How is fungal pneumonia prevented?

Updated: Jun 21, 2019
  • Author: Romeo A Mandanas, MD, FACP; Chief Editor: Guy W Soo Hoo, MD, MPH  more...
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Answer

Answer

Instruct patients to avoid travel to and exposure in endemic areas.

Patients undergoing bone marrow transplantation or any period of prolonged neutropenia are advised to avoid activities (eg, gardening, cleaning, agitating debris) or objects (eg, potted plants, flowers, fresh fruits and vegetables, uncooked spices) that may unduly cause exposure to spores of Aspergillus species or other ubiquitous fungi.

For patients undergoing bone marrow transplantation, solid organ transplantation, or antileukemic chemotherapy, the use of high efficiency particulate air (HEPA) filtration systems in the treatment units may minimize patient risk of exposure to Aspergillus spores.

Administer prophylactic antifungal therapy (ie, treatment with intranasal or intravenous amphotericin B or its other formulations) in patients at high risk for opportunistic fungal infection, including patients with a history of fungal infection. [49]

In a study, prophylactic posaconazole was shown to be superior to fluconazole in reducing invasive aspergillosis incidence (1% vs 5.9%, respectively) in allogeneic hematopoietic stem cell transplant recipients with clinically significant graft-versus-host disease. [50]

In another trial, conducted using neutropenic patients undergoing chemotherapy for acute leukemia or myelodysplasia, prophylactic posaconazole again reduced the incidence of invasive aspergillosis to 1%. The incidence in patients in the study who received either fluconazole or itraconazole was 7%. [51]


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