Invasive pulmonary aspergillosis is an opportunistic mycosis, difficult to diagnose, due to the environmental fungi of the genus Aspergillus. The diagnostic tools, even if more are available, are still limited in number and effectiveness. Thus, medical imaging and serum galactomannan antigen currently constitute the basis of the screening approach, although they both have some limitations in specificity. Real-time PCR lacks standardization, and fungal culture from respiratory specimens is sometimes not sensitive enough. Histology allows proving the diagnosis of aspergillosis, but biopsy is not always possible in immunodepressed patients. We present the various arguments for the diagnosis of invasive aspergillosis, with a particular emphasis on recent exploration techniques.

Author:Akik Dagami
Language:English (Spanish)
Published (Last):23 October 2019
PDF File Size:3.42 Mb
ePub File Size:18.17 Mb
Price:Free* [*Free Regsitration Required]

We'd like to understand how you use our websites in order to improve them. Register your interest. Invasive pulmonary aspergillosis IPA is a severe and well recognized infection in patients with hematological malignancies. These patients are characterized by multifactorial impairments in their local defense. The major risk factors are systemic steroid use and administration of broad-spectrum antibiotics. IPA is responsible for high mortality, and its usual clinical, radiological, and biological specificities are generally absent in the immunocompetent patient.

Rapid diagnosis requires histological evidence. Sensitivity of lower respiratory tract cultures and serology remains poor. The detection of galactomannan fungal antigen in the bronchoalveolar lavage may offer an interesting alternative diagnostic tool.

The first-line recommended antifungal treatment is voriconazole, but other therapies exist like amphotericin, which was largely used in the past. We conducted a literature review focusing at IPA in the critically ill immunocompetent patients, in order to analyze its epidemiology, physiopathology, prognosis, diagnostic methods, and treatment. Download to read the full article text. Clin Infect Dis — Clin Microbiol Infect — Crit Care 9:R—R Xu H, Li L, Huang WJ, et al Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: a case control study from China.

J Chemother — Crit Care R Meersseman W Invasive aspergillosis in critically ill patients without malignancy. He H, Ding L, Li F, Zhan Q Clinical features of invasive bronchial-pulmonary aspergillosis in critically ill patients with chronic obstructive respiratory diseases: a prospective study. Crit Care R5. Chin Med J — N Engl J Med Peter E, Bakri F, Ball DM, et al Invasive pulmonary filamentous fungal infection in a patient receiving inhaled corticosteroid therapy.

Clin Infect Dis e54—e Barouky R, Badet M, Denis MS, et al Inhaled corticosteroids in chronic obstructive pulmonary disease and disseminated aspergillosis.

Eur J Intern Med — Bulpa P, Dive A, Sibille Y Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease.

Eur Respir J — Med Mycol — J Int Med Res — Int J Clin Lab Res — Ader F, Nseir S, Le Berre R, et al Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease: an emerging fungal pathogen.

Ader F Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: an emerging fungal disease. Curr Infect Dis Rep — Bulpa PA, Dive AM, Garrino mg, et al Chronic obstructive pulmonary disease patients with invasive pulmonary aspergillosis: benefits of intensive care? Intensive Care Med — Rello J, Esandi ME, Mariscal D, et al Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: report of eight cases and review.

Upton A, Kirby KA, Carpenter P, et al Invasive aspergillosis following hematopoietic cell transplantation: outcomes and prognostic factors associated with mortality.

Sethi S, Murphy TF Infection in the pathogenesis and course of chronic obstructive pulmonary disease. N Engl J Med — Khoufache K, Puel O, Loiseau N, et al Verruculogen associated with Aspergillus fumigatus hyphae and conidia modifies the electrophysiological properties of human nasal epithelial cells. BMC Microbiol Amitani R, Taylor G, Elezis EN, et al Purification and characterization of factors produced by Aspergillus fumigatus which affect human ciliated respiratory epithelium.

Infect Immun — Morgenstern DE, Gifford MA, Li LL, et al Absence of respiratory burst in X-linked chronic granulomatous disease mice leads to abnormalities in both host defense and inflammatory response to Aspergillus fumigatus. J Exp Med — Romani L Immunity to fungal infections. Nat Rev Immunol — J Biol Chem — Bellanger AP, Millon L, Khoufache K, et al Aspergillus fumigatus germ tube growth and not conidia ingestion induces expression of inflammatory mediator genes in the human lung epithelial cell line A J Med Microbiol — Curr Pharm Des — Respir Res Schaffner A Therapeutic concentrations of glucocorticoids suppress the antimicrobial activity of human macrophages without impairing their responsiveness to gamma interferon.

J Clin Invest — Diamond RD Inhibition of monocyte-mediated damage to fungal hyphae by steroid hormones. J Infect Dis Microbiology Reading, Engl. Antimicrob Agents Chemother — Am Rev Respir Dis — Vandewoude KH, Vogelaers D Medical imaging and timely diagnosis of invasive pulmonary aspergillosis.

Clin Radiol — Greub G, Bille J Aspergillus species isolated from clinical specimens: suggested clinical and microbiological criteria to determine significance. Persat F Aspergillus serology, from yesterday to today for tomorrow. J Mycol Med — Cornillet A, Camus C, Nimubona S, et al Comparison of epidemiological, clinical, and biological features of invasive aspergillosis in neutropenic and nonneutropenic patients: a 6-year survey.

J Antimicrob Chemother — Singh N, Obman A, Husain S, et al Reactivity of platelia Aspergillus galactomannan antigen with piperacillin-tazobactam: clinical implications based on achievable concentrations in serum. Sulahian A, Touratier S, Ribaud P False positive test for Aspergillus antigenemia related to concomitant administration of piperacillin and tazobactam. Viscoli C, Machetti M, Cappellano P, et al False-positive galactomannan platelia Aspergillus test results for patients receiving piperacillin-tazobactam.

Walsh TJ, Shoham S, Petraitiene R, et al Detection of galactomannan antigenemia in patients receiving piperacillintazobactam and correlations between in vitro, in vivo, and clinical properties of the drug-antigen interaction. J Clin Microbiol — Sanguinetti M, Posteraro B, Pagano L, et al Comparison of real-time PCR, conventional PCR, and galactomannan antigen detection by enzyme-linked immunosorbent assay using bronchoalveolar lavage fluid samples from hematology patients for diagnosis of invasive pulmonary aspergillosis.

Becker MJ, de Marie S, Fens MH, et al Effect of amphotericin B treatment on kinetics of cytokines and parameters of fungal load in neutropenic rats with invasive pulmonary aspergillosis. Musher B, Fredricks D, Leisenring W, et al Aspergillus galactomannan enzyme immunoassay and quantitative PCR for diagnosis of invasive aspergillosis with bronchoalveolar lavage fluid. Clancy CJ, Jaber RA, Leather HL, et al Bronchoalveolar lavage galactomannan in diagnosis of invasive pulmonary aspergillosis among solid-organ transplant recipients.

Significance and interpretation. Mycoses — He H, Ding L, Sun B, et al Role of galactomannan determinations in bronchoalveolar lavage fluid samples from critically ill patients with chronic obstructive pulmonary disease for the diagnosis of invasive pulmonary aspergillosis: a prospective study. Meersseman W, Lagrou K, Maertens J, et al Galactomannan in bronchoalveolar lavage fluid: a tool for diagnosing aspergillosis in intensive care unit patients. Mycopathologia — Hope WW Invasion of the alveolar-capillary barrier by Aspergillus spp.

Med Mycol 47Suppl 1:S—S Caillot D, Bassaris H, McGeer A, et al Intravenous itraconazole followed by oral itraconazole in the treatment of invasive pulmonary aspergillosis in patients with hematologic malignancies, chronic granulomatous disease, or AIDS. Clin Infect Dis e83—e Am J Med — Maertens J, Raad I, Petrikkos G, et al Efficacy and safety of caspofungin for treatment of invasive aspergillosis in patients refractory to or intolerant of conventional antifungal therapy.

Candoni A, Mestroni R, Damiani D, et al Caspofungin as first line therapy of pulmonary invasive fungal infections in 32 immunocompromised patients with hematologic malignancies. Eur J Haematol — Perea S, Gonzalez G, Fothergill AW, et al In vitro interaction of caspofungin acetate with voriconazole against clinical isolates of Aspergillus spp. Petraitis V, Petraitiene R, Sarafandi AA, et al Combination therapy in treatment of experimental pulmonary aspergillosis: synergistic interaction between an antifungal triazole and an echinocandin.

J Infect Dis — Schuster F, Moelter C, Schmid I, et al Successful antifungal combination therapy with voriconazole and caspofungin. Pediatr Blood Cancer — Ann Thorac Surg — Reichenberger F, Habicht J, Kaim A, et al Lung resection for invasive pulmonary aspergillosis in neutropenic patients with hematologic diseases. Download references. Correspondence to F.


Invasive pulmonary aspergillosis in critically ill immunocompetent patients



Aspergillose invasive


Related Articles