TY - JOUR
T1 - Influenza-associated and COVID-19-associated pulmonary aspergillosis in critically ill patients
AU - Feys, Simon
AU - Carvalho, Agostinho
AU - Clancy, Cornelius J.
AU - Gangneux, Jean Pierre
AU - Hoenigl, Martin
AU - Lagrou, Katrien
AU - Rijnders, Bart J.A.
AU - Seldeslachts, Laura
AU - Vanderbeke, Lore
AU - van de Veerdonk, Frank L.
AU - Verweij, Paul E.
AU - Wauters, Joost
N1 - Publisher Copyright:
© 2024 Elsevier Ltd
PY - 2024/9
Y1 - 2024/9
N2 - Influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) are increasingly recognised as important complications in patients requiring intensive care for severe viral pneumonia. The diagnosis can typically be made in 10–20% of patients with severe influenza or COVID-19, but only when appropriate diagnostic tools are used. Bronchoalveolar lavage sampling for culture, galactomannan testing, and PCR forms the cornerstone of diagnosis, whereas visual examination of the tracheobronchial tract during bronchoscopy is required to detect invasive Aspergillus tracheobronchitis. Azoles are the first-choice antifungal drugs, with liposomal amphotericin B as an alternative in settings where azole resistance is prevalent. Despite antifungal therapy, IAPA and CAPA are associated with poor outcomes, with fatality rates often exceeding 50%. In this Review, we discuss the mechanistic and clinical aspects of IAPA and CAPA. Moreover, we identify crucial knowledge gaps and formulate directions for future research.
AB - Influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) are increasingly recognised as important complications in patients requiring intensive care for severe viral pneumonia. The diagnosis can typically be made in 10–20% of patients with severe influenza or COVID-19, but only when appropriate diagnostic tools are used. Bronchoalveolar lavage sampling for culture, galactomannan testing, and PCR forms the cornerstone of diagnosis, whereas visual examination of the tracheobronchial tract during bronchoscopy is required to detect invasive Aspergillus tracheobronchitis. Azoles are the first-choice antifungal drugs, with liposomal amphotericin B as an alternative in settings where azole resistance is prevalent. Despite antifungal therapy, IAPA and CAPA are associated with poor outcomes, with fatality rates often exceeding 50%. In this Review, we discuss the mechanistic and clinical aspects of IAPA and CAPA. Moreover, we identify crucial knowledge gaps and formulate directions for future research.
UR - http://www.scopus.com/inward/record.url?scp=85198564668&partnerID=8YFLogxK
U2 - 10.1016/S2213-2600(24)00151-6
DO - 10.1016/S2213-2600(24)00151-6
M3 - Review article
C2 - 39025089
AN - SCOPUS:85198564668
SN - 2213-2600
VL - 12
SP - 728
EP - 742
JO - The Lancet Respiratory Medicine
JF - The Lancet Respiratory Medicine
IS - 9
ER -