Recent developments in the diagnosis and treatment of invasive aspergillosis

Invasive aspergillosis is a major cause of morbidity and mortality in immunosuppressed patients. Consideration of the epidemiology of infection and host risk factors may be useful in targeting patients with a likely diagnosis for this infection. Clinical presentation is still a factor used to establish the diagnosis, including pleuritic chest pain or hemoptysis, which result from angioinvasion by fungal organisms. Positive Aspergillus respiratory cultures in high-risk patients may be associated with infection. Chest computed tomographic scans may demonstrate lesions that are not visible on plain radiographs. A rapid diagnosis may also be established with detection of Aspergillus antigen in serum and other body fluids. Amphotericin B remains the standard therapy for invasive aspergillosis, but it is toxic and may not be successful in severely immunosuppressed patients. Newer azoles, lipid antifungal preparations, and new classes of antifungal agents, such as the echinocandins, are active against Aspergillus spp. Lipid formulations of amphotericin B offer the advantage of reduced toxicity, but the optimal dosage and/or use of these compounds is not known. The newer azoles, such as voriconazole, offer the potential advantage of fungicidal activity against Aspergillus as well as both intravenous and oral formulations. Prompt recognition along with intensive antifungal therapy and immune recovery are needed for successful therapy of patients with invasive aspergillosis.