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June 2016
New IDSA Guideline on Diagnosis and Treatment of Aspergillosis
An updated IDSA guideline on the diagnosis and treatment of aspergillosis has been published in Clinical Infectious Diseases. According to the guideline, new therapies are improving care, but early diagnosis remains critical in the effective treatment of the potentially deadly fungal infection.
The updated guideline focuses on the diagnosis and treatment of the major forms of aspergillosis: allergic, chronic and invasive, the latter which kills 40 percent to 80 percent of those with widespread infection. While generally harmless, it can cause an allergic reaction or chronic lung problems in some people and serious, invasive disease in vulnerable patients. Those at highest risk are people whose immune systems are suppressed, such as those undergoing stem cell and lung and other organ transplants. The infection also can affect those with severe influenza or who are on long-term steroids, or patients in the intensive care unit. 
Improved use of diagnostic tools, including blood tests, cultures and CT imaging, have enhanced the ability to identify the infection early, but because some of the methods are invasive, physicians often are reluctant to proceed. Because the infection is so deadly, physicians should be aggressive in diagnosing patients suspected of having the infection, according to lead guideline author Thomas Patterson, MD, FIDSA. 
Additionally, new more-effective and better-tolerated antifungal medications, or versions of existing medications (e.g., extended release) have improved care, including isavuconazole and posaconazole. In some cases, combination therapy with voriconazole and an echinocandin is recommended for certain patients at highest risk. 
Because invasive aspergillosis is so deadly, the guidelines recommend some patients at highest risk be treated with antifungals to prevent infection, including those with neutropenia and graft versus host disease (GVHD). Another prevention strategy is the use of special filtration systems for hospitalized immunosuppressed patients. 
In addition to Dr. Patterson, the guidelines panel includes: George R. Thompson III, MD; David W. Denning, MD, FIDSA; Jay A. Fishman, MD, FIDSA; Susan Hadley, MD, FIDSA; Raoul Herbrecht, MD; Dimitrios P. Kontoyiannis, MD, FIDSA; Kieren A. Marr, MD, FIDSA; Vicki A. Morrison, MD; M. Hong Nguyen, MD; Brahm H. Segal, MD, FIDSA; William J. Steinbach, MD, FIDSA; David A. Stevens, MD, FIDSA; Thomas J. Walsh, MD, FIDSA; John R. Wingard, MD, FIDSA; Jo-Anne H. Young, MD; and John E. Bennett, MD, FIDSA.

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