Aspergillosis Library - Rapid Diagnostics and Antifungals
A collection of links to relevant and recent publications
A collection of links to relevant and recent publications
How to make a fast diagnosis in invasive aspergillosis.
Author: Lass-Flörl C.
Medical Mycology, Volume 57, Issue Supplement_2, April 2019, https://doi.org/10.1093/mmy/myy103
Apart from winning the prize for the most appropriate title, this article covers all aspects of diagnosing aspergillus infection from preanalytical issues to the therapeutic monitoring of antifungal agents.
Already a little behind as the article states Aspergillus LFA 'commercial availability still pending' and 'Limited data are currently available for isavuconazole' as Isavuconazole if now one of BMJs treatment of choice.
It finishes by reminding us that 'all fungal diagnosis reflects a so-called puzzle diagnosis'
Author: Lass-Flörl C.
Medical Mycology, Volume 57, Issue Supplement_2, April 2019, https://doi.org/10.1093/mmy/myy103
Apart from winning the prize for the most appropriate title, this article covers all aspects of diagnosing aspergillus infection from preanalytical issues to the therapeutic monitoring of antifungal agents.
Already a little behind as the article states Aspergillus LFA 'commercial availability still pending' and 'Limited data are currently available for isavuconazole' as Isavuconazole if now one of BMJs treatment of choice.
It finishes by reminding us that 'all fungal diagnosis reflects a so-called puzzle diagnosis'
Empiric vs Pre-emptive Antifungal Strategy in High-Risk Neutropenic Patients on Fluconazole Prophylaxis: A Randomized Trial of the European Organization for Research and Treatment of Cancer
Johan Maertens et al July 2022 Clinical Infectious Diseases, ciac623, https://doi.org/10.1093/cid/ciac623
''Empiric antifungal therapy is considered the standard of care for high-risk neutropenic patients with persistent fever. The impact of a preemptive, diagnostic-driven approach based on galactomannan screening and chest computed tomography scan on demand on survival and on the risk of invasive fungal disease (IFD) during the first weeks of high-risk neutropenia is unknown.''
Conclusions The preemptive antifungal strategy was safe for high-risk neutropenic patients given fluconazole as prophylaxis, halving the number of patients receiving antifungals without excess mortality or IFDs.
Johan Maertens et al July 2022 Clinical Infectious Diseases, ciac623, https://doi.org/10.1093/cid/ciac623
''Empiric antifungal therapy is considered the standard of care for high-risk neutropenic patients with persistent fever. The impact of a preemptive, diagnostic-driven approach based on galactomannan screening and chest computed tomography scan on demand on survival and on the risk of invasive fungal disease (IFD) during the first weeks of high-risk neutropenia is unknown.''
Conclusions The preemptive antifungal strategy was safe for high-risk neutropenic patients given fluconazole as prophylaxis, halving the number of patients receiving antifungals without excess mortality or IFDs.
Multicenter evaluation of a lateral-flow device test for diagnosing invasive pulmonary aspergillosis in ICU patients
Susanne Eigl 1 2015 DOI: 10.1186/s13054-015-0905-x
''Aspergillus lateral-flow tests of BAL showed promising results for IPA diagnosis in ICU patients. Furthermore, the LFD test can be performed easily and provides rapid results. Therefore, it may be a reliable alternative for IPA diagnosis in ICU patients if GM results are not rapidly available.'' This multi-national publication shows the use of lateral flow devices for diagnosing aspergillosis is well established.
Susanne Eigl 1 2015 DOI: 10.1186/s13054-015-0905-x
''Aspergillus lateral-flow tests of BAL showed promising results for IPA diagnosis in ICU patients. Furthermore, the LFD test can be performed easily and provides rapid results. Therefore, it may be a reliable alternative for IPA diagnosis in ICU patients if GM results are not rapidly available.'' This multi-national publication shows the use of lateral flow devices for diagnosing aspergillosis is well established.
Serum galactomannan levels in the diagnosis of invasive aspergillosis
Yildiz Okutular et al 2015 doi: 10.3904/kjim.2015.30.6.899
''More frequent GM monitoring than twice a week controls starting from the first positivity may ensure discontinuation of unnecessary therapies and reduce the side effects and increased costs associated with medication.''
Yildiz Okutular et al 2015 doi: 10.3904/kjim.2015.30.6.899
''More frequent GM monitoring than twice a week controls starting from the first positivity may ensure discontinuation of unnecessary therapies and reduce the side effects and increased costs associated with medication.''
Galactomannan, a Surrogate Marker for Outcome in Invasive Aspergillosis: Finally Coming of Age
Toine Mercier et al. 2018 https://doi.org/10.3389%2Ffmicb.2018.00661
''serum galactomannan at baseline and galactomannan kinetics appear to be good predictors of therapy response and survival. However, breakpoints for predicting therapy failure and validation in different patient populations are still lacking.''
Toine Mercier et al. 2018 https://doi.org/10.3389%2Ffmicb.2018.00661
''serum galactomannan at baseline and galactomannan kinetics appear to be good predictors of therapy response and survival. However, breakpoints for predicting therapy failure and validation in different patient populations are still lacking.''
COVID-19-Associated Invasive Aspergillosis: Data from the UK National Mycology Reference Laboratory
Andrew M. Borman et al 2021 https://journals.asm.org/doi/pdf/10.1128/JCM.02136-20
''Overall, our results highlight the challenges in biomarker-driven diagnosis of CAPA, especially when only limited clinical samples are available for testing, and the importance of a multimodal diagnostic approach involving regular and repeat testing of both serum and respiratory samples.''
Andrew M. Borman et al 2021 https://journals.asm.org/doi/pdf/10.1128/JCM.02136-20
''Overall, our results highlight the challenges in biomarker-driven diagnosis of CAPA, especially when only limited clinical samples are available for testing, and the importance of a multimodal diagnostic approach involving regular and repeat testing of both serum and respiratory samples.''
A multisite evaluation of antifungal use in critical care: implications for antifungal stewardship
JAC-Antimicrobial Resistance, June 2022, dlac055, https://doi.org/10.1093/jacamr/dlac055
'Achieving a better balance between promptly treating IFI patients and avoiding inappropriate antifungal prescribing in the ICU requires timely post-prescription review by specialist multidisciplinary teams and improved, evidence-based-risk prescribing strategies incorporating rapid diagnostics to guide AFT start and stop decisions.'
JAC-Antimicrobial Resistance, June 2022, dlac055, https://doi.org/10.1093/jacamr/dlac055
'Achieving a better balance between promptly treating IFI patients and avoiding inappropriate antifungal prescribing in the ICU requires timely post-prescription review by specialist multidisciplinary teams and improved, evidence-based-risk prescribing strategies incorporating rapid diagnostics to guide AFT start and stop decisions.'
BMJ Best Practice Aspergillosis - Antifungal Treatment
December 2022
BMJ Best Practice has Isavuconazole as 1 of 2 antifungal agents of choice for Aspergillosis. Isavuconazole is well tolerated compared with Voriconazole which is the other agent of choice. Isavuconazole can be switched from intravenous to oral administration without losing bioavailability and renal impairment is not aggravated.
December 2022
BMJ Best Practice has Isavuconazole as 1 of 2 antifungal agents of choice for Aspergillosis. Isavuconazole is well tolerated compared with Voriconazole which is the other agent of choice. Isavuconazole can be switched from intravenous to oral administration without losing bioavailability and renal impairment is not aggravated.
Experience of Isavuconazole as a Salvage Therapy in Chronic Pulmonary Fungal Disease
Lisa Nwankwo Guys & St thomas' Trust.et al m 2022 doi: 10.3390/jof8040362
Isavuconazole is proving to be an important new addition to the repertoire of available antifungals, showing good bioavailability and tolerability compared to other triazoles used with chronic pulmonary fungal infections.
Lisa Nwankwo Guys & St thomas' Trust.et al m 2022 doi: 10.3390/jof8040362
Isavuconazole is proving to be an important new addition to the repertoire of available antifungals, showing good bioavailability and tolerability compared to other triazoles used with chronic pulmonary fungal infections.
New Perspectives on Antimicrobial Agents: Isavuconazole
Antimicrobial Chemotherapy Perspective August 2022 DOI: https://doi.org/10.1128/aac.00177-22
'Significant advantages of isavuconazole, primarily over voriconazole but in some circumstances posaconazole as well, make it an appealing option for the management of complex patients with invasive fungal infections. These potential advantages include lack of QTc interval prolongation, more predictable pharmacokinetics, a less complicated drug interaction profile, and improved tolerability, particularly when compared to voriconazole.'
Antimicrobial Chemotherapy Perspective August 2022 DOI: https://doi.org/10.1128/aac.00177-22
'Significant advantages of isavuconazole, primarily over voriconazole but in some circumstances posaconazole as well, make it an appealing option for the management of complex patients with invasive fungal infections. These potential advantages include lack of QTc interval prolongation, more predictable pharmacokinetics, a less complicated drug interaction profile, and improved tolerability, particularly when compared to voriconazole.'
EUCAST. Isavuconazole vs. Aspergillus v 2.0 (2020)
EUCAST Rationale for Isavuconazole states routine susceptibility testing is of utmost importance because acquired resistance to triazoles has been reported among A. fumigatus isolates. Results also support the use of Isavuconazole for the primary treatment of patients with invasive mould disease.
Isavuconazole is a triazole antifungal agent with broad-spectrum in vitro activity against Aspergillus spp. and other medically important fungal pathogens. It is available for iv and oral administration as a water soluble prodrug (isavuconazonium sulphate).
It is approved for the following indications in adults • invasive aspergillosis • mucormycosis in patients for whom amphotericin B is inappropriate.
EUCAST Rationale for Isavuconazole states routine susceptibility testing is of utmost importance because acquired resistance to triazoles has been reported among A. fumigatus isolates. Results also support the use of Isavuconazole for the primary treatment of patients with invasive mould disease.
Isavuconazole is a triazole antifungal agent with broad-spectrum in vitro activity against Aspergillus spp. and other medically important fungal pathogens. It is available for iv and oral administration as a water soluble prodrug (isavuconazonium sulphate).
It is approved for the following indications in adults • invasive aspergillosis • mucormycosis in patients for whom amphotericin B is inappropriate.
