Invasive aspergillosis: diagnosis, prophylaxis and treatment
Invasive aspergillosis: diagnosis, prophylaxis and treatment
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DOI：
10.1097/moh.0b013e328311890c
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发表时间：
2008-11-01
影响因子：
3.2
通讯作者：
Viscoli, Claudio
中科院分区：
文献类型：
--
作者：
Del Bono, Valerio;Mikulska, Malgorzata;Viscoli, Claudio
综述目的侵袭性曲霉病是造血干细胞移植受者发病和死亡的常见原因。由于其固有的高死亡率，早期诊断和治疗至关重要。本文就造血干细胞移植中侵袭性曲霉病的诊断、预防和治疗的最新研究进展作一综述。（其对于一线治疗具有众所周知的和巩固的作用）、联合治疗和预防方案，特别是与泊沙康唑。本文还将简要介绍诊断试验的临床作用，如半乳甘露聚糖在体液中的检测，而不是血液，β-D-葡聚糖在血清中和真菌DNA的Pi在体液中。SummaryGalactomannan抗原检测是一个相当可靠的诊断试验侵袭性曲霉病，特别是当使用较低的敏感性阈值。Pi还有待验证。脂质体阿替霉素B在31每天表现出类似的疗效侵袭性曲霉菌病报告伏立康唑。应尽可能对具有抗真菌活性的唑类药物进行治疗药物监测，以最大限度地发挥抗真菌作用并最大限度地减少毒性。泊沙康唑在预防方面表现出积极作用，但其在全球患者人群中的有效性仍存在争议。
Purpose of reviewInvasive aspergillosis is a common cause of morbidity and mortality in hematopoietic stem cells transplant recipients. Owing to its intrinsic high mortality rate,early diagnosis and treatment are critical. This review will therefore address the most important recent advances in diagnosing, preventing and treating invasive aspergillosis in hematopoietic stem cells transplant.Recent findingsThe present review will focus on therapeutic and prophylactic aspects, with particular regard to clinical use of drugs other than voriconazole (which has a well known and consolidated role for first-line therapy), combination therapy and prophylactic regimens, particularly with posaconazole. This review will also briefly deal with the clinical role of diagnostic tests such as the detection of galactomannan in body fluids other than blood, beta-D-glucan in serum and fungal DNA by Pi in body fluids.SummaryGalactomannan antigen detection is a rather reliable diagnostic test for invasive aspergillosis, particularly when a lower threshold of sensitivity is used. Pi is still to be validated. Liposomal amphotericin B at 3 1 per day showed a similar efficacy in invasive aspergillosis as reported for voriconazole. Therapeutic drug monitoring of Aspergillus-active azoles should be implemented whenever possible in order to maximize the antifungal effect and minimize toxicity. Posaconazole showed to be active in prophylaxis, though its effectiveness in the global patient population is still controversial.