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Open Access 01-08-2020 | Aspergillosis | Conference Reports and Expert Panel

Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion

Authors: Paul E. Verweij, Bart J. A. Rijnders, Roger J. M. Brüggemann, Elie Azoulay, Matteo Bassetti, Stijn Blot, Thierry Calandra, Cornelius J. Clancy, Oliver A. Cornely, Tom Chiller, Pieter Depuydt, Daniele Roberto Giacobbe, Nico A. F. Janssen, Bart-Jan Kullberg, Katrien Lagrou, Cornelia Lass-Flörl, Russell E. Lewis, Peter Wei-Lun Liu, Olivier Lortholary, Johan Maertens, Ignacio Martin-Loeches, M. Hong Nguyen, Thomas F. Patterson, Thomas R. Rogers, Jeroen A. Schouten, Isabel Spriet, Lore Vanderbeke, Joost Wauters, Frank L. van de Veerdonk

Published in: Intensive Care Medicine | Issue 8/2020

Abstract

Purpose

Invasive pulmonary aspergillosis is increasingly reported in patients with influenza admitted to the intensive care unit (ICU). Classification of patients with influenza-associated pulmonary aspergillosis (IAPA) using the current definitions for invasive fungal diseases has proven difficult, and our aim was to develop case definitions for IAPA that can facilitate clinical studies.

Methods

A group of 29 international experts reviewed current insights into the epidemiology, diagnosis and management of IAPA and proposed a case definition of IAPA through a process of informal consensus.

Results

Since IAPA may develop in a wide range of hosts, an entry criterion was proposed and not host factors. The entry criterion was defined as a patient requiring ICU admission for respiratory distress with a positive influenza test temporally related to ICU admission. In addition, proven IAPA required histological evidence of invasive septate hyphae and mycological evidence for Aspergillus. Probable IAPA required the detection of galactomannan or positive Aspergillus culture in bronchoalveolar lavage (BAL) or serum with pulmonary infiltrates or a positive culture in upper respiratory samples with bronchoscopic evidence for tracheobronchitis or cavitating pulmonary infiltrates of recent onset. The IAPA case definitions may be useful to classify patients with COVID-19-associated pulmonary aspergillosis (CAPA), while awaiting further studies that provide more insight into the interaction between Aspergillus and the SARS-CoV-2-infected lung.

Conclusion

A consensus case definition of IAPA is proposed, which will facilitate research into the epidemiology, diagnosis and management of this emerging acute and severe Aspergillus disease, and may be of use to study CAPA.

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Title: Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion
Authors: Paul E. Verweij
Bart J. A. Rijnders
Roger J. M. Brüggemann
Elie Azoulay
Matteo Bassetti
Stijn Blot
Thierry Calandra
Cornelius J. Clancy
Oliver A. Cornely
Tom Chiller
Pieter Depuydt
Daniele Roberto Giacobbe
Nico A. F. Janssen
Bart-Jan Kullberg
Katrien Lagrou
Cornelia Lass-Flörl
Russell E. Lewis
Peter Wei-Lun Liu
Olivier Lortholary
Johan Maertens
Ignacio Martin-Loeches
M. Hong Nguyen
Thomas F. Patterson
Thomas R. Rogers
Jeroen A. Schouten
Isabel Spriet
Lore Vanderbeke
Joost Wauters
Frank L. van de Veerdonk
Publication date: 01-08-2020
Publisher: Springer Berlin Heidelberg
Keywords: Aspergillosis
Influenza
COVID-19
Invasive Aspergillosis
Published in: Intensive Care Medicine / Issue 8/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-06091-6

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Springer Medicine

Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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