Section 2. Colombian consensus for prophylaxis, treatment and prevention of invasive aspergillosis in adult and pediatric patients*

Abstract

The invasive aspergillosis (IA) continues to be an important cause of morbidity and mortality, difficult to manage in severely immunocompromised patients, however, with its appearance in a heterogeneous group of patients (e.g., critical ICU patients, patients with human immunodeficiency virus [HIV/AIDS], etc.), who were not classically considered high risk, as well as more chronic forms of aspergillosis, (including those with a propensity for invasion), which have been better defined, different antifungal treatment modalities have been established for Aspergillus-associated infections according to the specific patient’s condition. The understanding of the different risk factors for the development of IFI/IA, which are constantly evolving, and which include, among others, the underlying malignancy, the associated condition and treatment, the presence of comorbidities, environmental exposure, and the presence of certain genetic polymorphisms in the patient, allows for a more precise risk stratification, which together with the use of diagnostic algorithms, would allow the characterization of patients who would benefit from the different early intervention strategies, and the optimization of management protocols. The evaluation of the clinical manifestations of the patient is an essential step, as it involves the site of infection, the severity and dynamic nature of immunosuppression, and the characteristics of the etiological agent involved, which with the use of imaging modalities (with an increasingly important role in diagnosis), and of novel and accessible diagnostic tools, useful for the detection and follow-up of the disease, allow the early recognition of the infection, the selection of an early antifungal treatment, the use of more effective antifungal drugs and the development of local clinical practice guidelines.