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Semin Respir Crit Care Med 2020; 41(06): 851-861
DOI: 10.1055/s-0040-1702210
Review Article

Invasive Pulmonary Aspergillosis in Chronic Obstructive Pulmonary Disease Exacerbations

Pierre Bulpa
1   Department of Intensive Care Unit, Mont-Godinne University Hospital, CHU UCL Namur, Namur, Belgium
,
Fabrice Duplaquet
2   Department of Pneumology, Mont-Godinne University Hospital, CHU UCL Namur, Namur, Belgium
,
George Dimopoulos
3   Department of Critical Care Medicine, Attikon University Hospital, Haidari, Greece
,
Dirk Vogelaers
4   Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
,
Stijn Blot
4   Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
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Abstract

Nowadays, reports in the literature support that patients with severe chronic obstructive pulmonary disease (COPD) are at higher risk to develop invasive pulmonary aspergillosis (IPA). However, the interpretation of Aspergillus-positive cultures from the airways in critically ill COPD is still a challenge. Indeed, as the patient could be merely colonized, tissue samples are required to ascertain IPA diagnosis but they are rarely obtained before death. Consequently, diagnosis is often only suspected on the basis of a combination of three elements: clinical characteristics, radiological images (mostly thoracic CT scan), and microbiological, and occasionally serological, results. To facilitate the analysis of these data, several algorithms have been developed, and the best effectiveness has been demonstrated by the Clinical algorithm. This is of importance as IPA prognosis in these patients remains presently very poor and using such an algorithm could promote prompter diagnosis, early initiation of treatment, and subsequently improved outcome.

While the most classical presentation of IPA in critically ill COPD patients features a combination of obstructive respiratory failure, antibiotic-resistant pneumonia, recent or chronic corticosteroid therapy, and positive Aspergillus cultures from the lower respiratory tract, the present article will also address less typical presentations and discuss the most appropriate treatments which could alter prognosis.

Keywords

Aspergillus - invasive pulmonary aspergillosis - COPD - exacerbation


Publication History

Article published online:
29 June 2020

© 2020. Thieme. All rights reserved.

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