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Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology
Published on: March 22, 2012
The spectrum of pulmonary aspergillosis
Amjad Kanj1, Nadine Abdallah1, Ayman O Soubani1
1Division of Pulmonary Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
Abstract:
Notable progress has been made in the past years in the classification, diagnosis and treatment of pulmonary aspergillosis. New criteria were proposed by the Working Group of the International Society for Human and Animal Mycology (ISHAM) for the diagnosis of allergic bronchopulmonary aspergillosis (ABPA). The latest classification of chronic pulmonary aspergillosis (CPA) suggested by the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) has become widely accepted among clinicians. Subacute invasive pulmonary aspergillosis is now considered a type of CPA, yet it is still diagnosed and treated similarly to invasive pulmonary aspergillosis (IPA). Isavuconazole, an extended-spectrum triazole, has recently been approved by the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for the treatment of IPA. The most recent Infectious Diseases Society of America (IDSA) guidelines strongly recommend reducing mold exposure to patients at high risk for pulmonary aspergillosis. The excessive relapse rate following discontinuation of therapy remains a common reality to all forms of this semi-continuous spectrum of diseases. This highlights the need to continuously reassess patients and individualize therapy accordingly. Thus far, the duration of therapy and the frequency of follow-up have to be well characterized.
Insights
Recent advancements in pulmonary aspergillosis include new diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA). New treatments like isavuconazole offer hope, but managing relapses requires ongoing patient assessment and individualized therapy.
Area of Science:
- Pulmonology
- Mycology
- Infectious Diseases
Background:
- Pulmonary aspergillosis classification, diagnosis, and treatment have seen significant progress.
- New diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA) have been proposed and accepted.
- Subacute invasive pulmonary aspergillosis is now classified under CPA but managed similarly to invasive pulmonary aspergillosis (IPA).
Purpose of the Study:
- To summarize recent advancements in the understanding and management of pulmonary aspergillosis.
- To highlight new diagnostic criteria and therapeutic options.
- To emphasize the challenges in managing relapses and the need for individualized treatment strategies.
Main Methods:
- Review of recent guidelines and classifications from international societies (ISHAM, ESCMID, IDSA).
- Inclusion of newly approved treatments such as isavuconazole.
- Discussion of clinical observations regarding relapse rates and patient management.
Main Results:
- New diagnostic criteria for ABPA and CPA have been established.
- Isavuconazole is a newly approved treatment for IPA.
- High relapse rates necessitate continuous patient reassessment and tailored therapy.
Conclusions:
- Pulmonary aspergillosis management has evolved with updated classifications and treatments.
- Individualized therapy and frequent follow-up are crucial due to high relapse rates.
- Further characterization of optimal therapy duration and follow-up frequency is needed.
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