Prognosis

Successful outcome of invasive aspergillosis (IA) depends upon:

  • Early diagnosis and consequent early initiation of antifungal therapy

  • Restoration of underlying immunological deficiency.

With the availability of tools for early diagnosis (e.g., high-resolution computed tomography scan, fungal biomarkers), the outlook has considerably improved. In addition, antifungal drugs such as voriconazole are more effective and better tolerated than amphotericin B.[2]

Establishing early diagnosis and initiating treatment are also key to improving prognosis of chronic pulmonary aspergillosis (CPA).[127]

Risk of death

The following factors have been reported to increase the risk of death from IA:

  • After haematopoietic stem cell transplantation: graft-versus-host disease; neutropenia; cytomegalovirus seropositivity; prolonged use of corticosteroids; prolonged immunosuppression; disseminated IA; presence of pleural effusion and monocyte count <120 cells/mm³

  • After heart, lung, liver, and kidney transplantation: hyperimmunosuppression; renal failure; stormy postoperative course; recurrent bacterial infection; old age.[1]

In one cohort study of patients with CPA, survival at 1, 5, and 10 years was 86%, 62%, and 47%, respectively.[127] The following factors were reported to increase the risk of death:

  • Non-tuberculous mycobacterial infection, COPD, pleural involvement, cavitary disease, presence of an aspergilloma, shortness of breath, low physical activity, and low body mass.

In patients with aspergilloma, untreated severe haemoptysis is frequently fatal.

Recurrence

After successful treatment of invasive aspergillosis, Aspergillus remains quiescent/dormant until immunosuppression is restarted. In patients with a prior history of invasive aspergillosis, the infection may relapse when immunosuppressive therapy is reintroduced or increased. In such cases, secondary prophylaxis with antifungal therapy may be reasonable.[2][128]

Relapse of CPA is relatively common after antifungal therapy is stopped, and long-term treatment may be necessary.[3][4][129]

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