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Published on: March 22, 2012
Invasive pulmonary aspergillosis in the ICU: tale of a broadening risk profile
Despoina Koulenti1,2, Georgios Papathanakos3, Stijn Blot2,4
12nd Critical Care Department, Attikon University Hospital, Athens, Greece.
Purpose Of Review:
In the absence of histopathological proof, the diagnosis of invasive pulmonary aspergillosis (IPA) is usually based on mycology (not on tissue), medical imaging, and the patient's risk profile for acquiring invasive fungal disease. Here, we review the changes in risk profile for IPA that took place over the past decades.
Recent Findings:
In the early 2000s IPA was considered exclusively a disease of immunocompromised patients. Particularly in the context of critical illness, the risk profile has been broadened steadily. Acute viral infection by influenza or SARS-Cov-2 are now well recognized risk factors for IPA.
Summary:
The classic risk profile ('host factors') reflecting an immunocompromised status was first enlarged by a spectrum of chronic conditions such as AIDS, cirrhosis, and chronic obstructive pulmonary disease. In the presence of critical illness, especially characterized by sepsis and/or severe respiratory distress, any chronic condition could add to the risk profile. Recently, acute viral infections have been associated with IPA leading to the concepts of influenza-associated IPA and COVID-19-associated IPA. These viral infections may affect patients without underlying disease. Hence, the risk for IPA is now a reality for ICU patients, even in the absence of any chronic conditions.
Insights
The risk profile for invasive pulmonary aspergillosis (IPA) has expanded beyond immunocompromised patients. Viral infections like influenza and COVID-19 are now recognized as significant risk factors for IPA, even in critically ill patients without underlying conditions.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pulmonology
Background:
- Invasive pulmonary aspergillosis (IPA) diagnosis traditionally relies on mycology, imaging, and risk assessment, often without histopathological confirmation.
- Historically, IPA was primarily associated with immunocompromised individuals.
Conclusions:
- The risk of IPA is no longer confined to immunocompromised individuals and now extends to critically ill patients, including those with viral infections.
- Understanding the expanded and evolving risk factors is crucial for timely diagnosis and management of invasive pulmonary aspergillosis.
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