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The epidemiology of IA, the major invasive mould infection in immunocompromised patients, has evolved over the last several decades. During the 1990s, increasing morbidity and mortality from these infections, particularly amongst the increasing numbers of patients being treated for haematological malignancies and those undergoing allogeneic haematopoietic stem cell transplantation, became a universal...
The study of the pathogenesis of invasive pulmonary aspergillosis has advanced significantly over recent years because of scientific achievements on two fronts: sequencing of the genomes of three Aspergillus species and elucidation of the innate immune mechanisms involved in defence against Aspergillus infection. The principal events that lead to invasive aspergillosis take place in the alveolus,...
The clinical manifestations of invasive pulmonary aspergillosis (IPA) are protean and may vary over time as IPA progresses. Early, fever may be the sole manifestation. Later, cough, pleuritic pain, dyspnoea, haemoptysis, rales, and friction rub may occur. Several clinical findings are strongly suggestive of the diagnosis of IPA, but most are non-specific and other aetiologies may account for the constellation...
The diagnosis of invasive aspergillosis remains challenging and current conventional methods are limited for the diagnosis of invasive fungal infections. The gold-standard for the definite diagnosis of proven invasive pulmonary aspergillosis remains either histopathologic, cytopathologic or direct tissue examination, based on the documentation of typical hyphae and a positive culture of Aspergillus...
Invasive pulmonary aspergillosis (IPA) is a leading cause of morbidity and mortality in immunocompromised patients. The main determinant of the poor outcome of IPA is the severity of immunosuppression associated with this infection. However, a delay in the diagnosis may be an important contributor. Therefore, attempts to early diagnose IPA are crucial. Non-invasive methods for the diagnosis of IPA...
The EORTC/MSG definitions are being widely used for clinical trials of therapy and prophylaxis, evaluating diagnostic tests, and for epidemiology studies. However shortfalls were obvious hence a consensus group was initiated in 2003 with the clear goal of building on what the original definitions had achieved whilst improving the definitions to address the known issues. The revised definitions were...
Treatment of invasive aspergillosis requires consideration of appropriate antifungal therapy, potential surgical management, and modulation of immunity. In the past several years, advances in therapy include the availability of multiple new antifungal drugs that have activity against Aspergillus species (expanded spectrum azole antifungals and echinocandins), with some studies showing potentially...
Invasive fungal diseases are a source of significant morbidity and mortality in patients with haematological malignancies, particularly those with prolonged and severe neutropenia. In view of the poor prognosis associated with tardy treatment initiation, antifungal prophylaxis has become increasingly popular. Until recently, fluconazole – a drug with no Aspergillus activity – and itraconazole, which...
Invasive aspergillosis is an important cause of infectious morbidity and mortality in children with innate or acquired deficiencies in phagocytic host defences and anatomical barriers. Similar to adults, it most commonly affects the lung, and remains difficult to diagnose. Prognosis depends on early recognition, prompt institution of appropriate treatment and restoration of host defences. Paediatric...
Data about incidence of invasive aspergillosis in intensive care units (ICU) are scarce and variable. Incidences ranging from 2 to 24% have been reported, which might reflect different autopsy policies amongst centres. Recent studies have shown that many patients with invasive aspergillosis do not have a haematological diagnosis. Instead, conditions such as chronic obstructive pulmonary disease and...
Most physicians will promptly consider the possibility of invasive aspergillosis in high-risk patients in the presence of an appropriate clinical syndrome. Aspergillosis will however only rarely be listed amongst the possible aetiologies of surgical site infections, although hundreds of cases have been published so far. This chapter reviews the current literature on post-operative aspergillosis. A...
Chronic granulomatous disease (CGD) is a rare inherited disorder of the NADPH oxidase complex in which phagocytes are defective in generating superoxide anion. NADPH oxidase activation leads to release of sequestered neutrophil granular proteases, which are likely the principal antimicrobial effectors. CGD is characterized by recurrent life-threatening bacterial and fungal infections and by inflammatory...
Infections might seriously harm individuals who are addicted to illicit drugs, with systemic fungal infections being occasionally implicated. Drug users can acquire different forms of aspergillosis by inhalation of fungal spores during marijuana smoking or by direct inoculation from a contaminated drug supply or injection material. Marijuana may sometimes be contaminated with Aspergillus, and that...
Invasive aspergillosis was previously considered an AIDS-defining disease. However, this infection is seen only occasionally in HIV-infected patients, usually affecting patients with advanced disease. The most commonly implicated factors for invasive aspergillosis are neutropenia, granulocyte dysfunction, exposure to broad-spectrum antibacterial therapy and a long term steroid use. The diagnosis of...
Invasive aspergillosis (IA) continues to be a significant cause of morbidity and mortality in solid organ transplant recipients. The highest incidence of IA is noted in lung transplant recipients, while the lowest incidence is in kidney transplant recipients. Common risk factors for the development of invasive aspergillosis include environmental exposures and net state of immunosuppression. Unique...
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