Invasive pulmonale Aspergillose

2019 ◽  
Vol 144 (17) ◽  
pp. 1218-1222
Author(s):  
Hanna Matthews ◽  
Holger Rohde ◽  
Dominic Wichmann ◽  
Stefan Kluge
Keyword(s):  
Influenza Infection ◽  
Invasive Pulmonary Aspergillosis ◽  
Organ Transplant ◽  
Severe Neutropenia ◽  
Solid Organ ◽  
First Line ◽  
Pulmonary Aspergillosis ◽  
Hematopoietic Stem ◽  
Severe Influenza ◽  
Life Threatening

AbstractInvasive pulmonary aspergillosis is a life-threatening disease occurring in patients with severe immunosuppression. It is classically associated with severe neutropenia following hematopoietic stem cell transplantation, but other risk factors include COPD, corticosteroid therapy, solid organ transplant, liver failure and preceding severe influenza infection. Due to the high mortality of the disease, rapid diagnosis and treatment are crucial. Diagnosis is based on CT scan and bronchoscopy including microscopy, culture and galactomannan detection in BAL. Histopathology remains the gold standard diagnosis but is not feasible in many cases. First line treatment is voriconazole, new recommendations also support the triazole isavuconazole.

scholarly journals Invasive pulmonary aspergillosis complicating non-influenza respiratory viral infections in solid organ transplant recipients

2021 ◽  
Author(s):  
Anna Apostolopoulou ◽  
Cornelius J Clancy ◽  
Abigail Skeel ◽  
M Hong Nguyen
Keyword(s):  
Small Bowel ◽  
Viral Infections ◽  
Invasive Pulmonary Aspergillosis ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Pulmonary Aspergillosis ◽  
Small Bowel Transplant ◽  
Respiratory Viral Infections

Abstract Invasive pulmonary aspergillosis (IPA) is increasingly recognized as a complication of severe influenza and coronavirus disease-2019. The extent to which other respiratory viral infections (RVIs) predispose to IPA is unclear. We performed a retrospective review of IPA occurring within 90-days of respiratory syncytial virus (RSV), parainfluenza or adenovirus infections (non-influenza respiratory viral infections; NI-RVI) in patients who underwent solid organ transplant between 1/15/2011 and 12/19/2017. At median post-transplant follow-up of 43.4 months, 221 of 2986 patients (7.4%) developed 255 RSV, parainfluenza or adenovirus infections. IPA complicating these NI-RVIs was exclusively observed in lung and small bowel transplant recipients, in whom incidence was 5% and 33%, respectively. Cumulative prednisone doses >140 mg within 7 days and pneumonia at time of NI-RVI were independent risk factors for IPA (odds ratios: 22.6 (4.5-112) and 7.2 (1.6-31.7), respectively). Mortality at 180-days following NI-RVI was 27% and 7% among patients with and without IPA, respectively (p=0.04). In conclusion, IPA can complicate RSV, parainfluenza and adenovirus infection in lung and small bowel transplant recipients. Future research is needed on the epidemiology of IPA complicating various RVIs. In the interim, physicians should be aware of this complication.

Bronchoalveolar Lavage Lateral-Flow Device Test for Invasive Pulmonary Aspergillosis in Solid Organ Transplant Patients

2014 ◽  
Vol 98 (8) ◽  
pp. 898-902 ◽  
Author(s):  
Birgit Willinger ◽  
Michaela Lackner ◽  
Cornelia Lass-Flörl ◽  
Jürgen Prattes ◽  
Verena Posch ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Invasive Pulmonary Aspergillosis ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Lateral Flow ◽  
Solid Organ ◽  
Pulmonary Aspergillosis ◽  
Transplant Patients ◽  
Flow Device ◽  
Device Test

scholarly journals Invasive pulmonary aspergillosisas a complication of severe influenza (case report)

2020 ◽  
Vol 12 (1) ◽  
pp. 96-103
Author(s):  
Yu. E. Melekhina ◽  
O. V. Shadrivova ◽  
E. V. Frolova ◽  
Yu. V. Borzova ◽  
E. V. Shagdileeva ◽  
...  
Keyword(s):  
Case Report ◽  
Influenza A ◽  
Clinical Case ◽  
Influenza Infection ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis ◽  
Severe Influenza ◽  
Influenza A H1n1 ◽  
Influenza Case ◽  
Immunocompetent Patients

During  last  years  the  frequency  of  invasive  pulmonary aspergillosis  (IPA)  in  immunocompetent  patients  has  increased. Clinical case report of successful treatment invasive aspergillosis  with  influenza  A(H1N1)  presented  in  the  article. We analyzed the special literature of patients with IPA following influenza infection. The timely identification and treatment of these patients are necessary.

scholarly journals 1101. Pulmonary Aspergillosis Complicating Non-Influenza Respiratory Virus Infections Among Solid Organ Transplant Recipients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S581-S581
Author(s):  
Anna Apostolopoulou ◽  
Cornelius J Clancy ◽  
J Alex Viehman ◽  
Minh Hong T Nguyen
Keyword(s):  
Median Time ◽  
Lung Transplant ◽  
Invasive Pulmonary Aspergillosis ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Research Support ◽  
Pulmonary Aspergillosis ◽  
Steroid Dose ◽  
Syncytial Virus

Abstract Background Invasive pulmonary aspergillosis (IPA) complicating influenza (flu) has been increasingly recognized. We have shown that IPA occurred in 22% of solid organ transplant (SOT) patients (pts) with flu. Associations between IPA and non-flu respiratory infections (non-flu-RVI) in SOT are unknown. Methods Retrospective review of consecutive pts transplanted from Jan 15, 2010-Dec 19, 2017. Pts who died within 100 days of SOT were excluded. Non-flu-RVI IFI was defined according to revised EORTC/MSG criteria. IFI had to occur within 100 days of non-flu-RVI. Colonization (COL) was defined as recovery of mold from airways in absence of IFI. Results 3,077 pts were included. 256 cases of non-flu-RVI were identified in lung (28%), multi-organ (16%), heart (6%), liver (1.3%) and kidney (1%) SOT pts. Parainfluenza (PIV) was most common (44%), followed by Respiratory Syncytial Virus (RSV, 60%) and Adenovirus (ADV, 15%). Median time to non-flu-RVI infections was 18.1 mos. 24% of pts with non-flu-RVI had lower tract disease. ADV was associated with longer hospital stay (median 14.5 days) than PIV (6.5 days) or RSV (6 days) (p=0.004). 59% of pts with non-flu-RVI required admission, and 64% received augmented steroids. Aspergillus was recovered from respiratory culture in 17% of non-flu-RVI pts. No other fungi were identified. Median time from non-flu-RVI to + culture was 29 days (Figure). 23% of pts with + culture had proven (7) or probable IPA (3), respectively; 77% had COL. 8% (3/37), 5% (6/114) and 7% (1/15) of pts with ADV, PIV, RSV infections developed IPA, respectively. 36% of pts were treated with a mold-active azole after + culture. Multivariate analysis identified lung transplant (p=0.02), PIV infection (p=0.02) and cumulative steroid dose in preceding 7 days (p=0.015) as independent risk factors for Aspergillus culture positivity. Cumulative steroid dose in preceding 7 days was an independent risk factor for IPA (p=0.03). Cumulative incidence of Aspergillus infections within 100 days of non-flu RVI Conclusion IPA and COL occurred in 4% and 13% of non-flu-RVI in SOT recipients. Routine antifungal prophylaxis is not recommended for SOT pts with non-flu-RVI. The value of prophylaxis at time of PIV infection for lung transplant pts with recent steroid augmentation should be studied. Disclosures Cornelius J. Clancy, MD, Astellas (Consultant, Grant/Research Support)Cidara (Consultant, Research Grant or Support)Melinta (Grant/Research Support)Merck (Consultant, Grant/Research Support)Needham Associates (Consultant)Qpex (Consultant)Scynexis (Consultant)Shionogi (Consultant)

Invasive pulmonary aspergillosis in solid organ transplant patients in the ICU

2021 ◽  
Author(s):  
Joachim Klein ◽  
Jordi Rello ◽  
George Dimopoulos ◽  
Pierre Bulpa ◽  
Koen Blot ◽  
...  
Keyword(s):  
Invasive Pulmonary Aspergillosis ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Pulmonary Aspergillosis ◽  
Transplant Patients

Invasive Pulmonary Aspergillosis

2020 ◽  
Vol 41 (01) ◽  
pp. 080-098 ◽  
Author(s):  
Marie-Pierre Ledoux ◽  
Blandine Guffroy ◽  
Yasmine Nivoix ◽  
Célestine Simand ◽  
Raoul Herbrecht
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Immunosuppressive Agents ◽  
Invasive Pulmonary Aspergillosis ◽  
Solid Organ ◽  
Pulmonary Aspergillosis ◽  
Hematopoietic Stem

AbstractInvasive pulmonary aspergillosis (IPA) remains difficult to diagnose and to treat. Most common risk factors are prolonged neutropenia, hematopoietic stem cell or solid organ transplantation, inherited or acquired immunodeficiency, administration of steroids or other immunosuppressive agents including monoclonal antibodies and new small molecules used for cancer therapy. Critically ill patients are also at high risk of IPA. Clinical signs are unspecific. Early computed tomography (CT)-scan identifies the two main aspects, angioinvasive and airway invasive aspergillosis. Although CT-scan findings are not fully specific they usually allow early initiation of therapy before mycological confirmation of the diagnosis. Role of 18F-fludeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) is discussed. Confirmation is based on microscopy and culture of respiratory samples, histopathology in case of biopsy, and importantly by detection of Aspergillus galactomannan using an immunoassay in serum and bronchoalveolar lavage fluid. Deoxyribonucleic acid detection by polymerase chain reaction is now standardized and increases the diagnosis yield. Two point of care tests detecting an Aspergillus glycoprotein using a lateral flow assay are also available. Mycological results allow classification into proven (irrespective of underlying condition), probable or possible (for cancer and severely immunosuppressed patients) or putative (for critically ill patients) IPA. New antifungal agents have been developed over the last 2 decades: new azoles (voriconazole, posaconazole, isavuconazole), lipid formulations of amphotericin B (liposomal amphotericin B, amphotericin B lipid complex), echinocandins (caspofungin, micafungin, anidulafungin). Results of main trials assessing these agents in monotherapy or in combination are presented as well as the recommendations for their use according to international guidelines. New agents are under development.

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