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Updated: Jul 4, 2025
Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis
Published on: March 9, 2018
How do I manage refractory invasive pulmonary aspergillosis
Paschalis Vergidis1, Parham Sendi2, Hassan B Alkhateeb3
1Section of Infectious Diseases, Mayo Clinic, Rochester, MN, USA.
Background:
Invasive aspergillosis is associated with significant morbidity and mortality in patients with haematologic malignancies and haematopoietic cell transplant recipients. The prognosis is worse among patients who have failed primary antifungal treatment.
Objectives:
We aim to provide guidance on the diagnosis and management of refractory invasive pulmonary aspergillosis.
Sources:
Using PubMed, we performed a review of original articles, meta-analyses, and systematic reviews.
Content:
We discuss the diagnostic criteria for invasive pulmonary aspergillosis and the evidence on the treatment of primary infection. We outline our diagnostic approach to refractory disease. We propose a treatment algorithm for refractory disease and discuss the role of experimental antifungal agents.
Implications:
For patients with worsening disease while on antifungal therapy, a thorough diagnostic evaluation is required to confirm the diagnosis of aspergillosis and exclude another concomitant infection. Treatment should be individualized. Current options include switching to another triazole, transitioning to a lipid formulation of amphotericin B, or using combination antifungal therapy.
Insights
Refractory invasive pulmonary aspergillosis in immunocompromised patients requires careful diagnosis and individualized treatment. Options include switching antifungals, using lipid amphotericin B, or combination therapy for better outcomes.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Hematology Oncology
Background:
- Invasive aspergillosis presents a significant challenge in immunocompromised patients, particularly those with hematologic malignancies and transplant recipients.
- Outcomes are notably worse for patients who do not respond to initial antifungal treatments.
- Refractory disease necessitates specialized diagnostic and management strategies.
Purpose of the Study:
- To offer clinical guidance for diagnosing and managing invasive pulmonary aspergillosis that is refractory to standard treatments.
- To review current evidence and propose an evidence-based approach for complex cases.
Main Methods:
- A comprehensive literature review was conducted using PubMed.
- Included were original research articles, meta-analyses, and systematic reviews.
- Focused on diagnostic criteria and treatment evidence for primary and refractory invasive pulmonary aspergillosis.
Main Results:
- Diagnostic evaluation is crucial to confirm aspergillosis and rule out other infections in patients with worsening symptoms despite antifungal therapy.
- Treatment decisions for refractory cases must be individualized based on patient factors and disease characteristics.
- Experimental antifungal agents may play a role in select situations.
Conclusions:
- Individualized treatment is key for refractory invasive pulmonary aspergillosis.
- Therapeutic options include switching to alternative azoles, using lipid formulations of amphotericin B, or employing combination antifungal regimens.
- Further research into novel antifungal agents is warranted.
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