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.
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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.
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Invasive pulmonary aspergillosis in critically ill immunocompetent patients