Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Aspergillosis Treatment & Management

  • Author: Eloise M Harman, MD; Chief Editor: Ryland P Byrd, Jr, MD  more...
 
Updated: Apr 01, 2015
 

Medical Care

Treatment of chronic necrotizing pulmonary aspergillosis (CNPA) and invasive aspergillosis differs significantly from treatment of allergic bronchopulmonary aspergillosis (ABPA) and aspergilloma.

Allergic bronchopulmonary aspergillosis

ABPA is a hypersensitivity reaction that requires treatment with oral corticosteroids. Inhaled steroids are not effective.

Adding oral itraconazole to steroids in patients with recurrent or chronic ABPA may be helpful.[7, 8, 9, 10] This may allow more rapid resolution of infiltrates and symptoms, facilitating steroid tapering or lowering the needed maintenance corticosteroid dosage. In CF patients with ABPA, the concomitant use of itraconazole and inhaled corticosteroids may increase the risk of adrenal insufficiency.

Patients who have associated allergic fungal sinusitis benefit from surgical resection of obstructing nasal polyps and inspissated mucus in addition to corticosteroid therapy. Nasal washes with amphotericin or itraconazole have also been employed.

Case reports have described the beneficial use of the anti-immunoglobulin E (IgE) monoclonal antibody omalizumab (Xolair) in patients with ABPA.[27]

Aspergilloma

Treatment of aspergilloma is considered when patients become symptomatic, usually with hemoptysis. Surgical resection is curative but may not be possible in patients with limited pulmonary function. Oral itraconazole may provide partial or complete resolution of aspergillomas in 60% of patients. Successful intracavitary treatment using computed tomography (CT)-guided, percutaneously placed catheters to instill amphotericin (alone or with other drugs, including acetylcysteine and aminocaproic acid) has been reported in small numbers of patients.[11]

Bronchial artery embolization may be used for life-threatening hemoptysis in patients thought to have insufficient pulmonary reserve to tolerate surgery or in patients with recurrent hemoptysis (eg, patients with CF in whom hemoptysis may be related to underlying bronchiectasis with or without aspergilloma).[12] Bronchial artery embolization requires a skilled and experienced radiologist because localizing the abnormal vessel(s) may be challenging. Because the anterior spinal arteries may originate from the bronchial vessels, serious neurologic complications, although rare, may occur.

Chronic necrotizing pulmonary aspergillosis

Treatment of CNPA consists of administration of voriconazole, or, in some cases, itraconazole (if expense is an issue), caspofungin, or amphotericin B or amphotericin lipid formulation. A prolonged course of therapy with the goal of radiographic resolution is required. In addition, reduction or elimination of immunosuppression should be attempted, if possible.

Surgical resection may be considered when localized disease fails to respond to antifungal therapy.

Invasive aspergillosis

Invasive aspergillosis[28, 29] is often rapidly progressive and has a high mortality. Therefore, preventive therapy and rapid institution of therapy in patients in whom invasive aspergillosis is suggested may be lifesaving.

Prophylactic antifungal therapy and the use of laminar airflow (LAF) or high-efficiency particulate air (HEPA) filtration of patient rooms in patients who receive bone marrow transplants and other high-risk patients may prevent invasive aspergillosis. In patients with solid organ transplants, especially lung, in whom Aspergillus is cultured from sputum without evidence of pneumonia (colonization), inhaled amphotericin B may be administered.

When high-risk patients develop a compatible clinical picture, empiric treatment for aspergillosis should be initiated as diagnostic testing is undertaken. Voriconazole is now considered the drug of choice for invasive aspergillosis because of better tolerance and improved survival in comparison with amphotericin.[13]

Posaconazole, amphotericin B, or amphotericin B lipid formulations may be considered as empiric therapy in critically ill patients if the clinical picture, particularly the presence of sinusitis, could be compatible with mucormycosis, because voriconazole is ineffective for Zygomycetes infection. Caspofungin has also been approved for treatment of invasive aspergillosis in patients who are unable to tolerate or are resistant to other therapies.[14] Initial combination therapy is usually not indicated and should generally be reserved for treatment failures.[30]

If possible, the level of immunosuppression should be decreased. For example, patients who are neutropenic may receive growth factors (ie, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor), and patients with certain types of transplants, in which transplanted organ dysfunction will not be life threatening (eg, renal transplant), may have immunosuppressive medications, including corticosteroids, reduced or discontinued.

Combination antifungal therapy is sometimes used for patients whose disease progresses while on single-drug therapy. Concomitant therapy with azole antifungals and amphotericin is controversial because the azole antifungals decrease amphotericin-binding sites and may therefore diminish its effectiveness. Be alert to the possibility of diminished effectiveness of amphotericin in any patient who has received prior treatment with an azole antifungal, including voriconazole, itraconazole, fluconazole, or ketoconazole. Newer antifungal azoles are under study (eg, ravuconazole) and may be available for compassionate use in patients in whom other therapies have failed.

In November 2013, the FDA approved a 100-mg delayed-release formulation of the triazole antifungal posaconazole (Noxafil). The formulation is indicated for the prophylaxis of invasive Aspergillus and Candida infections in severely immunocompromised patients aged 13 years and older who are at high risk of developing these infections. The tablets are administered as a loading dose of 300 mg twice daily on day 1, followed by a once-daily maintenance dose of 300 mg.[31]

In March 2015, the FDA approved isavuconazole (Cresemba) for invasive aspergillosis. It has activity against most strains of the following microorganisms, both in vitro and in clinical infection: Aspergillus flavus, Aspergillus fumigatus, and Aspergillus niger. Approval was based on the SECURE study (n = 516) that demonstrated isavuconazole was noninferior voriconazole on the primary endpoint of all-cause mortality at day 42 for the treatment of adult patients with invasive aspergillosis or other filamentous fungi (isavuconazole 18.6% vs voriconazole 20.2%).[32]

Next

Surgical Care

Allergic bronchopulmonary aspergillosis

Areas of mucoid impaction in ABPA may have a masslike appearance and are sometimes resected as an undiagnosed lung mass; however, steroid therapy and oral itraconazole therapy are preferred. Allergic fungal sinusitis usually requires endoscopic sinus surgery to improve drainage.

Aspergilloma

Surgical resection may be considered for massive hemoptysis in patients with aspergilloma if pulmonary function is sufficient for this sort of intervention. Assessment of operative risk necessitates obtaining pulmonary function studies, arterial blood gas determinations, and, possibly, split lung function studies (eg, quantitative perfusion lung scanning). Because aspergilloma occurs in cavitary areas, the affected lung may not be functional. Surgical resection may be difficult because of scarring, pleural adhesion, and the presence of abnormal vasculature.

Chronic necrotizing pulmonary aspergillosis and invasive aspergillosis

Surgical resection is a consideration for localized CNPA that has failed to respond to prolonged antifungal therapy.[33] Aspergillomas may occasionally form in areas of necrotizing pneumonia. These necrotic areas may bleed, sometimes massively, necessitating consideration of surgical resection. Patients may be high-risk surgical candidates because of underlying disease, coagulopathy, or thrombocytopenia and limited pulmonary reserve.

Previous
Next

Consultations

Consultation with a pulmonologist may be helpful for patients suggested to have invasive aspergillosis or chronic necrotizing Aspergillus pneumonia in order to establish a definitive diagnosis. Once the diagnosis is established, consultation with an infectious diseases specialist is usually helpful in management, especially if patients do not respond to initial fungal therapy.

Patients with ABPA or allergic fungal sinusitis should be treated by a pulmonologist or allergist familiar with the management of these conditions. Consultation with a pulmonologist is also indicated in patients with aspergilloma. Input from a thoracic surgeon may also be needed if surgical resection is feasible. In selected patients, consultation with an invasive radiologist may be indicated for CT-directed catheter placement to allow intracavitary therapy or bronchial artery embolization.

Previous
 
 
Contributor Information and Disclosures
Author

Eloise M Harman, MD Staff Physician and MICU Director, Pulmonary Division, Gainesville Veterans Affairs Medical Center

Eloise M Harman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Chest Physicians, American Medical Womens Association, American Thoracic Society, Phi Beta Kappa, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Ryland P Byrd, Jr, MD Professor of Medicine, Division of Pulmonary Disease and Critical Care Medicine, James H Quillen College of Medicine, East Tennessee State University

Ryland P Byrd, Jr, MD is a member of the following medical societies: American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Acknowledgements

Oleh Wasyl Hnatiuk, MD Program Director, National Capital Consortium, Pulmonary and Critical Care, Walter Reed Army Medical Center; Associate Professor, Department of Medicine, Uniformed Services University of Health Sciences

Oleh Wasyl Hnatiuk, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

References
  1. Brooks M. FDA Clears IV Formulation of Antifungal Posaconazole. Medscape Medical News. Available at http://www.medscape.com/viewarticle/822125. Accessed: March 25, 2014.

  2. Samarakoon P, Soubani AO. Invasive pulmonary aspergillosis in patients with COPD: a report of five cases and systematic review of the literature. Chron Respir Dis. 2008. 5(1):19-27. [Medline].

  3. Ader F, Bienvenu AL, Rammaert B, Nseir S. Management of invasive aspergillosis in patients with COPD: rational use of voriconazole. Int J Chron Obstruct Pulmon Dis. 2009. 4(2):279-87. [Medline]. [Full Text].

  4. Maertens J, Verhaegen J, Lagrou K, Van Eldere J, Boogaerts M. Screening for circulating galactomannan as a noninvasive diagnostic tool for invasive aspergillosis in prolonged neutropenic patients and stem cell transplantation recipients: a prospective validation. Blood. 2001 Mar 15. 97(6):1604-10. [Medline].

  5. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis. 2006 May 15. 42(10):1417-27. [Medline].

  6. Kuhlman JE, Fishman EK, Siegelman SS. Invasive pulmonary aspergillosis in acute leukemia: characteristic findings on CT, the CT halo sign, and the role of CT in early diagnosis. Radiology. 1985 Dec. 157(3):611-4. [Medline].

  7. Salez F, Brichet A, Desurmont S, Grosbois JM, Wallaert B, Tonnel AB. Effects of itraconazole therapy in allergic bronchopulmonary aspergillosis. Chest. 1999 Dec. 116(6):1665-8. [Medline].

  8. Stevens DA, Schwartz HJ, Lee JY, Moskovitz BL, Jerome DC, Catanzaro A, et al. A randomized trial of itraconazole in allergic bronchopulmonary aspergillosis. N Engl J Med. 2000 Mar 16. 342(11):756-62. [Medline].

  9. Wark PA, Gibson PG, Wilson AJ. Azoles for allergic bronchopulmonary aspergillosis associated with asthma. Cochrane Database Syst Rev. 2003. (3):CD001108. [Medline].

  10. Wark PA, Hensley MJ, Saltos N, Boyle MJ, Toneguzzi RC, Epid GD, et al. Anti-inflammatory effect of itraconazole in stable allergic bronchopulmonary aspergillosis: a randomized controlled trial. J Allergy Clin Immunol. 2003 May. 111(5):952-7. [Medline].

  11. Giron JM, Poey CG, Fajadet PP, Balagner GB, Assoun JA, Richardi GR, et al. Inoperable pulmonary aspergilloma: percutaneous CT-guided injection with glycerin and amphotericin B paste in 15 cases. Radiology. 1993 Sep. 188(3):825-7. [Medline].

  12. Mal H, Rullon I, Mellot F, Brugiere O, Sleiman C, Menu Y, et al. Immediate and long-term results of bronchial artery embolization for life-threatening hemoptysis. Chest. 1999 Apr. 115(4):996-1001. [Medline].

  13. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002 Aug 8. 347(6):408-15. [Medline].

  14. Maertens J, Raad I, Petrikkos G, Boogaerts M, Selleslag D, Petersen FB, et al. Efficacy and safety of caspofungin for treatment of invasive aspergillosis in patients refractory to or intolerant of conventional antifungal therapy. Clin Infect Dis. 2004 Dec 1. 39(11):1563-71. [Medline].

  15. Addrizzo-Harris DJ, Harkin TJ, McGuinness G, Naidich DP, Rom WN. Pulmonary aspergilloma and AIDS. A comparison of HIV-infected and HIV-negative individuals. Chest. 1997 Mar. 111(3):612-8. [Medline].

  16. Virnig C, Bush RK. Allergic bronchopulmonary aspergillosis: a US perspective. Curr Opin Pulm Med. 2007 Jan. 13(1):67-71. [Medline].

  17. Meersseman W, Vandecasteele SJ, Wilmer A, Verbeken E, Peetermans WE, Van Wijngaerden E. Invasive aspergillosis in critically ill patients without malignancy. Am J Respir Crit Care Med. 2004 Sep 15. 170(6):621-5. [Medline].

  18. Smith NL, Denning DW. Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma. Eur Respir J. 2011 Apr. 37(4):865-72. [Medline].

  19. Stevens DA, Moss RB, Kurup VP, Knutsen AP, Greenberger P, Judson MA, et al. Allergic bronchopulmonary aspergillosis in cystic fibrosis--state of the art: Cystic Fibrosis Foundation Consensus Conference. Clin Infect Dis. 2003 Oct 1. 37 Suppl 3:S225-64. [Medline].

  20. Chai LY, Kullberg BJ, Johnson EM, Teerenstra S, Khin LW, Vonk AG, et al. Early Serum Galactomannan Trend as a Predictor of Outcome in Invasive Aspergillosis. J Clin Microbiol. 2012 May 2. [Medline].

  21. Becker MJ, Lugtenburg EJ, Cornelissen JJ, Van Der Schee C, Hoogsteden HC, De Marie S. Galactomannan detection in computerized tomography-based broncho-alveolar lavage fluid and serum in haematological patients at risk for invasive pulmonary aspergillosis. Br J Haematol. 2003 May. 121(3):448-57. [Medline].

  22. Guo YL, Chen YQ, Wang K, Qin SM, Wu C, Kong JL. Accuracy of BAL galactomannan in diagnosing invasive aspergillosis: a bivariate metaanalysis and systematic review. Chest. 2010 Oct. 138(4):817-24. [Medline].

  23. Luong ML, Clancy CJ, Vadnerkar A, et al. Comparison of an Aspergillus real-time polymerase chain reaction assay with galactomannan testing of bronchoalvelolar lavage fluid for the diagnosis of invasive pulmonary aspergillosis in lung transplant recipients. Clin Infect Dis. 2011 May. 52(10):1218-26. [Medline].

  24. Agarwal R. Allergic bronchopulmonary aspergillosis. Chest. 2009 Mar. 135(3):805-26. [Medline].

  25. Gruson D, Hilbert G, Valentino R, Vargas F, Chene G, Bebear C, et al. Utility of fiberoptic bronchoscopy in neutropenic patients admitted to the intensive care unit with pulmonary infiltrates. Crit Care Med. 2000 Jul. 28(7):2224-30. [Medline].

  26. Patterson R, Greenberger PA, Radin RC, Roberts M. Allergic bronchopulmonary aspergillosis: staging as an aid to management. Ann Intern Med. 1982 Mar. 96(3):286-91. [Medline].

  27. van der Ent CK, Hoekstra H, Rijkers GT. Successful treatment of allergic bronchopulmonary aspergillosis with recombinant anti-IgE antibody. Thorax. 2007 Mar. 62(3):276-7. [Medline].

  28. Krishnan-Natesan S, Chandrasekar PH. Current and future therapeutic options in the management of invasive aspergillosis. Drugs. 2008. 68(3):265-82. [Medline].

  29. Magill SS, Chiller TM, Warnock DW. Evolving strategies in the management of aspergillosis. Expert Opin Pharmacother. 2008 Feb. 9(2):193-209. [Medline].

  30. Kontoyiannis DP, Hachem R, Lewis RE, Rivero GA, Torres HA, Thornby J, et al. Efficacy and toxicity of caspofungin in combination with liposomal amphotericin B as primary or salvage treatment of invasive aspergillosis in patients with hematologic malignancies. Cancer. 2003 Jul 15. 98(2):292-9. [Medline].

  31. Brooks M. FDA Okays Antifungal Delayed-Release Tablets. Available at http://www.medscape.com/viewarticle/815030. Accessed: December 3, 2013.

  32. National Institutes of Health. Isavuconazole (BAL8557) for primary treatment of invasive Aspergillosis.NLM identfier: NCT00412893. ClinicalTrials.gov. Available at http://clinicaltrials.gov/ct2/show/NCT00412893. Accessed: April 2, 2015.

  33. Pidhorecky I, Urschel J, Anderson T. Resection of invasive pulmonary aspergillosis in immunocompromised patients. Ann Surg Oncol. 2000 May. 7(4):312-7. [Medline].

  34. Schubert MS, Goetz DW. Evaluation and treatment of allergic fungal sinusitis. I. Demographics and diagnosis. J Allergy Clin Immunol. 1998 Sep. 102(3):387-94. [Medline].

  35. Boyle BM, McCann SR. The use of itraconazole as prophylaxis against invasive fungal infection in blood and marrow transplant recipients. Transpl Infect Dis. 2000 Jun. 2(2):72-9. [Medline].

  36. Cordonnier C, Maury S, Pautas C, Bastie JN, Chehata S, Castaigne S, et al. Secondary antifungal prophylaxis with voriconazole to adhere to scheduled treatment in leukemic patients and stem cell transplant recipients. Bone Marrow Transplant. 2004 May. 33(9):943-8. [Medline].

  37. Kontoyiannis DP, Lionakis MS, Lewis RE, Chamilos G, Healy M, Perego C. Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: a case-control observational study of 27 recent cases. J Infect Dis. 2005 Apr 15. 191(8):1350-60. [Medline].

  38. Wirk B, Wingard JR. Current approaches in antifungal prophylaxis in high risk hematologic malignancy and hematopoietic stem cell transplant patients. Mycopathologia. 2009 Dec. 168(6):299-311. [Medline].

  39. Mohammad RA, Klein KC. Inhaled amphotericin B for prophylaxis against invasive Aspergillus infections. Ann Pharmacother. 2006 Dec. 40(12):2148-54. [Medline].

  40. Avery RK. Aspergillosis in hematopoietic stem cell transplant recipients: risk factors, prophylaxis, and treatment. Curr Infect Dis Rep. 2009 May. 11(3):223-8. [Medline].

  41. Denning DW, Park S, Lass-Florl C, et al. High-frequency triazole resistance found In nonculturable Aspergillus fumigatus from lungs of patients with chronic fungal disease. Clin Infect Dis. 2011 May. 52(9):1123-9. [Medline]. [Full Text].

  42. Bartlett JG. Aspergillosis update. Medicine (Baltimore). 2000 Jul. 79(4):281-2. [Medline].

  43. Caillot D, Casasnovas O, Bernard A, Couaillier JF, Durand C, Cuisenier B, et al. Improved management of invasive pulmonary aspergillosis in neutropenic patients using early thoracic computed tomographic scan and surgery. J Clin Oncol. 1997 Jan. 15(1):139-47. [Medline].

  44. Clancy CJ, Nguyen MH. Invasive sinus aspergillosis in apparently immunocompetent hosts. J Infect. 1998 Nov. 37(3):229-40. [Medline].

  45. Cockrill BA, Hales CA. Allergic bronchopulmonary aspergillosis. Annu Rev Med. 1999. 50:303-16. [Medline].

  46. Collin BA, Ramphal R. Pneumonia in the compromised host including cancer patients and transplant patients. Infect Dis Clin North Am. 1998 Sep. 12(3):781-805, xi. [Medline].

  47. Denning DW. Invasive aspergillosis. Clin Infect Dis. 1998 Apr. 26(4):781-803; quiz 804-5. [Medline].

  48. Graybill JR. Itraconazole: managing mycotic complications in immunocompromised patients. Semin Oncol. 1998 Jun. 25(3 Suppl 7):58-63. [Medline].

  49. Jean-Baptiste E. Clinical assessment and management of massive hemoptysis. Crit Care Med. 2000 May. 28(5):1642-7. [Medline].

  50. Klastersky J. Antifungal therapy in patients with fever and neutropenia--more rational and less empirical?. N Engl J Med. 2004 Sep 30. 351(14):1445-7. [Medline].

  51. Klein NC, Cunha BA. New antifungal drugs for pulmonary mycoses. Chest. 1996 Aug. 110(2):525-32. [Medline].

  52. Marr KA, Boeckh M, Carter RA, Kim HW, Corey L. Combination antifungal therapy for invasive aspergillosis. Clin Infect Dis. 2004 Sep 15. 39(6):797-802. [Medline].

  53. Massachusetts General Hospital. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 24-2001. A 46-year-old woman with chronic sinsusitis, pulmonary nodules, and hemoptysis. N Engl J Med. 2001 Aug 9. 345(6):443-9. [Medline].

  54. Mehrad B, Paciocco G, Martinez FJ, Ojo TC, Iannettoni MD, Lynch JP 3rd. Spectrum of Aspergillus infection in lung transplant recipients: case series and review of the literature. Chest. 2001 Jan. 119(1):169-75. [Medline].

  55. Mylonakis E, Barlam TF, Flanigan T, Rich JD. Pulmonary aspergillosis and invasive disease in AIDS: review of 342 cases. Chest. 1998 Jul. 114(1):251-62. [Medline].

  56. Nagappan V, Deresinski S. Reviews of anti-infective agents: posaconazole: a broad-spectrum triazole antifungal agent. Clin Infect Dis. 2007 Dec 15. 45(12):1610-7. [Medline].

  57. Nepomuceno IB, Esrig S, Moss RB. Allergic bronchopulmonary aspergillosis in cystic fibrosis: role of atopy and response to itraconazole. Chest. 1999 Feb. 115(2):364-70. [Medline].

  58. Novey HS. Epidemiology of allergic bronchopulmonary aspergillosis. Immunol All Clin North Am. 1998. 18:641-53.

  59. Paterson DL, Singh N. Invasive aspergillosis in transplant recipients. Medicine (Baltimore). 1999 Mar. 78(2):123-38. [Medline].

  60. Patterson TF, Kirkpatrick WR, White M, Hiemenz JW, Wingard JR, Dupont B, et al. Invasive aspergillosis. Disease spectrum, treatment practices, and outcomes. I3 Aspergillus Study Group. Medicine (Baltimore). 2000 Jul. 79(4):250-60. [Medline].

  61. Sambatakou H, Dupont B, Lode H, Denning DW. Voriconazole treatment for subacute invasive and chronic pulmonary aspergillosis. Am J Med. 2006 Jun. 119(6):527.e17-24. [Medline].

  62. Saraceno JL, Phelps DT, Ferro TJ, Futerfas R, Schwartz DB. Chronic necrotizing pulmonary aspergillosis: approach to management. Chest. 1997 Aug. 112(2):541-8. [Medline].

  63. Serody JS, Shea TC. Prevention of infections in bone marrow transplant recipients. Infect Dis Clin North Am. 1997 Jun. 11(2):459-77. [Medline].

  64. Singh N, Limaye AP, Forrest G, Safdar N, Munoz P, Pursell K, et al. Combination of voriconazole and caspofungin as primary therapy for invasive aspergillosis in solid organ transplant recipients: a prospective, multicenter, observational study. Transplantation. 2006 Feb 15. 81(3):320-6. [Medline].

  65. Smith J, Safdar N, Knasinski V, Simmons W, Bhavnani SM, Ambrose PG, et al. Voriconazole therapeutic drug monitoring. Antimicrob Agents Chemother. 2006 Apr. 50(4):1570-2. [Medline].

  66. Stevens DA, Kan VL, Judson MA, Morrison VA, Dummer S, Denning DW, et al. Practice guidelines for diseases caused by Aspergillus. Infectious Diseases Society of America. Clin Infect Dis. 2000 Apr. 30(4):696-709. [Medline].

  67. Tillie-Leblond I, Tonnel AB. Allergic bronchopulmonary aspergillosis. Allergy. 2005 Aug. 60(8):1004-13. [Medline].

  68. Ullmann AJ, Lipton JH, Vesole DH, Chandrasekar P, Langston A, Tarantolo SR, et al. Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease. N Engl J Med. 2007 Jan 25. 356(4):335-47. [Medline].

  69. Viscoli C, Machetti M, Cappellano P, Bucci B, Bruzzi P, Van Lint MT, et al. False-positive galactomannan platelia Aspergillus test results for patients receiving piperacillin-tazobactam. Clin Infect Dis. 2004 Mar 15. 38(6):913-6. [Medline].

  70. [Guideline] Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis. 2008 Feb 1. 46(3):327-60. [Medline].

  71. Walsh TJ, Hiemenz JW, Anaissie E. Recent progress and current problems in treatment of invasive fungal infections in neutropenic patients. Infect Dis Clin North Am. 1996 Jun. 10(2):365-400. [Medline].

  72. Walsh TJ, Teppler H, Donowitz GR, Maertens JA, Baden LR, Dmoszynska A, et al. Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. N Engl J Med. 2004 Sep 30. 351(14):1391-402. [Medline].

  73. Ward S, Heyneman L, Lee MJ, Leung AN, Hansell DM, Muller NL. Accuracy of CT in the diagnosis of allergic bronchopulmonary aspergillosis in asthmatic patients. AJR Am J Roentgenol. 1999 Oct. 173(4):937-42. [Medline].

  74. Yao Z, Liao W. Fungal respiratory disease. Curr Opin Pulm Med. 2006 May. 12(3):222-7. [Medline].

  75. Zmeili OS, Soubani AO. Pulmonary aspergillosis: a clinical update. QJM. 2007 Jun. 100(6):317-34. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.