Managing invasive aspergillosis: impact on health and personalized prevention or treatment strategies

Despite developments in the prevention of invasive aspergillosis, the incidence rates are up to 10% in high risk groups. Within high risk groups, individual patients with an even higher risks can be identified, such as those suffering from relapsed AML. Mortality of IA is high within all populations and is mainly found in the first 30 days after diagnosis. Because of the serious nature of the underlying diseases that predispose for IA, it can be challenging to quantify the contribution of IA to mortality; crude mortality rates cannot distinguish death due to IA-unrelated causes from IA-related death, almost certainly leading to inflation of mortality rates. It can be helpful to assess contributability of IA to death to provide a better understanding of the impact of IA in this vulnerable patient population. Additionally, we have explored the new problem that is posed by the increase of triazoleresistant Aspergillus fungi, resulting in challenges in the application of antifungal therapies. Treatment strategies involving the use of LAmB are becoming more prevalent in areas withhigh resistance rates, but should be applied with care due to concerns of renal toxicity and decreased efficacy against triazole-susceptible isolates when compared to voriconazole. Rational application of PCR could help us to initiate the right therapy sooner, by possibly providing information about the susceptibility of the Aspergillus fungus.