Further Outpatient Care
See the list below:
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Patients who continue to undergo treatment with oral or intravenous antifungal medications require periodic follow-up care as outpatients.
Further Inpatient Care
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Patients with aspergillosis who have concomitant underlying illness may need additional medical care.
Transfer
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Transfer to an ICU for close monitoring for patients with acute invasive pulmonary aspergillosis who develop complications such as hemoptysis.
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Patients with cerebral aspergillosis and patients with invasive aspergillosis (IA) who are severely immunocompromised require frequent monitoring and assessment.
Deterrence/Prevention
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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.
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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.
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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.
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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.
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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.
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HEPA filter masks can be fitted to patients as young as 5 years and can be used during patient transport.
Complications
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Erosion of a major pulmonary artery caused by angiotropism of the Aspergillus species may lead to severe hemorrhage.
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Fungal and necrotic debris obstructing the airway may cause fatality in patients with pseudomembranous tracheobronchitis.
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Disseminated intravascular coagulation and jaundice may be complications of disseminated aspergillosis.
Prognosis
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Of all forms of invasive aspergillosis, the worst prognosis is for patients with cerebral involvement; most die despite appropriate systemic antifungal therapy.
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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.
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Patients with AIDS usually have a poor prognosis if invasive aspergillosis develops.
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Poor prognoses are also associated with evidence of angioinvasion, continued immunosuppression, persistent neutropenia, leukemia relapse, and delayed or suboptimal therapy.
Patient Education
See the list below:
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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.
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For excellent patient education resources, see eMedicineHealth's patient education article Bronchoscopy.
