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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

Pathogen identification

  • 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.

Antifungal therapy

  • 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

Prophylaxis

  • 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.