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 languageEnglish
Pages (from-to)e1-e38
Number of pages38
JournalClinical Microbiology and Infection
Volume24
Issue numberSuppl. 1
Early online date12 Mar 2018
DOIs
Publication statusPublished - May 2018

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Keywords

  • Haematology
  • Transplantation
  • Invasive Fungal Infection
  • Treatment
  • Aspergillosis
  • Diagnosis

Cite this

Ullmann, A. J., Aguado, J. M., Arikan-Akdagli, S., Denning, D. W., Groll, A. H., Lagrou, K., ... 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