Overview
Invasive aspergillosis (IA) of the digestive tract is a serious opportunistic infection caused by Aspergillus species, particularly in immunocompromised individuals. It can manifest as a localized infection or a disseminated disease.
Diagnosis
Direct microscopy (preferably with optical brighteners), histopathology, and culture are strongly recommended for diagnosis 1.
Serum and bronchoalveolar lavage (BAL) galactomannan assays are recommended markers for IA diagnosis 1.
Chest computed tomography (CT) and bronchoscopy with BAL are strongly recommended in patients with suspected pulmonary IA 1.
PCR should be considered in conjunction with other diagnostic tests 1.
Pathogen identification to species complex level is strongly recommended for all clinically relevant Aspergillus* isolates 1.
Antifungal susceptibility testing should be performed in patients with invasive disease in regions with documented resistance 1.Management
Isavuconazole and voriconazole are preferred first-line agents for pulmonary IA 1.
Liposomal amphotericin B is moderately supported for first-line treatment of pulmonary IA 1.
Combinations of antifungals as primary treatment options are not recommended 1.
Therapeutic drug monitoring is strongly recommended for patients receiving posaconazole suspension or any form of voriconazole for IA treatment 1.
A personalized approach is recommended for refractory disease 1.Key Recommendations
Chest computed tomography as well as bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) are strongly recommended 1. (Evidence: Strong)
Direct microscopy, preferably using optical brighteners, histopathology and culture are strongly recommended for diagnosis 1. (Evidence: Strong)
Isavuconazole and voriconazole are the preferred agents for first-line treatment of pulmonary IA 1. (Evidence: Strong)References
1 Ullmann AJ, Aguado JM, Arikan-Akdagli S, Denning DW, Groll AH, Lagrou K et al.. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2018. link