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Semin Respir Crit Care Med 2015; 36(05): 662-672
DOI: 10.1055/s-0035-1562893
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Invasive Aspergillosis: Epidemiology, Clinical Aspects, and Treatment

Kevin S. Gregg
1   Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
,
Carol A. Kauffman
1   Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
2   Division of Infectious Diseases, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
› Author Affiliations
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Publication History

Publication Date:
23 September 2015 (online)

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Abstract

Invasive aspergillosis remains an often fatal, difficult-to treat infection in immunocompromised patients. Patients not classically defined as immunocompromised, especially those in an intensive care unit setting, also develop invasive aspergillosis. Clinical clues suggesting angioinvasion and radiographic modalities, especially computed tomographic scans, combined with newer non–culture-based diagnostic techniques, have allowed earlier recognition of invasive aspergillosis. Although mortality remains high, it has greatly decreased over the past 15 years. Voriconazole has supplanted amphotericin B, with its various toxicities, as primary treatment for invasive aspergillosis. Combination therapy with voriconazole and an echinocandin for initial therapy, based on results from a recent controlled clinical trial, could become the standard of care in high-risk patients.

Keywords

aspergillosis - Aspergillus fumigatus - voriconazole - echinocandins - amphotericin B - epidemiology - hematopoietic cell transplant - solid-organ transplant