HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Permissions Request Permissions Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Reichenberger, F. Articles by Tamm, M. Search for Related Content PubMed PubMed Citation Articles by Reichenberger, F. Articles by Tamm, M.

Diagnosis and treatment of invasive pulmonary aspergillosis in neutropenic patients

¹ Division of Pneumology, Dept of Internal Medicine, University Hospital Leipzig, Germany, ² Dept of Cardio-thoracic Surgery, and ³ Division of Haematology and ⁴ Division of Pneumology, Dept of Internal Medicine, University Hospital Basel, Switzerland

CORRESPONDENCE: F. Reichenberger, Division of Pneumology, Dept of Internal Medicine, University Hospital Leipzig, Johannisallee 32, 04103, Leipzig, Germany. Fax: 49 3419712629. E-mail: reichenf@hotmail.com

Keywords: antifungal therapy, diagnosis, invasive pulmonary aspergillosis, neutropenia, surgery, treatment

Received: July 27, 2001
Accepted September 17, 2001

Abstract

Invasive pulmonary aspergillosis is a major cause of morbidity and mortality in neutropenic patients.

Microbiological and serological tests are of limited value. The diagnosis should be considered in neutropenic patients with fever not responding to antibiotics, and typical findings on thoracic computed tomography scan. Whenever possible, diagnosis should be confirmed by tissue examination. Newer techniques, such as polymerase chain reaction may change the current diagnostic approach.

Therapeutic strategies consist of prophylaxis in risk groups and the early application of antifungal agents in suspected or probable disease. Amphotericin B as desoxycholate or lipid formulation is the current standard medication in invasive infection, although it has major side effects. Its role is challenged by the new azole derivates, such as itraconazole and voriconazole, and the new echinocandins. Additional therapies with cytokines, such as granulocyte macrophage colony stimulating factor and interferon-, and with granulocyte transfusions are under evaluation. In selected cases lung resection is of proven diagnostic and therapeutic value.

This paper analyses the current understanding of the pathogenesis and epidemiology of invasive aspergillosis and reviews the actual diagnostic and therapeutic strategies for invasive pulmonary aspergillosis in neutropenic patients.