Invasive Aspergillosis and the Clinical Management

Kang, Jae Myung; Woo, Jun Hee; Ryu, Ji So

Abstract

Invasive aspergillosis remains a major cause of morbidity and mortality in immunocompromised patients. And there has been substantial increase in the number of cases documented at autopsy in all developed nations. There are probably many factors responsible for this substantial increase, but they include the following: greater numbers of transplantation patients; more aggressive chemotherapy for such conditions as myeloma, breast cancer, and certain lymphomas; more aggressive immunosuppressive regimens for patients with autoimmune disease; and the emergence of AIDS. The use of hepafiltration and, in particular, laminar air flow reduces the risk of invasive aspergillosis. The portal of entry for Aspergillus include the respiratory tract, damaged skin or other operative wounds, the cornea, and the ear. The majority of patients (80~90%) have pulmonary disease, but some have other manifestations of disease, including aspergillus rhinosinusitis. Prognosis of invasive aspergillosis has in general relied on making a prompt diagnosis of infection, and early treatment. Unfortunately, the rapid diagnosis of invasive aspergillosis is difficult, as no rapid methods to establish definitely the diagnosis of infection are available in most clinical settings. An ELISA for detecting Aspergillus galactomannan is used to establish an early diagnosis in Western Europe. Invasive aspergillosis carries a nearly 100% mortality if untreated. There are currently two antifungal agents with activity against Aspergillus-amphotericin B and itraconazole. Several novel agents are under investigation, including Liposomal nystatin (Nyotran), Voriconazole, Posaconazole, Caspofungin. The most advanced azole is the voriconazole, which has shown good clinical efficacy and tolerability among immunocompromised patients with invasive aspergillosis.