Challenges and Solution of Invasive Aspergillosis in Non-neutropenic Patients: A Review

Abstract

Invasive aspergillosis (IA) is a serious opportunistic infection, which has increasingly been recognized as an emerging disease of non-neutropenic patients. In this group of patients, the diagnosis of IA can be challenging owing to the lack of specificity of symptoms, the difficulty in discriminating colonization from infection, and the lower sensitivity of microbiological and radiological tests compared with immunocompromised patients. The aim of this article is to present to clinicians a critical review on the management of IA in non-neutropenic patients.

Point‐of‐care diagnosis of invasive aspergillosis in non‐neutropenic patients: Aspergillus Galactomannan Lateral Flow Assay versus Aspergillus‐specific Lateral Flow Device test in bronchoalveolar lavage

“…In patients with traditional risk factors for IPA, such as those with haematological malignancies and prolonged neutropaenia, the use of mould‐active prophylaxis has been associated with a decrease in the prevalence of IPA . Conversely, the prevalence of IPA continues to increase in non‐neutropenic patients with other severe underlying diseases, including patients in the intensive care unit (ICU) where prevalence rates vary between 0.33% and 19%, solid organ transplant (SOT) recipients, patients receiving systemic glucocorticoids, patients with underlying respiratory conditions, patients with solid cancers and other patient groups . Given this increase and the importance of early treatment to improve survival, there is an unmet need for better tests for early diagnosis IPA in non‐neutropenic patients, including those critically ill in the ICU.…”

Fatal case of cerebral aspergilloma complicated by ventriculitis and bacteremia due to Salmonella species in a sickle cell disease patient

“…Combination therapy with voriconazole and caspofungin in treatment of CNS aspergillosis is promosing. 10 However, we believe that, the severity of infection, coinfection with Salmonella ventriculitis and sepsis contribute to the poor outcome in this patient.…”

“…Voriconazole, isavuconazole and amphotericin B are the antifungal agents used for the first-line treatment of IA. 9 , 10 Caspofungin have been shown to exert in vitro and in vivo activity against Aspergillus spp and is approved for the treatment of IA in patients who are intolerant to first-line therapy. 9 Our patient was treated with voriconazole and caspofungin.…”

Blood Aspergillus PCR: The Good, the Bad, and the Ugly

“…The limited utility of PCR from blood specimens in non-neutropenic patients is a very relevant limitation given that the prevalence of IA continues to increase in non-neutropenic patients with other severe underlying diseases. This includes patients in the ICU where prevalence rates vary between 0.33%-19% [66][67][68][69], solid organ transplant recipients [70], patients receiving systemic glucocorticoids [71], patients with underlying respiratory conditions [66,72], patients with solid cancers [66,73], and other patient groups [66,74].…”