Cited by 366Antifungal resistance and susceptibilityFungal Infections and StudiesFungal and yeast genetics research

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Invasive Aspergillosis: Epidemiology, Diagnosis and Management in Immunocompromised Patients

Maschmeyer, Georg, Haas, Antje, Cornely, Oliver A·2007·Drugs

DOI 10.2165/00003495-200767110-00004

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Abstract

Morbidity and mortality caused by invasive Aspergillus infections are increasing. This is because of the higher number of patients with malignancies treated with intensive immunosuppressive therapy regimens as well as their improved survival from formerly fatal bacterial infections, and the rising number of patients undergoing allogeneic haematopoietic stem cell or organ transplantation. Early initiation of effective systemic antifungal treatment is essential for a successful clinical outcome in these patients; however, clinical clues for diagnosis are sparse and early microbiological proof of invasive aspergillosis (IA) is rare. Clinical diagnosis is based on pulmonary CT scan findings and non-culture based diagnostic techniques such as galactomannan or DNA detection in blood or bronchoalveolar lavage samples. Most promising outcomes can be expected in patients at high risk for aspergillosis in whom antifungal treatment has been started pre-emptively, backed up by laboratory and imaging findings. The gold standard of systemic antifungal treatment is voriconazole, which has been proven to be significantly superior to conventional amphotericin B and has led to a profound improvement of survival rates in patients with cerebral aspergillosis. Liposomal amphotericin B at standard dosages appears to be a suitable alternative for primary treatment, while caspofungin, amphotericin B lipid complex or posaconazole have shown partial or complete response in patients who had been refractory to or intolerant of primary antifungal therapy. Combination therapy with two antifungal compounds may be a promising future strategy for first-line treatment. Lung resection helps to prevent fatal haemorrhage in single patients with pulmonary lesions located in close proximity to larger blood vessels, but is primarily considered for reducing the risk of relapse during subsequent periods of severe immunosuppression. Strict reverse isolation appears to reduce the incidence of aspergillosis in allogeneic stem cell transplant recipients and patients with acute myeloid leukaemia undergoing aggressive anticancer therapy. Well designed, prospective randomised studies on infection control measures effective to prevent aspergillosis are lacking. Prophylactic systemic antifungal treatment with posaconazole significantly improves survival and reduces IA in acute myeloid leukaemia patients and reduces aspergillosis incidence rates in patients with intermediate-to-severe graft-versus-host reaction emerging after allogeneic haematopoietic stem cell transplantation. Voriconazole prophylaxis may be suitable for prevention of IA as well; however, the results of large clinical trials are still awaited.

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Authors: Maschmeyer, G., Haas, A., & Cornely, O. A.
Affiliations: Klinikum Ernst von Bergmann (DE)
University Hospital Cologne (DE)
Corresponding author: Maschmeyer, Georg
ORCID: Maschmeyer, Georg
Cornely, Oliver A
Venue: Drugs
Publisher: Springer Science and Business Media LLC
Published: 2007
Volume: 67
Issue: 11
Pages: 1567-1601
ISSN: 0012-6667 (ISSN-L)
DOI: 10.2165/00003495-200767110-00004
OpenAlex: W2088013043
Cited by: 366
References: 276
Citations by year: 2026: 4 · 2025: 7 · 2024: 13 · 2023: 9 · 2022: 8 · 2021: 16 · 2020: 15 · 2019: 14 · 2018: 13 · 2017: 12 · 2016: 21 · 2015: 23 · 2014: 27 · 2013: 24 · 2012: 30
FWCI: 4.01
Type: journal article
Language: en
Open access: closed
Locations: Drugs (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
Health Sciences › Medicine › Infectious Diseases › Fungal Infections and Studies
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Fungal and yeast genetics research
Keywords: invasive aspergillosis, Aspergillus, voriconazole, amphotericin B, caspofungin, posaconazole, antifungal prophylaxis, immunosuppression, hematopoietic stem cell transplantation, acute myeloid leukemia, galactomannan, cerebral aspergillosis, lung resection, infection control, graft-versus-host disease
MeSH terms: Antifungal Agents, Antineoplastic Agents, Aspergillosis, Drug Therapy, Combination, Humans, Neoplasms, Quarantine, Risk Factors, Transplantation Immunology, Organ Transplantation, Immunocompromised Host, Hematopoietic Stem Cell Transplantation

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Invasive Aspergillosis: Epidemiology, Diagnosis and Management in Immunocompromised Patients

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