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Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis.
Verweij, Paul E; Brüggemann, Roger J M; Azoulay, Elie; Bassetti, Matteo; Blot, Stijn; Buil, Jochem B; Calandra, Thierry; Chiller, Tom; Clancy, Cornelius J; Cornely, Oliver A; Depuydt, Pieter; Koehler, Philipp; Lagrou, Katrien; de Lange, Dylan; Lass-Flörl, Cornelia; Lewis, Russell E; Lortholary, Olivier; Liu, Peter-Wei Lun; Maertens, Johan; Nguyen, M Hong; Patterson, Thomas F; Rijnders, Bart J A; Rodriguez, Alejandro; Rogers, Thomas R; Schouten, Jeroen A; Wauters, Joost; van de Veerdonk, Frank L; Martin-Loeches, Ignacio.
  • Verweij PE; Department of Medical Microbiology, Radboudumc Center for Infectious Diseases (RCI), Radboud University Medical Center, PO box 9101, 6500 HB, Nijmegen, The Netherlands. paul.verweij@radboudumc.nl.
  • Brüggemann RJM; Radboudumc-CWZ Center of Expertise for Mycology, Radboudumc Center for Infectious Diseases (RCI), Nijmegen, The Netherlands. paul.verweij@radboudumc.nl.
  • Azoulay E; Center for Infectious Disease Research, Diagnostics and Laboratory Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands. paul.verweij@radboudumc.nl.
  • Bassetti M; Radboudumc-CWZ Center of Expertise for Mycology, Radboudumc Center for Infectious Diseases (RCI), Nijmegen, The Netherlands.
  • Blot S; Department of Pharmacy and Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
  • Buil JB; Medical Intensive Care Unit, Saint-Louis Hospital, APHP, Paris, France.
  • Calandra T; Clinica Malattie Infettive, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.
  • Chiller T; Department of Health Sciences, DISSAL, University of Genoa, Genoa, Italy.
  • Clancy CJ; Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
  • Cornely OA; Burns, Trauma, and Critical Care Research Centre, Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
  • Depuydt P; Department of Medical Microbiology, Radboudumc Center for Infectious Diseases (RCI), Radboud University Medical Center, PO box 9101, 6500 HB, Nijmegen, The Netherlands.
  • Koehler P; Radboudumc-CWZ Center of Expertise for Mycology, Radboudumc Center for Infectious Diseases (RCI), Nijmegen, The Netherlands.
  • Lagrou K; Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, 1011, Lausanne, Switzerland.
  • de Lange D; Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
  • Lass-Flörl C; Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, PA, USA.
  • Lewis RE; Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
  • Lortholary O; Department I of Internal Medicine, ECMM Center of Excellence for Medical Mycology, German Centre for Infection Research, Partner Site Bonn-Cologne (DZIF), University of Cologne, Cologne, Germany.
  • Liu PL; Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.
  • Maertens J; Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium.
  • Nguyen MH; Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.
  • Patterson TF; Department I of Internal Medicine, ECMM Center of Excellence for Medical Mycology, German Centre for Infection Research, Partner Site Bonn-Cologne (DZIF), University of Cologne, Cologne, Germany.
  • Rijnders BJA; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
  • Rodriguez A; Department of Laboratory Medicine, National Reference Centre for Mycosis, University Hospitals Leuven, Leuven, Belgium.
  • Rogers TR; Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands.
  • Schouten JA; Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria.
  • Wauters J; Department of Medical and Surgical Sciences, Infectious Diseases Hospital, IRCSS S'Orsola-Malpighi, University of Bologna, Bologna, Italy.
  • van de Veerdonk FL; Necker-Pasteur Center for Infectious Diseases and Tropical Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris University, Paris, France.
  • Martin-Loeches I; Institut Pasteur, Molecular Mycology Unit, National Reference Center for Invasive Mycoses and Antifungals, CNRS UMR 2000, Paris, France.
Intensive Care Med ; 47(8): 819-834, 2021 08.
Article in English | MEDLINE | ID: covidwho-1279405
ABSTRACT

PURPOSE:

Invasive pulmonary aspergillosis (IPA) is increasingly reported in patients with severe coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU). Diagnosis and management of COVID-19 associated pulmonary aspergillosis (CAPA) are challenging and our aim was to develop practical guidance.

METHODS:

A group of 28 international experts reviewed current insights in the epidemiology, diagnosis and management of CAPA and developed recommendations using GRADE methodology.

RESULTS:

The prevalence of CAPA varied between 0 and 33%, which may be partly due to variable case definitions, but likely represents true variation. Bronchoscopy and bronchoalveolar lavage (BAL) remain the cornerstone of CAPA diagnosis, allowing for diagnosis of invasive Aspergillus tracheobronchitis and collection of the best validated specimen for Aspergillus diagnostics. Most patients diagnosed with CAPA lack traditional host factors, but pre-existing structural lung disease and immunomodulating therapy may predispose to CAPA risk. Computed tomography seems to be of limited value to rule CAPA in or out, and serum biomarkers are negative in 85% of patients. As the mortality of CAPA is around 50%, antifungal therapy is recommended for BAL positive patients, but the decision to treat depends on the patients' clinical condition and the institutional incidence of CAPA. We recommend against routinely stopping concomitant corticosteroid or IL-6 blocking therapy in CAPA patients.

CONCLUSION:

CAPA is a complex disease involving a continuum of respiratory colonization, tissue invasion and angioinvasive disease. Knowledge gaps including true epidemiology, optimal diagnostic work-up, management strategies and role of host-directed therapy require further study.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pulmonary Aspergillosis / Invasive Pulmonary Aspergillosis / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Limits: Humans Language: English Journal: Intensive Care Med Year: 2021 Document Type: Article Affiliation country: S00134-021-06449-4

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pulmonary Aspergillosis / Invasive Pulmonary Aspergillosis / COVID-19 Type of study: Diagnostic study / Observational study / Prognostic study Limits: Humans Language: English Journal: Intensive Care Med Year: 2021 Document Type: Article Affiliation country: S00134-021-06449-4