Treatment of Invasive Aspergillosis: Relation of Early Diagnosis and Treatment to Response

TLDR

Aspergillus infections in cancer patients are hard to diagnose, often only identified at necropsy, and earlier therapy has been suggested to improve outcomes. The study reviewed 17 consecutive aspergillosis patients to assess whether earlier diagnosis and prompt amphotericin B treatment improve outcomes. Patients had hematologic malignancies with marked granulocytopenia, and six were diagnosed and treated within 96 hours of infiltrate appearance. Among the six early‑treated patients, three achieved complete resolution and three had partial responses, whereas all 11 patients who received delayed or no therapy for at least two weeks experienced progressive disease.

Abstract

Aspergillus infections in patients with cancer are difficult to diagnose, and such diagnoses are frequently made at necropsy. Earlier therapy has been proposed to provide better response. We reviewed 17 consecutive patients with documented aspergillosis to determine the impact of earlier diagnosis and prompt treatment with amphotericin B. Sixteen had hematologic malignancies, and all had marked granulocytopenia. Six were diagnosed and treated within 96 h of the appearance of infiltrates. Three of these six had complete resolution of all signs and symptoms of aspergillus infection. The other three had a partial response to therapy despite continued granulocytopenia. All 11 patients in whom antifungal therapy was either delayed (six) or not given (five) for at least 2 weeks after the infiltrate was present diet with progressive aspergillosis aggressive diagnostic methods to establish the diagnosis of aspergillosis are warranted so that antifungal therapy can be started early, which may then be successful in resolving these potentially fatal infections.