New ESCMID-ECMM-ERS clinical guidelines for aspergillosis released
May 02 2018
In a major coming together of several European medical mycology groups, this aspergillosis guidance document represents a fine example of collaboration and cooperation between groups across Europe with the aim of improving clinical management of patients with aspergillosis
The groups involved were:
- ESCMID-EFISG (ESCMID Fungal Infection Study Group)
- ESGICH (ESCMID Study Group for Infections in Compromised Hosts - ESGICH)
- ECMM (ECMM European Confederation of Medical Mycology)
- ERS (European Respiratory Society).
Some of the key points are summarised as follows:
Diagnosis of invasive aspergillosis (IA)
- Carry out chest CT and bronchoalveolar lavage
- Test for galactomannan in serum and BAL
- Identify all clinical isolates to species complex level and perform antifungal susceptibility testing in IA cases in regions where resistance is detected by surveillances programmes.
- Direct microscopy (preferably using optical brighteners) histopathology and culture are strongly recommended.
- PCR should be considered.
- Isavuconazole and voriconazole are the preferred agents for first-line treatment of pulmonary IA, whereas liposomal amphotericin B is moderately supported.
- Combinations of antifungals as primary treatment options are not recommended.
- Use therapeutic drug monitoring when treating with posaconazole suspension or any form or voriconazole
- Primary prophylaxis with posaconazole is strongly recommended in patients with acute myelogenous leukaemia or myelodysplastic syndrome receiving induction chemotherapy.
- Secondary prophylaxis is strongly recommended in high-risk patients.
- Read the exectuvie summary: Ullmann et al (2018) Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clinical Microbiology & Infection. 24(1):e1-38
- Read a brief history of the development of the guidelines