The Infectious Diseases Society of America (IDSA) announced the release of updated guidelines on the diagnosis and treatment of allergic, chronic, and invasive aspergillosis. The full guidelines are published in Clinical Infectious Diseases

The guidelines emphasize that though new treatments are improving care, early diagnosis is still critical for effective treatment of invasive aspergillosis. Invasive aspergillosis is known to kill 40–80% of those with widespread infection. Patients at highest risk for infection are those with suppressed immune systems, such as those with stem cell, lung, or other organ transplants. Patients with severe influenza, taking long-term steroids, or those in the intensive care unit are also at risk of infection. 

As an update from the 2008 guidelines, the new guidelines focus on the increased evidence for antifungal treatment recommendations and diagnostic tests. Improved diagnostic tools include blood tests, cultures, and computed tomography (CT) imaging. Physicians are recommended to be aggressive in diagnosing patients suspected of having the infection because it can be deadly. 

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The availability of new antifungal medications with better tolerability and higher efficacy, or versions of existing medications have also shown to enhance care; these agents include isavuconazole and posaconazole. For some patients at the highest risk, voriconazole combined with an echinocandin is recommended. 

The guidelines also recommend some high risk patients to be treated with antifungal medications as prophylaxis, including those with neutropenia and graft versus host disease (GVHD). Special filtration systems for immunosuppressed patients in hospitals are also listed as another prevention strategy. 

The expert panel stated that gaps in knowledge still remain, including “the optimal utility of combination therapy, tools for early detection of these infections, evaluation of response, therapy for patients with breakthrough or refractory infection, and the population of patients for whom prophylaxis would be most beneficial.”

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