Invasive pulmonary aspergillosis: Therapeutic and prophylactic strategies

Invasive aspergillosis is a common cause of infectious disease related to morbidity and mortality in immunocompromised patients, with the lungs serving as a primary point of entry and site of infection for invasive infections caused by Aspergillus species. Over the last few decades the incidence of invasive aspergillosis has increased. While our antifungal armamentarium has also increased with newer agents having broader spectrums of in vitro activity and improved safety profiles compared to older antifungal drugs, response rates in the treatment of invasive aspergillosis remain suboptimal. Because of poor outcomes associated with the treatment of invasive mycoses in immunocompromised patients, antifungal prophylaxis in populations at high risk for these infections has gained increased interest. However, this strategy is often limited by toxicities and adverse effects associated with systemic exposure. To overcome these limitations many investigators have begun to study the use of aerosolized antifungal agents as prophylaxis with the goal of achieving high localized concentrations at the primary site of infection.