Aspergillosis: Emerging risk groups in critically ill patients

Kluge S, Strauss R, Kochanek M, Weigand MA, Rohde H, Lahmer T (2021)

Publication Type: Journal article, Review article

Publication year: 2021

Journal

Medical Mycology Oxford University Press

Book Volume: 60

Journal Issue: 1

DOI: 10.1093/mmy/myab064

Abstract

Information on invasive aspergillosis (IA) and other invasive filamentous fungal infections is limited in non-neutropenic patients admitted to the intensive care unit (ICU) and presenting with no classic IA risk factors. This review is based on the critical appraisal of relevant literature, on the authors' own experience and on discussions that took place at a consensus conference. It aims to review risk factors favoring aspergillosis in ICU patients, with a special emphasis on often overlooked or neglected conditions. In the ICU patients, corticosteroid use to treat underlying conditions such as chronic obstructive pulmonary disease (COPD), sepsis, or severe COVID-19, represents a cardinal risk factor for IA. Important additional host risk factors are COPD, decompensated cirrhosis, liver failure, and severe viral pneumonia (influenza, COVID-19). Clinical observations indicate that patients admitted to the ICU because of sepsis or acute respiratory distress syndrome are more likely to develop probable or proven IA, suggesting that sepsis could also be a possible direct risk factor for IA, as could small molecule inhibitors used in oncology. There are no recommendations for prophylaxis in ICU patients; posaconazole mold-active primary prophylaxis is used in some centers according to guidelines for other patient populations and IA treatment in critically ill patients is basically the same as in other patient populations. A combined evaluation of clinical signs and imaging, classical biomarkers such as the GM assay, and fungal cultures examination, remain the best option to assess response to treatment.

Authors with CRIS profile

Richard Strauss Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology

Involved external institutions

Universitätsklinikum Hamburg-Eppendorf (UKE) DE Germany (DE) Universität zu Köln DE Germany (DE) Universitätsklinikum Heidelberg DE Germany (DE) Technische Universität München (TUM) DE Germany (DE)

How to cite

APA:

Kluge, S., Strauss, R., Kochanek, M., Weigand, M.A., Rohde, H., & Lahmer, T. (2021). Aspergillosis: Emerging risk groups in critically ill patients. Medical Mycology, 60(1). https://doi.org/10.1093/mmy/myab064

MLA:

Kluge, Stefan, et al. "Aspergillosis: Emerging risk groups in critically ill patients." Medical Mycology 60.1 (2021).

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