Medicine
A patient with acute leukemia recently underwent allogenic bone marrow transplantation.
After 2 weeks, she was neutropenic and developed a fever and cough. She was diagnosed with invasive aspergillosis based on radiological and microbiological assessment. Which of the following is the most appropriate treatment?
Explanation
Core Concept: Invasive aspergillosis is a severe opportunistic fungal infection that predominantly affects profoundly immunocompromised patients, such as those with prolonged neutropenia post-hematopoietic stem cell transplant.
Clinical Presentation:
- Fever, pleuritic chest pain, hemoptysis, and cough
- Chest CT showing the 'halo sign' (nodules surrounded by ground-glass opacity) or cavitation
Diagnosis:
- First-line diagnostic plan: High-resolution chest CT, serum galactomannan assay, and BAL fluid analysis
- Gold standard: Histopathological demonstration of tissue invasion by septate hyphae branching at acute angles, or positive fungal culture
Management:
- Acute management: Prompt initiation of targeted antifungal therapy
- Gold standard long-term management: Voriconazole is the first-line gold standard treatment for invasive aspergillosis. Alternatives include isavuconazole or liposomal amphotericin B. Therapy is continued until immune reconstitution.