Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis.

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Version: Final published version
License: CC BY-NC 4.0
Serval ID
serval:BIB_4FF82B926360
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis.
Journal
Intensive care medicine
Author(s)
Verweij P.E., Brüggemann RJM, Azoulay E., Bassetti M., Blot S., Buil J.B., Calandra T., Chiller T., Clancy C.J., Cornely O.A., Depuydt P., Koehler P., Lagrou K., de Lange D., Lass-Flörl C., Lewis R.E., Lortholary O., Liu P.L., Maertens J., Nguyen M.H., Patterson T.F., Rijnders BJA, Rodriguez A., Rogers T.R., Schouten J.A., Wauters J., van de Veerdonk F.L., Martin-Loeches I.
ISSN
1432-1238 (Electronic)
ISSN-L
0342-4642
Publication state
Published
Issued date
08/2021
Peer-reviewed
Oui
Volume
47
Number
8
Pages
819-834
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
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.
Keywords
COVID-19, Humans, Intensive Care Units, Invasive Pulmonary Aspergillosis/diagnosis, Pulmonary Aspergillosis/diagnosis, Pulmonary Aspergillosis/drug therapy, Pulmonary Aspergillosis/epidemiology, SARS-CoV-2, ICU, Invasive aspergillosis, Viral pneumonia
Pubmed
Web of science
Open Access
Yes
Create date
29/06/2021 7:56
Last modification date
12/01/2022 7:09
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