Several European medical mycology groups have joined to release guidelines to improve the clinical management of patients with aspergillosis.
The groups involved were: ESCMID-EFISG (ESCMID Fungal Infection Study Group); ESGICH (ESCMID Study Group for Infections in Compromised Hosts – ESGICH); ECMM (ECMM European Confederation of Medical Mycology); and ERS (European Respiratory Society).
Some of the key points are summarised as follows:
Diagnosis of invasive aspergillosis (IA)
Carry out chest CT and bronchoalveolar lavage
Test for galactomannan in serum and BAL
Identify all clinical isolates to species complex level and perform antifungal susceptibility testing in IA cases in regions where resistance is detected by surveillances programmes.
Direct microscopy (preferably using optical brighteners) histopathology and culture are strongly recommended.
PCR should be considered.
Isavuconazole and voriconazole are the preferred agents for first-line treatment of pulmonary IA, whereas liposomal amphotericin B is moderately supported.
Combinations of antifungals as primary treatment options are not recommended.
Use therapeutic drug monitoring when treating with posaconazole suspension or any form or voriconazole
Primary prophylaxis with posaconazole is strongly recommended in patients with acute myelogenous leukaemia or myelodysplastic syndrome receiving induction chemotherapy.
Secondary prophylaxis is strongly recommended in high-risk patients.