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Invasive Aspergillosis and the ICU

Invasive aspergillosis is a serious opportunistic infection associated with extremely high mortality.1 It typically affects individuals who are severely immunocompromised and/or have well-established risk factors, which may be related to:2-5​​​​​​​

Overall, the majority of patients that contract the infection have a haematological malignancy as an underlying condition (>50% of cases).Looking specifically at the ICU patient population, however, information about the epidemiology of invasive aspergillosis is scarce, but data are emerging for this particular and unique setting.4

Unusual suspects

In addition to immunocompromised patients, it has become clear in recent years that Aspergillus species can cause invasive disease in less traditional categories of hosts for whom clinical risk factors are less defined, including critically ill patients admitted to the ICU.2–4,7 These patients may be mildly immunocompromised due to non-malignant conditions,8 or even have no immunosuppression or underlying diseases at all.3 As such, they may fall outside the standard EORTC/MSG definitions for invasive fungal disease,9 making the diagnosis of invasive aspergillosis a real challenge.4 In particular, invasive aspergillosis is a common complication of severe influenza in the ICU, affecting ~20% of patients.10,11
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Underlying conditions in ICU patients with invasive aspergillosis (n=297)4

Key Facts about the ICU7,10,11​​​​​​​

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Invasive Aspergillosis

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Abbreviations:

​​​​​​​​​​​​​​ ARDS, acute respiratory distress syndrome; BMT, bone marrow transplant; COPD, chronic obstructive pulmonary disease; EORTC/MSG, European Organization for Research and Treatment of Cancer/Mycosis Study Group; HIV, human immunodeficiency virus; ICU, intensive care unit; TNF, tumour necrosis factor.

References
  1. Lin SJ et al. Clin Infect Dis 2001;32(3):358–366.
  2. Bassetti M et al. Infect Dis Ther 2018;7(1):17–27. ECDC. Influenza-associated invasive pulmonary. 
  3. aspergillosis, Europe. 2018. Available from: https://www.ecdc.europa.eu/sites/portal/files/documents/aspergillus-and-.... Accessed October 2020.
  4. Taccone FS et al. Crit Care 2015;19:7. 
  5. Baddley JW. Med Mycol 2011;49 Suppl 1:S7–S12.
  6. Cornillet A et al. Clin Infect Dis 2006;43(5):577–584. 
  7. Bassetti M et al. IDCases 2018;12:7–9.
  8. Delsuc C et al. Crit Care 2015;19:421. 
  9. De Pauw B et al. Clin Infect Dis 2008;46(12):1813–1821.
  10. Schauwvlieghe A et al. Lancet Respir Med. 2018;6(10):782–792. 
  11. Wauters J et al. Intensive Care Med 2012;38(11):1761–1768.
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