What is the recommended management approach for early-stage aspergillosis with a CT halo sign and negative cultures?

• A. Start antifungal therapy based on radiographic suspicion; confirm with biomarkers.
• B. Wait for cultures to become positive before starting antifungal therapy.
• C. Begin broad-spectrum antibacterial therapy and reassess.
• D. Deferring treatment until invasive biopsy.

Answer: (A)

When there is a CT halo sign in a patient at risk for invasive fungal infection, the situation is managed with empiric antifungal therapy even if cultures are negative. Cultures can be falsely negative or take too long to become positive, and delaying treatment in suspected invasive aspergillosis increases mortality. Starting antifungal therapy based on radiographic and clinical suspicion addresses the real-time threat while you pursue noninvasive confirmation with biomarkers such as galactomannan or beta-D-glucan. These biomarkers help support the diagnosis and guide ongoing treatment. If feasible, a biopsy can provide a definitive diagnosis, but it shouldn’t delay starting therapy due to the risk and time involved.