Approach to managing invasive pulmonary aspergillosis
Invasive pulmonary aspergillosis usually occurs in patients with prolonged severe neutropenia, solid organ transplant recipients and haematopoietic stem cell transplant recipients. Rarely, this infection can occur in patients without immune compromise following severe influenza (influenza-associated pulmonary aspergillosis).
If a patient without a history of immune compromise develops invasive pulmonary aspergillosis, consider testing for immune system disorders.
Invasive pulmonary aspergillosis can be associated with severe immunosuppression due to HIV infection and is an indicator condition for HIV testing1. If invasive pulmonary aspergillosis is identified, offer HIV testing, regardless of whether the patient has behavioural or epidemiological risk factors for HIV infection.
Invasive pulmonary aspergillosis usually progresses rapidly – seek expert advice for management. Systemic antifungal treatment should be administered promptly. The treatment recommendations included in this topic are not appropriate for aspergillosis with central nervous system (CNS) involvement – seek expert advice on diagnostic imaging and management.
Many factors influence drug choice for invasive pulmonary aspergillosis without CNS involvement, including:
- whether the patient developed invasive pulmonary aspergillosis while being treated with antifungal prophylaxis
- anticipated drug interactions with antifungal therapy
- kidney and liver function
- cost of treatment
- susceptibility results, if available.
Systemic antifungal therapy for invasive pulmonary aspergillosis without CNS involvement is included for: