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Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease exacerbations

Pierre Bulpa, Fabrice Duplaquet, George Dimopoulos, Dirk Vogelaers (UGent) and Stijn Blot (UGent)
(2020) SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE. 41(06). p.851-861
Author
Organization
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
Critical Care and Intensive Care Medicine, Pulmonary and Respiratory Medicine, Aspergillus, invasive pulmonary aspergillosis, COPD, exacerbation, BRONCHOALVEOLAR LAVAGE FLUID, CRITICALLY-ILL PATIENTS, LINKED-IMMUNOSORBENT-ASSAY, RESPIRATORY-TRACT, RISK-FACTORS, CIRCULATING GALACTOMANNAN, CLINICAL PRESENTATION, TOMOGRAPHIC SCAN, EARLY-DIAGNOSIS, AMPHOTERICIN-B

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Citation

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MLA
Bulpa, Pierre, et al. “Invasive Pulmonary Aspergillosis in Chronic Obstructive Pulmonary Disease Exacerbations.” SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE, vol. 41, no. 06, 2020, pp. 851–61, doi:10.1055/s-0040-1702210.
APA
Bulpa, P., Duplaquet, F., Dimopoulos, G., Vogelaers, D., & Blot, S. (2020). Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease exacerbations. SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE, 41(06), 851–861. https://doi.org/10.1055/s-0040-1702210
Chicago author-date
Bulpa, Pierre, Fabrice Duplaquet, George Dimopoulos, Dirk Vogelaers, and Stijn Blot. 2020. “Invasive Pulmonary Aspergillosis in Chronic Obstructive Pulmonary Disease Exacerbations.” SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE 41 (06): 851–61. https://doi.org/10.1055/s-0040-1702210.
Chicago author-date (all authors)
Bulpa, Pierre, Fabrice Duplaquet, George Dimopoulos, Dirk Vogelaers, and Stijn Blot. 2020. “Invasive Pulmonary Aspergillosis in Chronic Obstructive Pulmonary Disease Exacerbations.” SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE 41 (06): 851–861. doi:10.1055/s-0040-1702210.
Vancouver
1.
Bulpa P, Duplaquet F, Dimopoulos G, Vogelaers D, Blot S. Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease exacerbations. SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE. 2020;41(06):851–61.
IEEE
[1]
P. Bulpa, F. Duplaquet, G. Dimopoulos, D. Vogelaers, and S. Blot, “Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease exacerbations,” SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE, vol. 41, no. 06, pp. 851–861, 2020.
@article{8670316,
  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.}},
  author       = {{Bulpa, Pierre and Duplaquet, Fabrice and Dimopoulos, George and Vogelaers, Dirk and Blot, Stijn}},
  issn         = {{1069-3424}},
  journal      = {{SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE}},
  keywords     = {{Critical Care and Intensive Care Medicine,Pulmonary and Respiratory Medicine,Aspergillus,invasive pulmonary aspergillosis,COPD,exacerbation,BRONCHOALVEOLAR LAVAGE FLUID,CRITICALLY-ILL PATIENTS,LINKED-IMMUNOSORBENT-ASSAY,RESPIRATORY-TRACT,RISK-FACTORS,CIRCULATING GALACTOMANNAN,CLINICAL PRESENTATION,TOMOGRAPHIC SCAN,EARLY-DIAGNOSIS,AMPHOTERICIN-B}},
  language     = {{eng}},
  number       = {{06}},
  pages        = {{851--861}},
  title        = {{Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease exacerbations}},
  url          = {{http://dx.doi.org/10.1055/s-0040-1702210}},
  volume       = {{41}},
  year         = {{2020}},
}
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