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Treatment and prevention of invasive aspergillosis

Kieren A Marr, MD
Section Editor
Carol A Kauffman, MD
Deputy Editor
Anna R Thorner, MD


Aspergillus species are ubiquitous and exposure to their spores is frequent, but invasive aspergillosis is uncommon and occurs primarily in immunocompromised hosts. Neutropenia and glucocorticoid use are the most common predisposing factors. The infecting species is most commonly Aspergillus fumigatus, but other species, including A. flavus, A. terreus, and A. niger, also cause disease. The effective management of invasive aspergillosis includes strategies to optimize prevention and early antifungal treatment, immunomodulation, and, in some cases, surgery.

The treatment and prevention of invasive aspergillosis will be reviewed here. The clinical features and diagnosis of invasive aspergillosis are discussed separately; treatment of the other manifestations of Aspergillus infection is also presented elsewhere. (See "Epidemiology and clinical manifestations of invasive aspergillosis" and "Diagnosis of invasive aspergillosis" and "Epidemiology and clinical manifestations of pulmonary aspergillosis and invasive disease in HIV-infected patients" and "Diagnosis and treatment of invasive pulmonary aspergillosis in HIV-infected patients" and "Fungal rhinosinusitis" and "Clinical manifestations and diagnosis of allergic bronchopulmonary aspergillosis" and "Treatment of chronic pulmonary aspergillosis".)

The epidemiology and prophylaxis of invasive fungal infections in patients with hematologic malignancies and hematopoietic cell transplant recipients are also discussed in greater detail separately. (See "Prophylaxis of invasive fungal infections in adults with hematologic malignancies" and "Prophylaxis of invasive fungal infections in adult hematopoietic cell transplant recipients".)


The Infectious Diseases Society of America (IDSA) released updated guidelines for the treatment of aspergillosis in 2016 [1]. The American Thoracic Society (ATS) published guidelines for treatment of fungal infections in adult pulmonary and critical care patients in 2011; the ATS recommendations for the management of invasive aspergillosis are generally similar to those of the IDSA [2].

Our recommendations agree with the recommendations in the IDSA and ATS with regard to voriconazole being an essential element of therapy for most patients. The IDSA guidelines recommend voriconazole as initial therapy of invasive aspergillosis, with consideration of combination therapy with voriconazole plus an echinocandin for initial therapy of severe disease, particularly in patients with hematologic malignancy and/or in those with profound and persistent neutropenia [1]. We suggest combination therapy with voriconazole plus an echinocandin for patients with severe, microbiologically documented invasive aspergillosis (ie, diagnosed by culture, galactomannan antigen, or histopathology), but we also consider combination therapy for all patients with an immunocompromising condition that led to disease. The data regarding combination therapy are discussed in detail below. (See 'Voriconazole and an echinocandin' below.)


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Literature review current through: Sep 2016. | This topic last updated: Jul 25, 2016.
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