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

Paul E. Verweij, Roger J. M. Brüggemann, Elie Azoulay, Matteo Bassetti, Stijn Blot (UGent) , Jochem B. Buil, Thierry Calandra, Tom Chiller, Cornelius J. Clancy, Oliver A. Cornely, et al.
(2021) INTENSIVE CARE MEDICINE. 47(8). p.819-834
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Abstract
Purpose 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. Methods A group of 28 international experts reviewed current insights in the epidemiology, diagnosis and management of CAPA and developed recommendations using GRADE methodology. Results 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. Conclusion 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
Critical Care and Intensive Care Medicine, Viral pneumonia, SARS-CoV-2, COVID-19, Invasive aspergillosis, ICU, CRITICALLY-ILL PATIENTS, INVASIVE ASPERGILLOSIS, VORICONAZOLE PHARMACOKINETICS, POSACONAZOLE, DIFFERENTIATION, GUIDELINES, SOCIETY, BETA, ICU

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MLA
Verweij, Paul E., et al. “Taskforce Report on the Diagnosis and Clinical Management of COVID-19 Associated Pulmonary Aspergillosis.” INTENSIVE CARE MEDICINE, vol. 47, no. 8, 2021, pp. 819–34, doi:10.1007/s00134-021-06449-4.
APA
Verweij, P. E., Brüggemann, R. J. M., Azoulay, E., Bassetti, M., Blot, S., Buil, J. B., … Martin-Loeches, I. (2021). Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis. INTENSIVE CARE MEDICINE, 47(8), 819–834. https://doi.org/10.1007/s00134-021-06449-4
Chicago author-date
Verweij, Paul E., Roger J. M. Brüggemann, Elie Azoulay, Matteo Bassetti, Stijn Blot, Jochem B. Buil, Thierry Calandra, et al. 2021. “Taskforce Report on the Diagnosis and Clinical Management of COVID-19 Associated Pulmonary Aspergillosis.” INTENSIVE CARE MEDICINE 47 (8): 819–34. https://doi.org/10.1007/s00134-021-06449-4.
Chicago author-date (all authors)
Verweij, Paul E., Roger J. M. Brüggemann, Elie Azoulay, Matteo Bassetti, Stijn Blot, Jochem B. Buil, Thierry Calandra, Tom Chiller, Cornelius J. Clancy, Oliver A. Cornely, Pieter Depuydt, Philipp Koehler, Katrien Lagrou, Dylan de Lange, Cornelia Lass-Flörl, Russell E. Lewis, Olivier Lortholary, Peter-Wei Lun Liu, Johan Maertens, M. Hong Nguyen, Thomas F. Patterson, Bart J. A. Rijnders, Alejandro Rodriguez, Thomas R. Rogers, Jeroen A. Schouten, Joost Wauters, Frank L. van de Veerdonk, and Ignacio Martin-Loeches. 2021. “Taskforce Report on the Diagnosis and Clinical Management of COVID-19 Associated Pulmonary Aspergillosis.” INTENSIVE CARE MEDICINE 47 (8): 819–834. doi:10.1007/s00134-021-06449-4.
Vancouver
1.
Verweij PE, Brüggemann RJM, Azoulay E, Bassetti M, Blot S, Buil JB, et al. Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis. INTENSIVE CARE MEDICINE. 2021;47(8):819–34.
IEEE
[1]
P. E. Verweij et al., “Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis,” INTENSIVE CARE MEDICINE, vol. 47, no. 8, pp. 819–834, 2021.
@article{8717315,
  abstract     = {{Purpose 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. Methods A group of 28 international experts reviewed current insights in the epidemiology, diagnosis and management of CAPA and developed recommendations using GRADE methodology. Results 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. Conclusion 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.}},
  author       = {{Verweij, Paul E. and Brüggemann, Roger J. M. and Azoulay, Elie and Bassetti, Matteo and Blot, Stijn and Buil, Jochem B. and Calandra, Thierry and Chiller, Tom and Clancy, Cornelius J. and Cornely, Oliver A. and Depuydt, Pieter and Koehler, Philipp and Lagrou, Katrien and de Lange, Dylan and Lass-Flörl, Cornelia and Lewis, Russell E. and Lortholary, Olivier and Liu, Peter-Wei Lun and Maertens, Johan and Nguyen, M. Hong and Patterson, Thomas F. and Rijnders, Bart J. A. and Rodriguez, Alejandro and Rogers, Thomas R. and Schouten, Jeroen A. and Wauters, Joost and van de Veerdonk, Frank L. and Martin-Loeches, Ignacio}},
  issn         = {{0342-4642}},
  journal      = {{INTENSIVE CARE MEDICINE}},
  keywords     = {{Critical Care and Intensive Care Medicine,Viral pneumonia,SARS-CoV-2,COVID-19,Invasive aspergillosis,ICU,CRITICALLY-ILL PATIENTS,INVASIVE ASPERGILLOSIS,VORICONAZOLE PHARMACOKINETICS,POSACONAZOLE,DIFFERENTIATION,GUIDELINES,SOCIETY,BETA,ICU}},
  language     = {{eng}},
  number       = {{8}},
  pages        = {{819--834}},
  title        = {{Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis}},
  url          = {{http://dx.doi.org/10.1007/s00134-021-06449-4}},
  volume       = {{47}},
  year         = {{2021}},
}
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