Primary prevention

Allogeneic stem cell recipients who develop graft-versus-host disease should receive antifungal prophylaxis with oral posaconazole.[2]

Patients undergoing induction chemotherapy for acute myelogenous leukaemia or myelodysplastic syndrome have a reduced risk for invasive aspergillosis (IA) and decreased mortality with oral posaconazole prophylaxis.[2][60][61] There are no data to support the use of isavuconazole for prophylaxis.[16]

In patients with chronic granulomatous disease, results from a randomised study showed that itraconazole prophylaxis in addition to the routine prophylaxis with interferon-gamma is safe and effective in preventing IA.[62] Benefit from chemoprophylaxis has not been shown in other high-risk populations.

For high-risk patients, rooms fitted with high-efficiency particulate air filters, frequent air exchanges, and positive-pressure ventilation may be useful in limiting exposure to Aspergillus conidia in the hospital setting.[63][64] In addition, attention to cleaning of showers and water systems may further reduce exposure.[65]

No preventive measures are recommended for chronic pulmonary aspergillosis/aspergilloma. The role of antifungal prophylaxis is uncertain.

Secondary prevention

Consider secondary prophylaxis with antifungal therapy in patients with prior invasive aspergillosis (IA) if they require subsequent immunosuppression, to prevent recurrence.[2]

Aspergillosis does not spread from one person to another. No public health reporting is required. No prophylactic/preventive measures are warranted for household contacts, partners, or society.

The patient at high risk for IA must be advised to avoid contact with soil (e.g., during gardening), since the conidia/spores from soil can become airborne and be inhaled.

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