Treatment of Primary Pulmonary Aspergillosis: An Assessment of the Evidence

Abstract

Aspergillus spp. are a group of filamentous molds that were first described due to a perceived similarity to an aspergillum, or liturgical device used to sprinkle holy water, when viewed under a microscope. Although commonly inhaled due to their ubiquitous nature within the environment, an invasive fungal infection (IFI) is a rare outcome that is often reserved for those patients who are immunocompromised. Given the potential for significant morbidity and mortality within this patient population from IFI due to Aspergillus spp., along with the rise in the use of therapies that confer immunosuppression, there is an increasing need for appropriate initial clinical suspicion leading to accurate diagnosis and effective treatment. Voriconazole remains the first line agent for therapy; however, the use of polyenes, novel triazole agents, or voriconazole in combination with an echinocandin may also be utilized. Consideration as to which particular agent and for what duration should be made in the individual context for each patient based upon underlying immunosuppression, comorbidities, and overall tolerance of therapy.

Effective Inhibition of Invasive Pulmonary Aspergillosis by Silver Nanoparticles Biosynthesized with Artemisia sieberi Leaf Extract

“…Higher rates of nephrotoxicity and hypokalemia were seen. Therefore, there appears to be no benefit, and significant harm, with a higher AMB dosing strategy in the treatment of invasive aspergillosis [ 62 ]. Furthermore, AMB therapy has major side effects, such as fever and shivering.…”

Coccidioidomycosis: A Review

“…The originally reported toxicity of ‘flashing lights’ based on the drug’s ability to activate retinal cells has been found to be of limited significance. 44 The originally noted side effects did not include photodermatitis. This has proven to be a major concern.…”

Aspergillus Section Terrei and Antifungals: From Broth to Agar-Based Susceptibility Testing Methods

“…Voriconazole remains the preferred agent for the treatment of aspergillosis, including A. terreus [ 16 ]. Alternative therapeutic options include isavuconazole, voriconazole plus an echinocandin, and liposomal AmB (L-AmB) [ 17 ]. As azole-resistance rates in A. terreus have been rising, other alternative therapeutic agents are being considered for investigation in the present study, including isavuconazole, another broad-spectrum azole, and conventional AmB and L-AmB, with less toxicity [ 14 , 17 , 18 ].…”