Genovefa A. Papanicolaou, MD

ABSTRACT: In general, the management of invasive pulmonaryaspergillosis is based on antifungal therapy and reversal of immunosuppression.Voriconazole is the preferred treatment inmost cases. Liposomal preparations of amphotericin B, caspofungin,and posaconazole are alternatives in patients whocannot tolerate voriconazole or have refractory aspergillosis.Prophylaxis in high-risk patients has gained popularity withthe availability of oral extended-spectrum azoles; posaconazoleis approved for prophylaxis in patients with acute leukemia,myelodysplastic syndrome, and graft versus host disease.(J Respir Dis. 2008;29(11):429-434)

ABSTRACT: The diagnosis of invasive pulmonary aspergillosis remainschallenging because of atypical clinical presentations,comorbid diseases, and the difficulty in culturing Aspergillus bystandard microbiological techniques. Serial monitoring withCT scans of the chest and serological markers can help withearly identification in high-risk patients, such as hematopoieticstem cell transplant recipients. The most common radiographicfindings are single or multiple nodules, wedge-shapedpleural-based infiltrates, and cavities. The halo sign is the mostsuggestive clue to aspergillosis and is manifested by a macronodulesurrounded by a perimeter of ground-glass opacity.(J Respir Dis. 2008;29(10):405-410)