Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis
| Autor: | Cornelius J. Clancy, Philipp Koehler, Jeroen Schouten, Stijn Blot, Roger J. M. Brüggemann, Elie Azoulay, Oliver A. Cornely, Paul E. Verweij, Matteo Bassetti, Peter Wei Lun Liu, Frank L. van de Veerdonk, Alejandro Rodriguez, Thomas R. Rogers, Olivier Lortholary, Ignacio Martin-Loeches, Cornelia Lass-Flörl, Pieter Depuydt, Russell E. Lewis, Joost Wauters, Katrien Lagrou, Jochem B. Buil, Thierry Calandra, Dylan W. de Lange, Thomas F. Patterson, Tom Chiller, Bart J. A. Rijnders, Johan Maertens, M. Hong Nguyen |
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| Přispěvatelé: | Verweij P.E., Bruggemann R.J.M., Azoulay E., Bassetti M., Blot S., Buil J.B., Calandra T., Chiller T., Clancy C.J., Cornely O.A., Depuydt P., Koehler P., Lagrou K., de Lange D., Lass-Florl C., Lewis R.E., Lortholary O., Liu P.-W.L., Maertens J., Nguyen M.H., Patterson T.F., Rijnders B.J.A., Rodriguez A., Rogers T.R., Schouten J.A., Wauters J., van de Veerdonk F.L., Martin-Loeches I., Internal Medicine |
| Rok vydání: | 2021 |
| Předmět: |
INVASIVE ASPERGILLOSIS
Conference Reports and Expert Panel lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4] COVID-19 Humans Intensive Care Units Invasive Pulmonary Aspergillosis/diagnosis Pulmonary Aspergillosis/diagnosis Pulmonary Aspergillosis/drug therapy Pulmonary Aspergillosis/epidemiology SARS-CoV-2 ICU Invasive aspergillosis Viral pneumonia Disease GUIDELINES Critical Care and Intensive Care Medicine POSACONAZOLE law.invention Invasive aspergillosi 0302 clinical medicine Bronchoscopy law Epidemiology Medicine and Health Sciences Invasive Pulmonary Aspergillosis medicine.diagnostic_test Incidence (epidemiology) Intensive care unit VORICONAZOLE PHARMACOKINETICS DIFFERENTIATION Life Sciences & Biomedicine CRITICALLY-ILL PATIENTS Human medicine.medical_specialty Intensive Care Unit Invasive Pulmonary Aspergillosi SOCIETY BETA 03 medical and health sciences Critical Care Medicine General & Internal Medicine Anesthesiology medicine Intensive care medicine Science & Technology business.industry 030208 emergency & critical care medicine medicine.disease lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] Bronchoalveolar lavage 030228 respiratory system Pulmonary Aspergillosis business |
| Zdroj: | Intensive Care Medicine, 47, 819-834 Intensive care medicine, vol. 47, no. 8, pp. 819-834 INTENSIVE CARE MEDICINE Intensive Care Medicine Intensive Care Medicine, 47, 8, pp. 819-834 Intensive Care Medicine, 47(8), 819-834. Springer-Verlag |
| ISSN: | 1432-1238 0342-4642 |
| DOI: | 10.1007/s00134-021-06449-4 |
| Popis: | Purpose Invasive pulmonary aspergillosis (IPA) is increasingly reported in patients with severe coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU). Diagnosis and management of COVID-19 associated pulmonary aspergillosis (CAPA) are challenging and our aim was to develop practical guidance. Methods A group of 28 international experts reviewed current insights in the epidemiology, diagnosis and management of CAPA and developed recommendations using GRADE methodology. Results The prevalence of CAPA varied between 0 and 33%, which may be partly due to variable case definitions, but likely represents true variation. Bronchoscopy and bronchoalveolar lavage (BAL) remain the cornerstone of CAPA diagnosis, allowing for diagnosis of invasive Aspergillus tracheobronchitis and collection of the best validated specimen for Aspergillus diagnostics. Most patients diagnosed with CAPA lack traditional host factors, but pre-existing structural lung disease and immunomodulating therapy may predispose to CAPA risk. Computed tomography seems to be of limited value to rule CAPA in or out, and serum biomarkers are negative in 85% of patients. As the mortality of CAPA is around 50%, antifungal therapy is recommended for BAL positive patients, but the decision to treat depends on the patients’ clinical condition and the institutional incidence of CAPA. We recommend against routinely stopping concomitant corticosteroid or IL-6 blocking therapy in CAPA patients. Conclusion CAPA is a complex disease involving a continuum of respiratory colonization, tissue invasion and angioinvasive disease. Knowledge gaps including true epidemiology, optimal diagnostic work-up, management strategies and role of host-directed therapy require further study. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06449-4. |
| Databáze: | OpenAIRE |
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