Department of Infectious Diseases, Haematology and Oncology, University Hospital Würzburg, Würzburg, Germany; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM).
Infectious Diseases Unit, University Hospital Madrid, Madrid, Spain; ESCMID Fungal Infection Study Group (EFISG); European Confederation of Medical Mycology (ECMM).
Clin Microbiol Infect. 2018 May;24 Suppl 1:e1-e38. doi: 10.1016/j.cmi.2018.01.002. Epub 2018 Mar 12.
The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of aspergillosis. Of the numerous recommendations, a few are summarized here. Chest computed tomography as well as bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) are strongly recommended. For diagnosis, direct microscopy, preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan measures are recommended as markers for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species complex level is strongly recommended for all clinically relevant Aspergillus isolates; antifungal susceptibility testing should be performed in patients with invasive disease in regions with resistance found in contemporary surveillance programmes. 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. Therapeutic drug monitoring is strongly recommended for patients receiving posaconazole suspension or any form of voriconazole for IA treatment, and in refractory disease, where a personalized approach considering reversal of predisposing factors, switching drug class and surgical intervention is also strongly recommended. 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. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging.
欧洲临床微生物学和传染病学会、欧洲医学真菌学联合会和欧洲呼吸学会联合临床指南重点关注曲霉病的诊断和管理。在众多建议中，这里总结了一些。强烈建议对疑似肺部侵袭性曲霉病（IA）的患者进行胸部计算机断层扫描以及支气管镜检查和支气管肺泡灌洗（BAL）。强烈推荐直接显微镜检查，最好使用光学增亮剂，组织病理学和培养作为诊断方法。推荐血清和 BAL 半乳甘露聚糖测量作为 IA 诊断的标志物。PCR 应与其他诊断测试一起考虑。强烈建议对所有临床相关的曲霉属分离株进行种复合物水平的病原体鉴定；在具有当代监测计划中发现的耐药性的地区，应对侵袭性疾病患者进行抗真菌药敏试验。伊曲康唑和伏立康唑是治疗肺部 IA 的一线首选药物，而脂质体两性霉素 B 则得到适度支持。不建议将联合抗真菌药物作为主要治疗选择。强烈建议接受泊沙康唑混悬液或任何形式的伏立康唑治疗 IA 的患者以及在难治性疾病中进行治疗药物监测，对于考虑逆转易感因素、切换药物类别和手术干预的个体化方法也强烈建议。强烈建议接受诱导化疗的急性髓细胞白血病或骨髓增生异常综合征患者进行泊沙康唑预防性治疗。强烈建议高危患者进行二级预防。我们强烈建议根据临床改善、免疫抑制程度和影像学反应来确定治疗持续时间。
