Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline

Andrew J. Ullmann; Jose M. Aguado; Sevtap Arikan-Akdagli; David W. Denning; Andreas H. Groll; Katrien Lagrou; Cornelia Lass-Flörl; Russel E. Lewis; Patricia Munoz; Paul E. Verweij; Adilia Warris; Florence Ader; Murat Akova; Maiken C. Arendrup; Rosemary A. Barnes; Catherine Beigelman-Aubry; Stijn Blot; Emilio Bouza; Roger J. M. Bruggemann; Dieter Buchheidt; Jacques Cadranel J; Elio Castagnola; Arunaloke Chakrabarti; Manuel Cuenca-Estrella; George Dimopoulos; Jesus Fortun; Jean-Pierre Gangneux; Jorge Garbino; Werner J. Heinz; Raoul Herbrecht; Claus P. Heussel; Chris Kibbler; Nikolay Klimko; Bart-Jan Kullberg; Christoph Lange; Thomas Lehrnbecher; Jürgen Löffler; Olivier Lortholary; Johan Maertens; Oscar Marchetti; Jacques F. G. M. Meis; Livio Pagano; Patricia Ribaud; Malcolm Richardson; Emmanuel Roilides; Markus Ruhnke; Maurizio Sanguinetti; Donald C. Sheppard; János Sinkó; Anna Skiada; Maria  J. G. T. Vehreschild; Claudio Viscoli; Oliver A. Cornely

doi:10.1016/j.cmi.2018.01.002

Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline

Andrew J. Ullmann, Jose M. Aguado, Sevtap Arikan-Akdagli, David W. Denning, Andreas H. Groll, Katrien Lagrou, Cornelia Lass-Flörl, Russel E. Lewis, Patricia Munoz, Paul E. Verweij, Adilia Warris, Florence Ader, Murat Akova, Maiken C. Arendrup, Rosemary A. Barnes, Catherine Beigelman-Aubry, Stijn Blot, Emilio Bouza, Roger J. M. Bruggemann, Dieter BuchheidtJacques Cadranel J, Elio Castagnola, Arunaloke Chakrabarti, Manuel Cuenca-Estrella, George Dimopoulos, Jesus Fortun, Jean-Pierre Gangneux, Jorge Garbino, Werner J. Heinz, Raoul Herbrecht, Claus P. Heussel, Chris Kibbler, Nikolay Klimko, Bart-Jan Kullberg, Christoph Lange, Thomas Lehrnbecher, Jürgen Löffler, Olivier Lortholary, Johan Maertens, Oscar Marchetti, Jacques F. G. M. Meis, Livio Pagano, Patricia Ribaud, Malcolm Richardson, Emmanuel Roilides, Markus Ruhnke, Maurizio Sanguinetti, Donald C. Sheppard, János Sinkó, Anna Skiada, Maria J. G. T. Vehreschild, Claudio Viscoli, Oliver A. Cornely

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Abstract

The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of major forms of aspergillosis. Only a few of the numerous recommendations can be summarized here. The performance of a chest computed tomographic scan as well as a bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) is strongly recommended. For diagnosis, direct microscopy preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan is recommended as accurate marker for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species level by molecular methods is strongly recommended for all clinical relevant Aspergillus isolates; antifungal susceptibility testing should be done in patients unresponsive to treatment, or in regions with a high prevalence of azole resistance. Isavuconazole and voriconazole are the preferred agents for first line treatment of pulmonary IA, followed by liposomal amphotericin B. In refractory disease we strongly recommend a personalized approach considering therapeutic drug monitoring (TDM), reversal of predisposing factors, switching drug class and surgical intervention. Primary prophylaxis with posaconazole is strongly recommended in patients with haematological malignancy, secondary prophylaxis in high risk patients. TDM is strongly recommended for patients receiving posaconazole suspension or voriconazole for IA treatment. Combinations of antifungals as primary treatment options are not recommended. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging.

Original language	English
Pages (from-to)	e1-e38
Number of pages	38
Journal	Clinical Microbiology and Infection
Volume	24
Issue number	Suppl. 1
Early online date	12 Mar 2018
DOIs	https://doi.org/10.1016/j.cmi.2018.01.002
Publication status	Published - May 2018

Bibliographical note

Acknowledgement: Professor William Hope was a member of the TDM group, however, he stepped down during the process of guideline development due to his new post as guideline director of ESCMID to avoid any conflicts of interest. His contributions were very much appreciated to the entry guideline group. We are thankful for his help.

Funding: European Society of Clinical Microbiology and Infectious Diseases (ESCMID), European Confederation of Medical Mycology (ECMM) and European Respiratory Society (ERS)

Keywords

Haematology
Transplantation
Invasive Fungal Infection
Treatment
Aspergillosis
Diagnosis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Ullmann, A. J., Aguado, J. M., Arikan-Akdagli, S., Denning, D. W., Groll, A. H., Lagrou, K., Lass-Flörl, C., Lewis, R. E., Munoz, P., Verweij, P. E., Warris, A., Ader, F., Akova, M., Arendrup, M. C., Barnes, R. A., Beigelman-Aubry, C., Blot, S., Bouza, E., Bruggemann, R. J. M., ... Cornely, O. A. (2018). Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clinical Microbiology and Infection, 24(Suppl. 1), e1-e38. https://doi.org/10.1016/j.cmi.2018.01.002

Ullmann, AJ, Aguado, JM, Arikan-Akdagli, S, Denning, DW, Groll, AH, Lagrou, K, Lass-Flörl, C, Lewis, RE, Munoz, P, Verweij, PE, Warris, A, Ader, F, Akova, M, Arendrup, MC, Barnes, RA, Beigelman-Aubry, C, Blot, S, Bouza, E, Bruggemann, RJM, Buchheidt, D, Cadranel J, J, Castagnola, E, Chakrabarti, A, Cuenca-Estrella, M, Dimopoulos, G, Fortun, J, Gangneux, J-P, Garbino, J, Heinz, WJ, Herbrecht, R, Heussel, CP, Kibbler, C, Klimko, N, Kullberg, B-J, Lange, C, Lehrnbecher, T, Löffler, J, Lortholary, O, Maertens, J, Marchetti, O, Meis, JFGM, Pagano, L, Ribaud, P, Richardson, M, Roilides, E, Ruhnke, M, Sanguinetti, M, Sheppard, DC, Sinkó, J, Skiada, A, Vehreschild, MJGT, Viscoli, C & Cornely, OA 2018, 'Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline', Clinical Microbiology and Infection, vol. 24, no. Suppl. 1, pp. e1-e38. https://doi.org/10.1016/j.cmi.2018.01.002

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title = "Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline",

abstract = "The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of major forms of aspergillosis. Only a few of the numerous recommendations can be summarized here. The performance of a chest computed tomographic scan as well as a bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) is strongly recommended. For diagnosis, direct microscopy preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan is recommended as accurate marker for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species level by molecular methods is strongly recommended for all clinical relevant Aspergillus isolates; antifungal susceptibility testing should be done in patients unresponsive to treatment, or in regions with a high prevalence of azole resistance. Isavuconazole and voriconazole are the preferred agents for first line treatment of pulmonary IA, followed by liposomal amphotericin B. In refractory disease we strongly recommend a personalized approach considering therapeutic drug monitoring (TDM), reversal of predisposing factors, switching drug class and surgical intervention. Primary prophylaxis with posaconazole is strongly recommended in patients with haematological malignancy, secondary prophylaxis in high risk patients. TDM is strongly recommended for patients receiving posaconazole suspension or voriconazole for IA treatment. Combinations of antifungals as primary treatment options are not recommended. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging. ",

keywords = "Haematology, Transplantation, Invasive Fungal Infection, Treatment, Aspergillosis, Diagnosis",

author = "Ullmann, {Andrew J.} and Aguado, {Jose M.} and Sevtap Arikan-Akdagli and Denning, {David W.} and Groll, {Andreas H.} and Katrien Lagrou and Cornelia Lass-Fl{\"o}rl and Lewis, {Russel E.} and Patricia Munoz and Verweij, {Paul E.} and Adilia Warris and Florence Ader and Murat Akova and Arendrup, {Maiken C.} and Barnes, {Rosemary A.} and Catherine Beigelman-Aubry and Stijn Blot and Emilio Bouza and Bruggemann, {Roger J. M.} and Dieter Buchheidt and {Cadranel J}, Jacques and Elio Castagnola and Arunaloke Chakrabarti and Manuel Cuenca-Estrella and George Dimopoulos and Jesus Fortun and Jean-Pierre Gangneux and Jorge Garbino and Heinz, {Werner J.} and Raoul Herbrecht and Heussel, {Claus P.} and Chris Kibbler and Nikolay Klimko and Bart-Jan Kullberg and Christoph Lange and Thomas Lehrnbecher and J{\"u}rgen L{\"o}ffler and Olivier Lortholary and Johan Maertens and Oscar Marchetti and Meis, {Jacques F. G. M.} and Livio Pagano and Patricia Ribaud and Malcolm Richardson and Emmanuel Roilides and Markus Ruhnke and Maurizio Sanguinetti and Sheppard, {Donald C.} and J{\'a}nos Sink{\'o} and Anna Skiada and Vehreschild, {Maria J. G. T.} and Claudio Viscoli and Cornely, {Oliver A.}",

note = "Acknowledgement: Professor William Hope was a member of the TDM group, however, he stepped down during the process of guideline development due to his new post as guideline director of ESCMID to avoid any conflicts of interest. His contributions were very much appreciated to the entry guideline group. We are thankful for his help. Funding: European Society of Clinical Microbiology and Infectious Diseases (ESCMID), European Confederation of Medical Mycology (ECMM) and European Respiratory Society (ERS) ",

year = "2018",

month = may,

doi = "10.1016/j.cmi.2018.01.002",

language = "English",

volume = "24",

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journal = "Clinical Microbiology and Infection",

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T2 - executive summary of the 2017 ESCMID-ECMM-ERS guideline

AU - Ullmann, Andrew J.

AU - Aguado, Jose M.

AU - Arikan-Akdagli, Sevtap

AU - Denning, David W.

AU - Groll, Andreas H.

AU - Lagrou, Katrien

AU - Lass-Flörl, Cornelia

AU - Lewis, Russel E.

AU - Munoz, Patricia

AU - Verweij, Paul E.

AU - Warris, Adilia

AU - Ader, Florence

AU - Akova, Murat

AU - Arendrup, Maiken C.

AU - Barnes, Rosemary A.

AU - Beigelman-Aubry, Catherine

AU - Blot, Stijn

AU - Bouza, Emilio

AU - Bruggemann, Roger J. M.

AU - Buchheidt, Dieter

AU - Cadranel J, Jacques

AU - Castagnola, Elio

AU - Chakrabarti, Arunaloke

AU - Cuenca-Estrella, Manuel

AU - Dimopoulos, George

AU - Fortun, Jesus

AU - Gangneux, Jean-Pierre

AU - Garbino, Jorge

AU - Heinz, Werner J.

AU - Herbrecht, Raoul

AU - Heussel, Claus P.

AU - Kibbler, Chris

AU - Klimko, Nikolay

AU - Kullberg, Bart-Jan

AU - Lange, Christoph

AU - Lehrnbecher, Thomas

AU - Löffler, Jürgen

AU - Lortholary, Olivier

AU - Maertens, Johan

AU - Marchetti, Oscar

AU - Meis, Jacques F. G. M.

AU - Pagano, Livio

AU - Ribaud, Patricia

AU - Richardson, Malcolm

AU - Roilides, Emmanuel

AU - Ruhnke, Markus

AU - Sanguinetti, Maurizio

AU - Sheppard, Donald C.

AU - Sinkó, János

AU - Skiada, Anna

AU - Vehreschild, Maria J. G. T.

AU - Viscoli, Claudio

AU - Cornely, Oliver A.

N1 - Acknowledgement: Professor William Hope was a member of the TDM group, however, he stepped down during the process of guideline development due to his new post as guideline director of ESCMID to avoid any conflicts of interest. His contributions were very much appreciated to the entry guideline group. We are thankful for his help. Funding: European Society of Clinical Microbiology and Infectious Diseases (ESCMID), European Confederation of Medical Mycology (ECMM) and European Respiratory Society (ERS)

PY - 2018/5

Y1 - 2018/5

N2 - The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of major forms of aspergillosis. Only a few of the numerous recommendations can be summarized here. The performance of a chest computed tomographic scan as well as a bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) is strongly recommended. For diagnosis, direct microscopy preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan is recommended as accurate marker for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species level by molecular methods is strongly recommended for all clinical relevant Aspergillus isolates; antifungal susceptibility testing should be done in patients unresponsive to treatment, or in regions with a high prevalence of azole resistance. Isavuconazole and voriconazole are the preferred agents for first line treatment of pulmonary IA, followed by liposomal amphotericin B. In refractory disease we strongly recommend a personalized approach considering therapeutic drug monitoring (TDM), reversal of predisposing factors, switching drug class and surgical intervention. Primary prophylaxis with posaconazole is strongly recommended in patients with haematological malignancy, secondary prophylaxis in high risk patients. TDM is strongly recommended for patients receiving posaconazole suspension or voriconazole for IA treatment. Combinations of antifungals as primary treatment options are not recommended. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging.

AB - The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of major forms of aspergillosis. Only a few of the numerous recommendations can be summarized here. The performance of a chest computed tomographic scan as well as a bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) is strongly recommended. For diagnosis, direct microscopy preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan is recommended as accurate marker for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species level by molecular methods is strongly recommended for all clinical relevant Aspergillus isolates; antifungal susceptibility testing should be done in patients unresponsive to treatment, or in regions with a high prevalence of azole resistance. Isavuconazole and voriconazole are the preferred agents for first line treatment of pulmonary IA, followed by liposomal amphotericin B. In refractory disease we strongly recommend a personalized approach considering therapeutic drug monitoring (TDM), reversal of predisposing factors, switching drug class and surgical intervention. Primary prophylaxis with posaconazole is strongly recommended in patients with haematological malignancy, secondary prophylaxis in high risk patients. TDM is strongly recommended for patients receiving posaconazole suspension or voriconazole for IA treatment. Combinations of antifungals as primary treatment options are not recommended. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging.

KW - Haematology

KW - Transplantation

KW - Invasive Fungal Infection

KW - Treatment

KW - Aspergillosis

KW - Diagnosis

U2 - 10.1016/j.cmi.2018.01.002

DO - 10.1016/j.cmi.2018.01.002

M3 - Article

SN - 1198-743X

VL - 24

SP - e1-e38

JO - Clinical Microbiology and Infection

JF - Clinical Microbiology and Infection

IS - Suppl. 1

ER -

Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline

Abstract

Bibliographical note

Keywords

UN SDGs

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