Detection of Invasive Aspergillosis in Critically Ill Patients with Influenza: The Role of Plasma Galactomannan

According to consensus criteria, IPA is diagnosed on the basis of clinical and radiological criteria in combination with the identification of Aspergillus species through growth in BAL fluid, histopathological evidence of lung tissue invasion, or galactomannan antigen detection in BAL or blood sampl...

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Bibliographic Details
Published in:	American journal of respiratory and critical care medicine 2019-09, Vol.200 (5), p.636-638
Main Authors:	van de Groep, Kirsten, Verboom, Diana M, van de Veerdonk, Frank L, Haas, Pieter-Jan A, van der Poll, Tom, Schultz, Marcus J, Bonten, Marc J M, Cremer, Olaf L
Format:	Article
Language:	eng
Subjects:	Biomarkers - blood Critical Illness Female Fungal infections Humans Infectious diseases Influenza Influenza, Human - complications Influenza, Human - physiopathology Intensive care Invasive Pulmonary Aspergillosis - diagnosis Invasive Pulmonary Aspergillosis - etiology Male Mannans - blood Mortality Patients Streptococcus infections
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Summary:	According to consensus criteria, IPA is diagnosed on the basis of clinical and radiological criteria in combination with the identification of Aspergillus species through growth in BAL fluid, histopathological evidence of lung tissue invasion, or galactomannan antigen detection in BAL or blood samples (4). Patients with Invasive Pulmonary Aspergillosis Influenza Diagnosis Sex/Age Host Factor Post Hoc Plasma GM BAL Culture BAL GM Radiology Treatment 28-Day Mortality (Co)pathogen sCAP, Remarks A-H1N1 Post hoc F/63 No t1: negative — — C-X-ray: possible infiltration, signs of severe emphysema — Died (+7), no PA Coinfection: Streptococcus pneumoniae, sputum culture Aspergillus fumigatus t7: 0.78 A-H1N1 Post hoc F/68 No t1: 5.63 — — C-X-ray: possible infiltration, signs of decompensation — Died (+2), PA negative* Coinfection: S. pneumoniae, patient refused invasive mechanical ventilation A-H1N1 Clinical M/62 No t1: 0.91 A. fumigatus t2: 3.34 C-X-ray: bilateral infiltrates t5: ampho B liposomal Died (+10), no PA Coinfection: none, t1 clinical serum GM: 0.25 t7: 5.15 A-H1N1 Clinical M/54† No t1: negative A. fumigatus t5:2.78 C-CT: bilateral infiltration, ground-glass spots t7: voriconazole Survived Coinfection: Staphylococcus aureus t7: negative A-H1N1 Clinical M/56† Yes t1: negative A. fumigatus t1: 0.45 C-X-ray: infiltrate t3: voriconazole Survived Coinfection: S. aureus, Pseudomonas aeruginosa t7: negative t5: 1.47 A-H3 Clinical F/48 Yes t1: negative Aspergillus terreus t1: 4.11 HR C-CT: bilateral diffuse infiltrates, ground glass t2: posaconazole Died (+20), no PA Coinfection: P. aeruginosa t7: negative A. fumigatus No Post hoc M/38 Yes t1: 1.28 — — C-X-ray: infiltrate Prophylactic posaconazole Survived Unknown causative pathogen, rapid clinical recovery (t4 hospital discharge) No Clinical F/57 Yes t1: negative Negative t2: 5.66 C-CTA: infiltrate, bilateral ground-glass spots t4: voriconazole Survived S. pneumoniae, Pneumocystis jirovecii t7: negative No Clinical M/50 No t1: negative A. fumigatus t1: 2.90 C-X-ray: infiltrates with ground glass, 2 round consolidations t1: ampho B liposomal Died (+1), no PA Unknown causative pathogen, diagnosed with acute myeloid leukemia in ICU No Clinical M/77 No t1: negative Negative t1: right 1.66, left 0.44 C-CTA: bilateral ground glass, possible infiltrate No treatment initiated Died (+10), no PA S. pneumoniae, positive BAL GM was clinically considered irrelevant t7: negative Definition of abbreviations: — = not performed;
ISSN:	1073-449X 1535-4970