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Open Access 01-08-2021 | Bronchoscopy | Conference Reports and Expert Panel

Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis

Authors: Paul E. Verweij, Roger J. M. Brüggemann, Elie Azoulay, Matteo Bassetti, Stijn Blot, Jochem B. Buil, Thierry Calandra, Tom Chiller, Cornelius J. Clancy, Oliver A. Cornely, Pieter Depuydt, Philipp Koehler, Katrien Lagrou, Dylan de Lange, Cornelia Lass-Flörl, Russell E. Lewis, Olivier Lortholary, Peter-Wei Lun Liu, Johan Maertens, M. Hong Nguyen, Thomas F. Patterson, Bart J. A. Rijnders, Alejandro Rodriguez, Thomas R. Rogers, Jeroen A. Schouten, Joost Wauters, Frank L. van de Veerdonk, Ignacio Martin-Loeches

Published in: Intensive Care Medicine | Issue 8/2021

Abstract

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.

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Title: Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis
Authors: Paul E. Verweij
Roger J. M. Brüggemann
Elie Azoulay
Matteo Bassetti
Stijn Blot
Jochem B. Buil
Thierry Calandra
Tom Chiller
Cornelius J. Clancy
Oliver A. Cornely
Pieter Depuydt
Philipp Koehler
Katrien Lagrou
Dylan de Lange
Cornelia Lass-Flörl
Russell E. Lewis
Olivier Lortholary
Peter-Wei Lun Liu
Johan Maertens
M. Hong Nguyen
Thomas F. Patterson
Bart J. A. Rijnders
Alejandro Rodriguez
Thomas R. Rogers
Jeroen A. Schouten
Joost Wauters
Frank L. van de Veerdonk
Ignacio Martin-Loeches
Publication date: 01-08-2021
Publisher: Springer Berlin Heidelberg
Keywords: Bronchoscopy
Voriconazole
Aspergillosis
SARS-CoV-2
Pneumonia
COVID-19
Invasive Aspergillosis
Published in: Intensive Care Medicine / Issue 8/2021
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-021-06449-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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