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Treatment Options in Invasive Aspergillosis

  • Fungal Infections (P Williamson, Section Editor)
  • Published:
Current Treatment Options in Infectious Diseases Aims and scope Submit manuscript

Opinion statement

Aspergillus species are septated molds that cause a wide spectrum of clinical syndromes. Among these, invasive aspergillosis (IA) causes very high morbidity and mortality among the most severely immunosuppressed, especially those with profound qualitative or quantitative neutropenia. Empirical, pre-emptive, and targeted approaches have been attempted to blunt establishment of infection with variable success. The preferred treatment of primary IA is voriconazole, which has been found to be superior to amphotericin B. Azoles interfere with the synthesis of ergosterol found in the fungal cell membrane, whereas polyenes—such as amphotericin B—interfere with ergosterol function. An echinocandin that disrupts fungal cell wall synthesis—caspofungin—and itraconazole have been approved for salvage therapy of IA. Lipid amphotericin B formulations are used in those intolerant to amphotericin B deoxycholate. Posaconazole is used for prophylaxis in high-risk groups such as those with acute myelogenous leukemia, myelodysplastic syndrome, and stem cell transplant recipients with graft versus host disease to reduce the incidence of invasive fungal infections (IFI) such as IA. Combining mold-active azoles or a lipid amphotericin B formulation with an echinocandin may have a role in refractory IA. Immunomodulatory properties of antifungals, growth factors, cytokines, and immune cell infusions may enhance host ability to facilitate adjunctive control of infection, but an uncontrolled, exuberant inflammatory response can also cause significant pathology. Surgical resection may be a last resort when angioinvasion of critical structures places a patient at high risk for bleeding, thrombosis, or embolic phenomena, despite medical therapy. Nevertheless, immune reconstitution with myeloid lineage recovery is the key to successful outcomes.

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Acknowledgments

This research was supported in part by the Intramural Research Program of the NIH/NIAID/DIR/LCID/TMU. The views herein do not reflect the official opinions of the Uniformed Services University or the Department of Defense.

Compliance with Ethics Guidelines

Conflict of Interest

Peter Williamson declares no conflicts of interest.

Anil Panackal is employed at the NIH and has stock in AMCAP.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Translational Mycology Unit, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Clinical Research Center, Bldg. 10, 11N-222, Bethesda, MD, 20892, USA

    Anil A. Panackal M.D. & Peter R. Williamson M.D., Ph.D.

  2. Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 9000 Rockville Pike, Clinical Research Center, Bldg. 10, 11N-222, Bethesda, MD, 20892, USA

    John E. Bennett M.D.

  3. Division of Infectious Diseases, Department of Medicine, F. Hèbert School of Medicine, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA

    Anil A. Panackal M.D.

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  2. John E. Bennett M.D.
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  3. Peter R. Williamson M.D., Ph.D.
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Correspondence to Anil A. Panackal M.D..

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Panackal, A.A., Bennett, J.E. & Williamson, P.R. Treatment Options in Invasive Aspergillosis. Curr Treat Options Infect Dis 6, 309–325 (2014). https://doi.org/10.1007/s40506-014-0016-2

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  • DOI: https://doi.org/10.1007/s40506-014-0016-2

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