From the Guidelines
Invasive aspergillosis in a relatively healthy patient is most likely to occur in individuals with underlying risk factors such as immunosuppression, neutropenia, or those undergoing intensive chemotherapy for acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) 1.
Risk Factors
The most common risk factors for invasive aspergillosis include:
- Immunosuppression from conditions like neutropenia, prolonged corticosteroid use, solid organ or stem cell transplantation, advanced HIV infection, or hematologic malignancies
- Chronic lung diseases such as COPD, asthma, or prior tuberculosis
- Recent influenza or COVID-19 infection
- Diabetes mellitus
- Liver cirrhosis
- Genetic defects in immune function
- Environmental exposures to high concentrations of Aspergillus spores during construction, renovation, or gardening activities
- Certain medications like TNF-alpha inhibitors, JAK inhibitors, or other biologic therapies
Evaluation and Prevention
A thorough evaluation should include:
- Complete blood count
- HIV testing
- Hemoglobin A1c
- Liver function tests
- Chest imaging
- Possibly genetic testing for immune defects Prophylaxis against invasive Aspergillus infections with posaconazole should be considered for selected patients >13 years of age who are undergoing intensive chemotherapy for AML or MDS in whom the risk of invasive aspergillosis without prophylaxis is substantial 1. Early identification of these risk factors is crucial for optimizing treatment and preventing future infections.
From the Research
Risk Factors for Invasive Aspergillosis
- Invasive aspergillosis is rare in immunocompetent patients, but it can occur even in relatively healthy individuals 2
- Traditional risk factors include immunosuppressive therapies, neutropenia, and hematological malignancies 3, 4
- Newer risk factors have emerged, such as the use of biological agents that target the immune system and postinfluenza infection, including COVID-19 infection 5
- Environmental factors, such as hospital construction, can also contribute to the risk of invasive aspergillosis 4
Patient Characteristics
- Invasive aspergillosis can affect various parts of the body, including the lungs, heart, and brain 2
- The disease can be severe and life-threatening, with a mortality rate of up to 50% or more 3, 4
- Timely diagnosis and effective long-term antifungal treatment are crucial for managing invasive aspergillosis 2
Diagnostic and Treatment Challenges
- Diagnosis of invasive aspergillosis remains a challenge, but non-culture-based methods are available 4, 5
- Antifungal resistance has emerged, and combination therapy may be used in severe cases or extensive infections 5
- Voriconazole is a commonly used treatment for invasive aspergillosis, but other options like isavuconazole and posaconazole are also available 5