eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Aspergillosis: Follow-up

Author: Vandana Batra, MD, Pediatrician, Department of Pediatrics, Division of General Pediatrics/Primary Care, Nemours Pediatrics
Coauthor(s): Basim Asmar, MD, Director, Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Michigan; Professor, Department of Pediatrics, Wayne State University School of Medicine; Jocelyn Y Ang, MD, Assistant Professor, Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Michigan and Wayne State University
Contributor Information and Disclosures

Updated: Oct 17, 2008

Follow-up

Further Inpatient Care

  • Patients with aspergillosis who have concomitant underlying illness may need additional medical care.

Further Outpatient Care

  • Patients who continue to undergo treatment with oral or intravenous antifungal medications require periodic follow-up care as outpatients.

Transfer

  • Transfer to an ICU for close monitoring for patients with acute invasive pulmonary aspergillosis who develop complications such as hemoptysis.
  • Patients with cerebral aspergillosis and patients with invasive aspergillosis (IA) who are severely immunocompromised require frequent monitoring and assessment.

Deterrence/Prevention

  • Because Aspergillus conidia are usually acquired from the environment, measures to reduce exposure to conidia are essential to prevent disease transmission. An effective method of protecting immunocompromised patients is to confine them to a room with sterile laminar airflow.
  • Episodic outbreaks of invasive aspergillosis have been documented in hospitalized immunosuppressed patients during construction in hospitals. To prevent this, installation of barriers between patient care areas and construction sites, cleaning of airflow systems, repairing faulty airflow meters help reduce the spread of aspergillosis.
  • Reducing exposure of immunosuppressed patients is one of the most important preventive strategies. High-risk patients should be isolated in rooms equipped with high-efficiency particulate air filters. An antifungal powder, aerosolized copper-8-quinolinolate, has been used to control spread.
  • Prophylactic antifungal therapy, such as amphotericin B nasal spray, may be effective in controlling respiratory and sinus colonization. The use of itraconazole and voriconazole as prophylactic agents have shown to be beneficial in some studies to protect granulocytopenic patients from invasive aspergillosis. Trials regarding the use of intravenous itraconazole and cyclodextrin oral solution for the prophylaxis of aspergillosis are in progress. No regimen has been reported to be clearly effective in the prophylaxis of aspergillosis, and further studies are required before recommendations can be made.
  • Recommendations for effective patient isolation by the Centers for Disease Control and Prevention include the following:
    • Provide a minimum of 15 air changes per hour in sealed rooms.
    • Filter air with high-efficiency particulate air (HEPA) filters, which remove more than 95% of particles 0.3 µm and larger.
    • Maintain higher (ie, positive) air pressure inside the room than pressures outside.
    • Provide directed airflow within the patient's room.
  • HEPA filter masks can be fitted to patients as young as 5 years and can be used during patient transport.

Complications

  • Erosion of a major pulmonary artery caused by angiotropism of the Aspergillus species may lead to severe hemorrhage.
  • Fungal and necrotic debris obstructing the airway may cause fatality in patients with pseudomembranous tracheobronchitis.
  • Disseminated intravascular coagulation and jaundice may be complications of disseminated aspergillosis.

Prognosis

  • Of all forms of invasive aspergillosis, the worst prognosis is for patients with cerebral involvement; most die despite appropriate systemic antifungal therapy.
  • Bilateral diffuse disease usually occurs in patients with an allogenic bone marrow transplant, and patients with this condition have a worse prognosis than patients with focal nodular disease.
  • Patients with AIDS usually have a poor prognosis if invasive aspergillosis develops.
  • Poor prognoses are also associated with evidence of angioinvasion, continued immunosuppression, persistent neutropenia, leukemia relapse, and delayed or suboptimal therapy.

Patient Education

  • Patients at risk should be counseled to avoid exposure to Aspergillus organisms.
    • Educate patients, especially those with granulocytopenic conditions, about measures to reduce exposure to conidia, including instructions to avoid areas under construction.
    • Emphasize to patients who have immunosuppression the importance of wearing a fitted HEPA mask while in nonprotected areas to avoid contact with airborne conidia.
  • For excellent patient education resources, visit eMedicine's Procedures Center. Also, see eMedicine's patient education article Bronchoscopy.

Miscellaneous

Medicolegal Pitfalls

  • Although no specific medicolegal issues directly pertain to the diagnosis or management of aspergillosis, delayed diagnosis of invasive aspergillosis (IA) that results from the low sensitivity of diagnostic tests may postpone the start of treatment and have potentially fatal consequences.

Special Concerns

  • The advent of aggressive immunosuppressive treatment indicates that IA will continue to be an important cause of opportunistic infection in patients with immunocompromise.
 


More on Aspergillosis

Overview: Aspergillosis
Differential Diagnoses & Workup: Aspergillosis
Treatment & Medication: Aspergillosis
Follow-up: Aspergillosis
References
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References

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Further Reading

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Keywords

aspergillosis, Aspergillus, Aspergillus fumigatus, Aspergillus flavus, allergic bronchopulmonary aspergillosis, ABPA, aspergilloma, invasive aspergillosis, IA, noninvasive aspergillosis, Aspergillus niger, Aspergillus terreus, Aspergillus amstelodami, Aspergillus avenaceus, Aspergillus caesiellus, Aspergillus carneus, Aspergillus clavatus, Aspergillus oryzae, Aspergillus versicolor, Aspergillus wentii, allergic sinusitis, asthma, alveolitis, cellulitis, pneumonia, esophagitis, cystic fibrosis, CF, tuberculosis, sarcoidosis, bone marrow transplantation, graft versus host disease, graft rejection, hematopoietic stem cell transplantation, HSCT, heart and lung transplantation, chronic granulomatous disease, leukemia, diabetes mellitus, respiratory failure

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Contributor Information and Disclosures

Author

Vandana Batra, MD, Pediatrician, Department of Pediatrics, Division of General Pediatrics/Primary Care, Nemours Pediatrics
Vandana Batra, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Coauthor(s)

Basim Asmar, MD, Director, Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Michigan; Professor, Department of Pediatrics, Wayne State University School of Medicine
Basim Asmar, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Jocelyn Y Ang, MD, Assistant Professor, Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Michigan and Wayne State University
Jocelyn Y Ang, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Medical Editor

Itzhak Brook, MD, MSc, Professor, Department of Pediatrics, Georgetown University School of Medicine
Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota School of Medicine
Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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