aspergillus-active azoles should be implemented whenever possible in order to maximize the antifungal effect and minimize toxicity. Posaconazole showed to be active in prophylaxis, though its effectiveness in the global patient population is still controversial.
Topics: Antifungal Agents; Aspergillosis; Galactose; Hematopoietic Stem Cell Transplantation; Humans; Mannans
PubMed: 18832929
DOI: 10.1097/MOH.0b013e328311890c