Sección 2. Consenso colombiano para profilaxis, tratamiento y prevención de la aspergilosis invasora en pacientes adultos y pediátricos
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La aspergilosis invasive (AI) continúa siendo una causa importante de morbilidad y mortalidad, de difícil manejo en los pacientes severamente inmunocomprometidos, sin embargo, con su aparición en un grupo heterogéneo de pacientes (ej., paciente críticos en UCI), pacientes con virus de inmunodeficiencia humana [HIV/sida], etc.), que clásicamente no se consideraban de alto riesgo, así como la manifestación de formas más crónicas de aspergilosis, (incluidas aquellas con propensión a la invasión), que han sido mejor definidas, se han establecido diferentes modalidades de tratamiento antifúngico para infecciones asociadas a Aspergillus de acuerdo a la condición específica del paciente. La comprensión de los diferentes factores de riesgo para el desarrollo de una EFI/AI, los cuales evolucionan constantemente, y que incluyen entre otros, la malignidad subyacente, el estado y tratamiento asociado, la presencia de comorbilidades, la exposición ambiental, y la presencia de ciertos polimorfismos genéticos en el paciente, permiten una estratificación de riesgo más precisa, que unido al uso de algoritmos de diagnóstico, permitirían caracterizar los pacientes que se beneficiarían de las diferentes estrategias de intervención temprana, y de la optimización de protocolos de manejo. La evaluación de las manifestaciones clínicas del pacientes es un paso esencial, ya que involucra el sitio de infección, la gravedad y la naturaleza dinámica de la inmunosupresión, y las características del agente etiológico implicado, que junto al uso de modalidades imagenológicas (con un papel cada vez más importante en el diagnóstico), y de herramientas diagnósticas novedosas y accesibles, útiles para la detección y el seguimiento de la enfermedad, permiten el reconocimiento precoz de la infección, la selección de un tratamiento antifúngico temprano, el uso de fármacos antifúngicos más efectivos y la elaboración de guías de práctica clínica locales.
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