Author:

Morrissey CO, Slavin MA.

Date: 16 February 2007

Abstract:

Invasive Aspergillosis (IA) is now the leading infectious cause of mortality in patients with haematological malignancies. Studies have identified those patient groups and the time-periods associated with high-risk for IA. The current management strategies for IA include prophylaxis and empiric antifungal therapy (EAFT). The rationale for prophylaxis in high-risk patients exists. However toxicities, drug interactions and breakthrough infections limit the benefits and the optimal duration for prophylaxis remains unknown. In recent EAFT studies in high-risk patients, <10% of persistent febrile neutropenic episodes were due to IA, suggesting that a disproportionate number of patients are treated with EAFT resulting in unnecessary drug-related costs. An increasing proportion of IA occurs in the absence of fevers and neutropenia, thus use of febrile neutropenia as the trigger to administer antifungal therapy will fail a significant proportion of patients. Recent research efforts have focused on the development of sensitive, specific and rapid diagnostic tests for IA, such as Aspergillus polymerase chain reaction (PCR) and antigen testing, which may be of value in guiding pre-emptive treatment strategies. However, studies evaluating the impact of pre-emptive therapy on patient outcomes and health-care costs have yet to be completed. Practical issues such as the combination of tests used and frequency of testing need to be resolved.

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