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Aspergillus species are ubiquitous fungi that infect humans after their asexual spores are inhaled and deposited in the respiratory tract. Neutrophils and cell-mediated immunity are crucial components of host defenses that prevent invasion of Aspergillus, and these elements are often lacking or impaired in transplant recipients. Aspergillosis is the most common invasive fungal infection in hematopoietic stem cell transplant recipients and the second most common in solid organ transplant recipients. Invasive pulmonary disease is the most common site of infection, followed by sinusitis. Infection can also disseminate to the central nervous system and virtually any organ system. Use of computed tomography and biomarkers provides additional sensitivity, compared to conventional culture and microscopy-based diagnostic methods. Voriconazole and isavuconazole are treatments of choice for invasive aspergillosis, with isavuconazole having fewer adverse effects and more predictable pharmacokinetics. Adding an echinocandin to voriconazole may provide additional benefit. Prophylaxis against invasive aspergillosis with mold-active antifungal agents is indicated in certain high-risk transplant recipients.

DOI: 10.1007/978-1-4939-9034-4_33