From the Guidelines
Aspergillus is not something you "catch" in the traditional sense, as it's a fungus naturally present in our environment, and the most effective way to prevent infection is by reducing exposure in high-risk individuals through measures like avoiding construction areas, using HEPA filters, and wearing N95 masks when necessary, as recommended by the Infectious Diseases Society of America in their 2016 guidelines 1.
Key Points to Consider
- Aspergillus species are ubiquitous in the environment, and people are exposed to their spores daily through the air, particularly in soil, decaying vegetation, and dust 1.
- Most healthy individuals don't develop illness when exposed to these spores because their immune systems effectively clear them.
- Aspergillus infections (aspergillosis) typically occur in people with weakened immune systems, pre-existing lung conditions, or after prolonged exposure to high concentrations of spores.
- The most common forms of aspergillosis include allergic bronchopulmonary aspergillosis, aspergilloma (fungal ball), and invasive aspergillosis.
- Prevention focuses on reducing exposure in high-risk individuals, and there's no person-to-person transmission of Aspergillus infections, so you don't "catch" it from others like you would a cold or flu.
Recommendations for Prevention
- Avoiding construction areas and using HEPA filters can reduce exposure to Aspergillus spores 1.
- Wearing N95 masks when necessary can also help prevent infection 1.
- The Infectious Diseases Society of America recommends voriconazole as the primary treatment for invasive aspergillosis in most patients 1.
Important Considerations
- Aspergillus infections can be life-threatening in immunocompromised patients, and prompt treatment is essential to improve outcomes 1.
- Regular surveillance and documentation of invasive mold infections can help identify potential outbreaks and guide prevention efforts 1.
From the Research
Catching Aspergillus
- Aspergillus spores are ubiquitous in the environment and may become concentrated in hospital ventilation systems 2
- Colonization in normal hosts can lead to allergic diseases ranging from asthma to allergic bronchopulmonary aspergillosis 2
- Normal hosts rarely develop invasive disease, which is primarily an infection of severely immunocompromised patients 2
- The major predisposing factors for infection include prolonged neutropenia, chronic administration of adrenal corticosteroids, the insertion of prosthetic devices, and tissue damage due to prior infection or trauma 2
Diagnosis and Treatment
- The diagnosis of pulmonary infection is usually difficult to establish because the organism is seldom cultured from sputum and can represent contamination in some cases 2
- Therapy in immunocompromised hosts is less than satisfactory and amphotericin B is the only agent with significant activity 2
- Voriconazole is a broad-spectrum triazole that is active against aspergillus species and has been shown to be effective in the treatment of invasive aspergillosis 3, 4
- Voriconazole has been shown to be superior to amphotericin B in the treatment of invasive aspergillosis after heart transplantation 3
- Voriconazole-treated patients had significantly fewer severe drug-related adverse events, but transient visual disturbances were common with voriconazole 4
Prevention and Management
- Patients at high risk of developing aspergillosis (e.g. those with granulocytopenia) should be treated on the basis of clinical or radiological criteria alone if microbiological or histological diagnosis would significantly delay treatment 5
- Restoration of host immune defences by tapering of immunosuppressive therapy in transplant patients or correction of granulocytopenia in haematological disease is the cornerstone of modern treatment of aspergillosis in immunocompromised patients 5
- For patients cured with amphotericin B, secondary prophylaxis is needed at the end of the intravenous therapy, with options including amphotericin B by aerosol or itraconazole 5