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The IDSA guidelines review management of aspergilloma, invasive, chronic pulmonary and allergic forms of aspergillosis. Voriconazole is recommended for the primary treatment of invasive aspergillosis in most patients. Liposomal amphotericin B therapy could be considered as alternative primary therapy in some patients. For salvage therapy, agents include liposomal amphotericin, posaconazole, itraconazole or caspofungin. In patients whose infection is refractory to voriconazole, there are few data. The role of combination therapy in treatment of IA is uncertain and warrants a prospective controlled clinical trial. Management of breakthrough invasive aspergillosis in the setting of azole prophylaxis or suppressive therapy is not defined by clinical trial data. Antifungal prophylaxis with posaconazole can be recommended in the subgroup of HSCT recipients with graft versus host disease at high risk for IA and in neutropenic patients with acute leukemia or myelodysplastic syndrome who are at high risk for IA. Surgical resection unilateral pulmonary infection, pulmonary lesions contiguous with the heart or great vessels, invasion of the chest wall, osteomyelitis, and endocarditis. Recovery from neutropenia in a persistently neutropenic host or reduction of corticosteroids in a patient receiving high dose glucocorticosteroids is paramount for improved outcome in invasive aspergillosis. Single pulmonary aspergillomas may be best managed by surgical resection, whereas chronic pulmonary aspergillosis requires long-term medical therapy. The management of ABPA involves the administration of itraconazole and corticosteroids.
