title: Our 2015 approach to invasive pulmonary aspergillosis.
abstract: At the University Hospital of Cologne, in general two patient groups at high risk for invasive aspergillosis receive posaconazole prophylaxis: Acute myelogenous leukaemia patients during remission induction chemotherapy and allogeneic haematopoietic stem cell transplant recipients. Other patients at risk undergo serum galactomannan testing three times weekly. At 72-96 h of persisting fever despite broad-spectrum antibiotics, or at onset of lower respiratory tract symptoms a thoracic computed tomography (CT) scan is performed. Without lung infiltrates on CT, IPA is ruled out. In lung infiltrates not suggestive for IPA mycological confirmation is pursued. In patients without posaconazole prophylaxis empiric caspofungin will be considered. CT findings typical for IPA prompt targeted treatment, and mycological confirmation. Bronchoalveolar lavage (BAL) is most important for cultural identification and susceptibility testing, and facilitates diagnosing other pathogens. BAL performance is virtually independent of platelet counts. If despite suggestive infiltrates BAL does not yield the diagnosis, CT-guided biopsy follows as soon as platelet counts allow. Surgery can also be beneficial in diagnosis and treatment of IPA. If the diagnosis of IPA is not established, mucormycosis is a valid concern. In patients with breakthrough IPA during posaconazole prophylaxis liposomal amphotericin B is the drug of choice. If no posaconazole prophylaxis was given, voriconazole is the treatment of choice for IPA.
authors: Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|Center for Integrated Oncology CIO KölnBonn, University of Cologne, Cologne, Germany.
authors: B
authors: B
authors: Liss
authors: Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|Center for Integrated Oncology CIO KölnBonn, University of Cologne, Cologne, Germany.|German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.
authors: J J
authors: JJ
authors: Vehreschild
authors: Department of Radiology, University Hospital of Cologne, Cologne, Germany.
authors: C
authors: C
authors: Bangard
authors: Department of Radiology, University Hospital of Cologne, Cologne, Germany.
authors: D
authors: D
authors: Maintz
authors: Department III of Internal Medicine, Heart Centre of the University of Cologne, Cologne, Germany.
authors: K
authors: K
authors: Frank
authors: Department III of Internal Medicine, Heart Centre of the University of Cologne, Cologne, Germany.
authors: S
authors: S
authors: Grönke
authors: Department III of Internal Medicine, Heart Centre of the University of Cologne, Cologne, Germany.
authors: G
authors: G
authors: Michels
authors: Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany.
authors: A
authors: A
authors: Hamprecht
authors: Institute for Medical Microbiology, Immunology and Hygiene, University Hospital of Cologne, Cologne, Germany.
authors: H
authors: H
authors: Wisplinghoff
authors: Institute of Pathology, University Hospital of Cologne, Cologne, Germany.
authors: B
authors: B
authors: Markiefka
authors: Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
authors: K
authors: K
authors: Hekmat
authors: Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|Center for Integrated Oncology CIO KölnBonn, University of Cologne, Cologne, Germany.|German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.
authors: M J G T
authors: MJ
authors: Vehreschild
authors: Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.|Center for Integrated Oncology CIO KölnBonn, University of Cologne, Cologne, Germany.|German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.|Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.|Clinical Trials Centre Cologne, ZKS Köln, University of Cologne, Cologne, Germany.
authors: O A
authors: OA
authors: Cornely
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage*; D001230:Aspergillus / Q000302:isolation & purification; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D018890:Chemoprevention / Q000379:methods*; D005335:Fever of Unknown Origin / Q000175:diagnosis; D005602:France; D005690:Galactose / Q000031:analogs & derivatives; D006785:Hospitals, University; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control*; D008351:Mannans / Q000032:analysis*; D008826:Microbial Sensitivity Tests; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000008:administration & dosage*
chemical_list: D000935:Antifungal Agents; D008351:Mannans; D014230:Triazoles; C012990:galactomannan; C101425:posaconazole; D005690:Galactose
keywords: Aspergillosis; caspofungin; liposomal amphotericin B; mould pneumonia; neutropaenia; voriconazole