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Consensus guidelines for the diagnosis and management of invasive aspergillosis, 2021.
Douglas, Abby P; Smibert, Olivia C; Bajel, Ashish; Halliday, Catriona L; Lavee, Orly; McMullan, Brendan; Yong, Michelle K; van Hal, Sebastiaan J; Chen, Sharon C-A.
  • Douglas AP; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
  • Smibert OC; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
  • Bajel A; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
  • Halliday CL; Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.
  • Lavee O; Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
  • McMullan B; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
  • Yong MK; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
  • van Hal SJ; Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.
  • Chen SC; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J ; 51 Suppl 7: 143-176, 2021 11.
Article in English | MEDLINE | ID: covidwho-1961593
ABSTRACT
Invasive aspergillosis (IA) in haematology/oncology patients presents as primary infection or breakthrough infection, which can become refractory to antifungal treatment and has a high associated mortality. Other emerging patient risk groups include patients in the intensive care setting with severe respiratory viral infections, including COVID-19. These guidelines present key diagnostic and treatment recommendations in light of advances in knowledge since the previous guidelines in 2014. Culture and histological-based methods remain central to the diagnosis of IA. There is increasing evidence for the utility of non-culture methods employing fungal biomarkers in pre-emptive screening for infection, as well as for IA diagnosis when used in combination. Although azole resistance appears to be uncommon in Australia, susceptibility testing of clinical Aspergillus fumigatus complex isolates is recommended. Voriconazole remains the preferred first-line antifungal agent for treating primary IA, including for extrapulmonary disease. Recommendations for paediatric treatment broadly follow those for adults. For breakthrough and refractory IA, a change in class of antifungal agent is strongly recommended, and agents under clinical trial may need to be considered. Newer immunological-based imaging modalities warrant further study, while surveillance for IA and antifungal resistance remain essential to informing the relevance of current treatment recommendations.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Aspergillosis / COVID-19 Type of study: Diagnostic study / Experimental Studies / Prognostic study / Randomized controlled trials Limits: Adult / Child / Humans Language: English Journal: Intern Med J Journal subject: Internal Medicine Year: 2021 Document Type: Article Affiliation country: Imj.15591

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Aspergillosis / COVID-19 Type of study: Diagnostic study / Experimental Studies / Prognostic study / Randomized controlled trials Limits: Adult / Child / Humans Language: English Journal: Intern Med J Journal subject: Internal Medicine Year: 2021 Document Type: Article Affiliation country: Imj.15591