Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis.
COVID-19
ICU
Invasive aspergillosis
SARS-CoV-2
Viral pneumonia
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
02
04
2021
accepted:
28
05
2021
pubmed:
24
6
2021
medline:
31
7
2021
entrez:
23
6
2021
Statut:
ppublish
Résumé
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. A group of 28 international experts reviewed current insights in the epidemiology, diagnosis and management of CAPA and developed recommendations using GRADE methodology. 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. 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.
Identifiants
pubmed: 34160631
doi: 10.1007/s00134-021-06449-4
pii: 10.1007/s00134-021-06449-4
pmc: PMC8220883
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
819-834Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR002645
Pays : United States
Informations de copyright
© 2021. The Author(s).
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