Prophylaxis for Aspergillosis

Prophylaxis of aspergillosis involves manipulation of the environment to create minimal exposure to both airborne and food-borne spores, as well as pharmacologic prophylaxis during periods of greatest risk. Prophylaxis against Aspergillus infections is important for several patient cohorts, primarily hematopoietic stem cell transplant (HSCT) recipients and burn victims, and to a lesser extent leukemia patients undergoing chemotherapy, lung transplant recipients, and liver transplant recipients. For burn victims, prevention of wound colonization is the key to prophylaxis for infection. Environmental surveys of airborne contamination related to construction are helpful in facilitating prevention of nosocomial aspergillosis outbreaks. In 2 years prior to institution of prophylaxis, 11% of historical controls developed invasive aspergillosis, but these patients were in rooms without high-efficiency particulate air (HEPA) filtration. One study reported no cases of invasive aspergillosis among 92 HSCT recipients who received voriconazole prophylaxis. There was a 10% rate of infection among 223 HSCT recipients who received other systemic antifungal agents for prophylaxis. As management of cases of invasive aspergillosis has improved, an increasing number of patients are recovering from the infection and can subsequently require additional chemotherapy or undergo HSCT. These patients are at high risk for infection relapse unless secondary prophylaxis is used. Lung and liver transplant recipients, as well as burn victims, are the other patient groups that will require invasive aspergillosis prophylaxis at select times. Prophylaxis against these infections requires minimization of exposure to airborne and food-borne spores as well as pharmacologic agents.