New Guidelines for Deadly Infection Advocate Early Diagnosis, Antifungal Treatment

The Infectious Diseases Society of America recently released new guidelines for the diagnosis and treatment of allergic, chronic, and invasive aspergillosis. Published online in Clinical Infectious Diseases (June 29, 2016; doi:10.1093/cid/ciw326), the guidelines promote aggressive diagnosing of patients suspected of having the potentially deadly infection as well as the use of new, better tolerated, and more effective antifungal medications to treat it. 

“Invasive aspergillosis often is overlooked, but early diagnosis and treatment are key,” said Thomas Patterson, MD, lead author of the guidelines and chief of the division of infectious disease and professor of medicine at The University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio. “These are complicated infections with a number of treatment options. Patients really benefit from a multidisciplinary approach, including the expertise of an infectious disease specialist.”

Aspergillosis is an airborne mold often found in air conditioning units or flood-damaged buildings. Invasive aspergillosis is especially dangerous to immunocompromised patients, with a mortality rate of 40% or higher in the population. While allergic and chronic aspergillosis typically are not deadly, they still require treatment.

Updating the 2008 guidelines, the new recommendations note that blood tests, cultures, and computed tomography imaging have enhanced clinicians’ ability to detect the infection early. Additionally, antifungal medications including isavuconazole and posaconazole have improved care. For certain patients at highest risk, combination therapy with voriconazole and an echinocandin is recommended.

The guidelines also recommend preventive antifungals for patients at highest risk of invasive aspergillosis, such as those with neutropenia and graft-vs-host disease. Special filtration systems for hospitalized patients who are immunosuppressed are another preventive strategy mentioned in the guidelines.—Jolynn Tumolo