Influenza-associated and COVID-19-associated pulmonary aspergillosis in critically ill patients.
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Publication year
2024Source
Lancet Respiratory Medicine, 12, 9, (2024), pp. 728-742ISSN
Annotation
01 september 2024
Publication type
Article / Letter to editor
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Organization
Internal Medicine
Medical Microbiology
Journal title
Lancet Respiratory Medicine
Volume
vol. 12
Issue
iss. 9
Page start
p. 728
Page end
p. 742
Subject
Internal Medicine - Radboud University Medical Center; Medical Microbiology - Radboud University Medical CenterAbstract
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.
This item appears in the following Collection(s)
- Academic publications [245050]
- Electronic publications [132309]
- Faculty of Medical Sciences [93209]
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