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Invasive Pulmonary Aspergillosis in Critically Ill Patients

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Annual Update in Intensive Care and Emergency Medicine 2013

Part of the book series: Annual Update in Intensive Care and Emergency Medicine ((AUICEM))

Abstract

Aspergillus is a ubiquitous fungus that can cause a wide spectrum of diseases including allergy, superficial infection related to (surgical) trauma, and invasive disease [1]. More than 180 species of Aspergillus have been described but A. fumigatus is most likely to cause disease as it is responsible for about 90 % of cases of invasive aspergillosis. The mechanism of infection is represented by aerosolized conidia by which these organisms spread in the environment and cause pulmonary infection after inhalation. Growth into angio-invasive filamentous forms results in local pulmonary inflammation, invasion, and eventually hematogenous spread to distal organs [1].

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References

  1. Marr KA, Patterson T, Denning D (2002) Aspergillosis. Pathogenesis, clinical manifestations, and therapy. Infect Dis Clin North Am 16:875–894

    Article  PubMed  Google Scholar 

  2. Vandewoude K, Vogelaers D, Blot S (2006) Aspergillosis in the ICU – the new 21st century problem. Med Mycol 44(S1):71–76

    Article  Google Scholar 

  3. Ascioglu S, Rex JH, de Pauw B et al (2002) Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 34:7–14

    Article  PubMed  CAS  Google Scholar 

  4. De Pauw B, Walsh TJ, Donnelly JP et al (2008) Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 46:1813–1821

    Article  PubMed  Google Scholar 

  5. Meersseman W, Vandecasteele SJ, Wilmer A, Verbeken E, Peetermans WE, Van Wijngaerden E (2004) Invasive aspergillosis in critically ill patients without malignancy. Am J Respir Crit Care Med 170:621–625

    Article  PubMed  Google Scholar 

  6. Vandewoude K, Blot S, Benoit D, Depuydt P, Vogelaers D, Colardyn F (2004) Invasive aspergillosis in critically ill patients: analysis of risk factors for acquisition and mortality. Acta Clin Belg 59:251–257

    PubMed  CAS  Google Scholar 

  7. Blot SI, Taccone FS, Van den Abeele AM et al (2012) A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am J Respir Crit Care Med 186:56–64

    Article  PubMed  Google Scholar 

  8. Bulpa P, Dive A, Sibille Y (2007) Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease. Eur Respir J 30:782–800

    Article  PubMed  CAS  Google Scholar 

  9. Guinea J, Torres-Narbona M, Gijon P et al (2010) Pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: incidence, risk factors, and outcome. Clin Microbiol Infect 16:870–877

    PubMed  CAS  Google Scholar 

  10. He H, Ding L, Li F, Zhan Q (2011) Clinical features of invasive bronchial-pulmonary aspergillosis in critically ill patients with chronic obstructive respiratory diseases: a prospective study. Crit Care 15:R5

    Article  PubMed  Google Scholar 

  11. Li D, Chen L, Ding X, Tao R, Zhang YX, Wang JF (2008) Hospital-acquired invasive pulmonary aspergillosis in patients with hepatic failure. BMC Gastroenterol 8:32

    Article  PubMed  Google Scholar 

  12. Prodanovic H, Cracco C, Massard J et al (2007) Invasive pulmonary aspergillosis in patients with decompensated cirrhosis: case series. BMC Gastroenterol 7:2

    Article  PubMed  Google Scholar 

  13. Hartemink KJ, Paul MA, Spijkstra JJ, Girbes AR, Polderman KH (2003) Immunoparalysis as a cause for invasive aspergillosis? Intensive Care Med 29:2068–2071

    Article  PubMed  Google Scholar 

  14. Blot S, Rello J, Dimopoulos G, Vandewoude K, Vogelaers D (2012) Risk factors and outcome in patients critically ill patients with invasive pulmonary aspergillosis. Abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy American Society for Microbiology, San Francisco, 2012, K-951 (abst)

    Google Scholar 

  15. Meersseman W, Lagrou K, Maertens J, Van Wijngaerden E (2007) Invasive aspergillosis in the intensive care unit. Clin Infect Dis 45:205–216

    Article  PubMed  Google Scholar 

  16. Vonberg RP, Gastmeier P (2006) Nosocomial aspergillosis in outbreak settings. J Hosp Infect 63:246–254

    Article  PubMed  Google Scholar 

  17. Maertens J, Theunissen K, Verbeken E et al (2004) Prospective clinical evaluation of lower cut-offs for galactomannan detection in adult neutropenic cancer patients and haematological stem cell transplant recipients. Br J Haematol 126:852–860

    Article  PubMed  CAS  Google Scholar 

  18. Nivoix Y, Velten M, Letscher-Bru V et al (2008) Factors associated with overall and attributable mortality in invasive aspergillosis. Clin Infect Dis 47:1176–1184

    Article  PubMed  Google Scholar 

  19. Vandewoude KH, Blot SI, Depuydt P et al (2006) Clinical relevance of Aspergillus isolation from respiratory tract samples in critically ill patients. Crit Care 10:R31

    Article  PubMed  Google Scholar 

  20. Garnacho-Montero J, Amaya-Villar R, Ortiz-Leyba C et al (2005) Isolation of Aspergillus spp. from the respiratory tract in critically ill patients: risk factors, clinical presentation and outcome. Crit Care 9:R191–R199

    Article  PubMed  Google Scholar 

  21. Maertens J, Maertens V, Theunissen K et al (2009) Bronchoalveolar lavage fluid galactomannan for the diagnosis of invasive pulmonary aspergillosis in patients with hematologic diseases. Clin Infect Dis 49:1688–1693

    Article  PubMed  Google Scholar 

  22. Maertens J, Verhaegen J, Lagrou K, Van Eldere J, Boogaerts M (2001) Screening for circulating galactomannan as a noninvasive diagnostic tool for invasive aspergillosis in prolonged neutropenic patients and stem cell transplantation recipients: a prospective validation. Blood 97:1604–1610

    Article  PubMed  CAS  Google Scholar 

  23. Herbrecht R, Letscher-Bru V, Oprea C et al (2002) Aspergillus galactomannan detection in the diagnosis of invasive aspergillosis in cancer patients. J Clin Oncol 20:1898–1906

    Article  PubMed  Google Scholar 

  24. Hope WW, Walsh TJ, Denning DW (2005) Laboratory diagnosis of invasive aspergillosis. Lancet Infect Dis 5:609–622

    Article  PubMed  CAS  Google Scholar 

  25. Meersseman W, Lagrou K, Maertens J et al (2008) Galactomannan in bronchoalveolar lavage fluid: a tool for diagnosing aspergillosis in intensive care unit patients. Am J Respir Crit Care Med 177:27–34

    Article  PubMed  Google Scholar 

  26. Bassetti M, Mikulska M, Repetto E et al (2010) Invasive pulmonary aspergillosis in intensive care units: is it a real problem? J Hosp Infect 74:186–187

    Article  PubMed  CAS  Google Scholar 

  27. Azie N, Neofytos D, Pfaller M et al (2012) The PATH (Prospective Antifungal Therapy) Alliance(R) registry and invasive fungal infections: update 2012. Diagn Microbiol Infect Dis 73:293–300

    Article  PubMed  Google Scholar 

  28. Denning DW, Venkateswarlu K, Oakley KL et al (1997) Itraconazole resistance in Aspergillus fumigatus. Antimicrob Agents Chemother 41:1364–1368

    PubMed  CAS  Google Scholar 

  29. Herbrecht R, Denning DW, Patterson TF et al (2002) Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 347:408–415

    Article  PubMed  CAS  Google Scholar 

  30. Walsh TJ, Anaissie EJ, Denning DW et al (2008) Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 46:327–360

    Article  PubMed  CAS  Google Scholar 

  31. Walsh TJ, Raad I, Patterson TF et al (2007) Treatment of invasive aspergillosis with posaconazole in patients who are refractory to or intolerant of conventional therapy: an externally controlled trial. Clin Infect Dis 44:2–12

    Article  PubMed  CAS  Google Scholar 

  32. Maertens J, Raad I, Petrikkos G et al (2004) Efficacy and safety of caspofungin for treatment of invasive aspergillosis in patients refractory to or intolerant of conventional antifungal therapy. Clin Infect Dis 39:1563–1571

    Article  PubMed  CAS  Google Scholar 

  33. Jarque I, Tormo M, Bello JL, et al (2012) Caspofungin for the treatment of invasive fungal disease in hematological patients (ProCAS Study). Med Mycol (in press)

    Google Scholar 

  34. von Mach MA, Burhenne J, Weilemann LS (2006) Accumulation of the solvent vehicle sulphobutylether beta cyclodextrin sodium in critically ill patients treated with intravenous voriconazole under renal replacement therapy. BMC Clin Pharmacol 6:6

    Article  Google Scholar 

  35. Park WB, Kim NH, Kim KH et al (2012) The effect of therapeutic drug monitoring on safety and efficacy of voriconazole in invasive fungal infections: A randomized controlled trial. Clin Infect Dis 55:1080–1087

    Article  PubMed  CAS  Google Scholar 

  36. Singh N, Limaye AP, Forrest G et al (2006) Combination of voriconazole and caspofungin as primary therapy for invasive aspergillosis in solid organ transplant recipients: a prospective, multicenter, observational study. Transplantation 81:320–326

    Article  PubMed  CAS  Google Scholar 

  37. Aliff TB, Maslak PG, Jurcic JG et al (2003) Refractory Aspergillus pneumonia in patients with acute leukemia: successful therapy with combination caspofungin and liposomal amphotericin. Cancer 97:1025–1032

    Article  PubMed  CAS  Google Scholar 

  38. Kontoyiannis DP, Hachem R, Lewis RE et al (2003) Efficacy and toxicity of caspofungin in combination with liposomal amphotericin B as primary or salvage treatment of invasive aspergillosis in patients with hematologic malignancies. Cancer 98:292–299

    Article  PubMed  CAS  Google Scholar 

  39. Garbati MA, Alasmari FA, Al-Tannir MA, Tleyjeh IM (2012) The role of combination antifungal therapy in the treatment of invasive aspergillosis: a systematic review. Int J Infect Dis 16:e76–81

    Article  PubMed  CAS  Google Scholar 

  40. Janssen JJ, Strack van Schijndel RJ et al (1996) Outcome of ICU treatment in invasive aspergillosis. Intensive Care Med 22:1315–1322

    Article  PubMed  CAS  Google Scholar 

  41. Vandewoude KH, Blot SI, Benoit D, Colardyn F, Vogelaers D (2004) Invasive aspergillosis in critically ill patients: attributable mortality and excesses in length of ICU stay and ventilator dependence. J Hosp Infect 56:269–276

    Article  PubMed  CAS  Google Scholar 

  42. Tong KB, Lau CJ, Murtagh K, Layton AJ, Seifeldin R (2009) The economic impact of aspergillosis: analysis of hospital expenditures across patient subgroups. Int J Infect Dis 13:24–36

    Article  PubMed  Google Scholar 

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Blot, S., Koulenti, D., Dimopoulos, G. (2013). Invasive Pulmonary Aspergillosis in Critically Ill Patients. In: Vincent, JL. (eds) Annual Update in Intensive Care and Emergency Medicine 2013. Annual Update in Intensive Care and Emergency Medicine. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35109-9_5

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  • DOI: https://doi.org/10.1007/978-3-642-35109-9_5

  • Publisher Name: Springer, Berlin, Heidelberg

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