Abstract：
The European Society for Clinical Microbiology and Infectious Diseases, the European Confederation of Medical Mycology and the European Respiratory Society Joint Clinical Guidelines focus on diagnosis and management of aspergillosis. Of the numerous recommendations, a few are summarized here. Chest computed tomography as well as bronchoscopy with bronchoalveolar lavage (BAL) in patients with suspicion of pulmonary invasive aspergillosis (IA) are strongly recommended. For diagnosis, direct microscopy, preferably using optical brighteners, histopathology and culture are strongly recommended. Serum and BAL galactomannan measures are recommended as markers for the diagnosis of IA. PCR should be considered in conjunction with other diagnostic tests. Pathogen identification to species complex level is strongly recommended for all clinically relevant Aspergillus isolates; antifungal susceptibility testing should be performed in patients with invasive disease in regions with resistance found in contemporary surveillance programmes. Isavuconazole and voriconazole are the preferred agents for first-line treatment of pulmonary IA, whereas liposomal amphotericin B is moderately supported. Combinations of antifungals as primary treatment options are not recommended. Therapeutic drug monitoring is strongly recommended for patients receiving posaconazole suspension or any form of voriconazole for IA treatment, and in refractory disease, where a personalized approach considering reversal of predisposing factors, switching drug class and surgical intervention is also strongly recommended. Primary prophylaxis with posaconazole is strongly recommended in patients with acute myelogenous leukaemia or myelodysplastic syndrome receiving induction chemotherapy. Secondary prophylaxis is strongly recommended in high-risk patients. We strongly recommend treatment duration based on clinical improvement, degree of immunosuppression and response on imaging.
摘要：
欧洲临床微生物学和传染病学会，欧洲医学真菌学联合会和欧洲呼吸学会联合临床指南重点关注曲霉病的诊断和治疗.在众多的建议中,这里总结了几个。强烈建议怀疑肺部侵袭性曲霉病（IA）的患者进行胸部计算机断层扫描以及支气管镜检查和支气管肺泡灌洗（BAL）。为了诊断，直接显微镜,优选使用荧光增白剂，强烈建议组织病理学和文化。建议将血清和BAL半乳甘露聚糖测定作为诊断IA的标志物。PCR应与其他诊断测试一起考虑。强烈建议对所有临床相关的曲霉分离株进行物种复杂水平的病原体鉴定；在当代监测计划中发现耐药性的地区，应对患有侵袭性疾病的患者进行抗真菌药敏试验。伊沙康康唑和伏立康唑是首选的一线治疗肺部IA的药物，而脂质体两性霉素B得到适度支持。不建议将抗真菌药物组合作为主要治疗选择。对于接受泊沙康唑混悬液或任何形式的伏立康唑治疗IA的患者，强烈建议进行治疗药物监测。在难治性疾病中，在考虑逆转诱发因素的个性化方法中，转换药物类别和手术干预也强烈建议。对于接受诱导化疗的急性骨髓性白血病或骨髓增生异常综合征患者，强烈建议使用泊沙康唑进行初级预防。强烈建议高危患者进行二级预防。我们强烈建议基于临床改善的治疗持续时间，免疫抑制程度和影像学反应。
