The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of major forms of aspergillosis. Only a few of the numerous recommendations can be summarized here. The performance of a chest computed tomographic scan as well as a bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) is strongly recommended. For diagnosis, direct microscopy preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan is recommended as accurate marker for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species level by molecular methods is strongly recommended for all clinical relevant Aspergillus isolates; antifungal susceptibility testing should be done in patients unresponsive to treatment, or in regions with a high prevalence of azole resistance. Isavuconazole and voriconazole are the preferred agents for first line treatment of pulmonary IA, followed by liposomal amphotericin B. In refractory disease we strongly recommend a personalized approach considering therapeutic drug monitoring (TDM), reversal of predisposing factors, switching drug class and surgical intervention. Primary prophylaxis with posaconazole is strongly recommended in patients with haematological malignancy, secondary prophylaxis in high risk patients. TDM is strongly recommended for patients receiving posaconazole suspension or voriconazole for IA treatment. Combinations of antifungals as primary treatment options are not recommended. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging.
Acknowledgement: Professor William Hope was a member of the TDM group, however, he stepped down during the process of guideline development due to his new post as guideline director of ESCMID to avoid any conflicts of interest. His contributions were very much appreciated to the entry guideline group. We are thankful for his help.
Funding: European Society of Clinical Microbiology and Infectious Diseases (ESCMID), European Confederation of Medical Mycology (ECMM) and European Respiratory Society (ERS)
- Invasive Fungal Infection