243.4 📌 章末速蚘

243.4.0.0.1 5 Clinical Forms
  1. Invasive Aspergillosis (IA): immunocompromise; halo + air crescent CT signs; voriconazole / isavuconazole + supportive
  2. ABPA: asthma + CF; IgE-mediated; prednisone + itraconazole 16 wk
  3. Aspergilloma: pre-existing cavity; “crescent sign”; hemoptysis; surgical / embolization
  4. CPA: underlying lung disease; long-term itraconazole/voriconazole
  5. Cutaneous / sinus / ocular: voriconazole + surgical
243.4.0.0.2 Diagnostics
  • Galactomannan (GM): serum + BAL; pip-tazo false+
  • β-D-glucan: nonspecific (IA + Candida + PJP)
  • Tissue hyphae 45° branching with septations
  • Chest CT: halo sign (early) + air crescent (recovery)
243.4.0.0.3 Treatment
  • Voriconazole first-line invasive (TDM 1-5.5 mg/L)
  • Isavuconazole alternative (linear PK, less toxic)
  • Liposomal AmB for severe / intolerance / A. terreus
  • 6-12+ weeks duration; reduce immunosuppression
  • Combination (vor + echinocandin) for severe (controversial)
  • Surgery for localized / hemoptysis
243.4.0.0.4 Resistance
  • TR34/L98H mutation (CYP51A) — azole-resistant Aspergillus
  • Netherlands → Asia → Europe → USA expanding
  • Agricultural fungicide selection
  • Liposomal AmB, isavuconazole alternatives; olorofim Phase 3
243.4.0.0.5 Special Forms
  • A. terreus intrinsic AmB R → voriconazole / isavuconazole
  • Influenza/COVID + IA (IAPA, CAPA) → surveillance + early treatment
  • CGD → lifelong itraconazole + BMT cure
243.4.0.0.6 盧醫垫 hint
  • Neutropenic + fever + halo sign / air crescent → empirical voriconazole + BAL GM
  • Asthma + recalcitrant + central bronchiectasis + high IgE → ABPA workup
  • Post-TB cavity + hemoptysis + crescent sign → aspergilloma → surgical / embolization
  • ICU + COVID-19 + clinical deterioration + steroid use → CAPA → BAL GM