Invasive aspergillosis in critically ill patients: Review of Definitions and Diagnostic Approaches

Invasive fungal disease (IFD) associated with Coronavirus Disease 2019 (COVID-19) has focussed predominantly on invasive pulmonary aspergillosis. However, increasingly emergent are non-Aspergillus fungal infections including candidiasis, mucormycosis, pneumocystosis, cryptococcosis, and endemic mycoses. These infections are associated with poor outcomes, and their management is challenged by delayed diagnosis due to similarities of presentation to aspergillosis or to non-specific features in already critically ill patients. There has been a variability in the incidence of different IFDs often related to heterogeneity in patient populations, diagnostic protocols, and definitions used to classify IFD. Here, we summarise and address knowledge gaps related to the epidemiology, risks, diagnosis, and management of COVID-19-associated fungal infections other than aspergillosis.

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Influence of Sustained Low-Efficiency Dialysis Treatment on Isavuconazole Plasma Levels in Critically Ill Patients

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01162-19 ◽

2019 ◽

Vol 63 (11) ◽

Cited By ~ 1

Author(s):

Tobias Lahmer ◽

Gonzalo Batres Baires ◽

Markus Heilmaier ◽

Roland M. Schmid ◽

Fritz Sörgel ◽

...

Keyword(s):

Invasive Aspergillosis ◽

Critically Ill ◽

Critically Ill Patients ◽

Plasma Levels ◽

Hematological Malignancies ◽

Plasma Concentrations ◽

Dialysis Treatment ◽

Before And After ◽

Low Efficiency

ABSTRACT Isavuconazole plasma concentrations were measured before and after sustained low-efficiency dialysis (SLED) treatment in 22 critically ill adult patients with probable invasive aspergillosis and underlying hematological malignancies. Isavuconazole levels were significantly lower after SLED treatment (5.73 versus 3.36 μg/ml; P < 0.001). However, even after SLED treatment, isavuconazole concentrations exceeded the in vivo MICs for several relevant Aspergillus species.

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Candida in the Respiratory Tract Potentially Triggers Galactomannan Positivity in Nonhematological Patients

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00138-19 ◽

2019 ◽

Vol 63 (6) ◽

Cited By ~ 2

Author(s):

M. Aigner ◽

M. Wanner ◽

P. Kreidl ◽

C. Lass-Flörl ◽

M. Lackner

Keyword(s):

Respiratory Tract ◽

Invasive Aspergillosis ◽

Critically Ill ◽

Critically Ill Patients ◽

False Positive ◽

Candida Glabrata ◽

Species Abundance ◽

Diagnostic Value ◽

Content Type ◽

Culture Positive

ABSTRACT BAL fluid samples from critically ill patients shared a rate of 29% false-positive galactomannan results. We aimed to determine whether Candida species abundance in BAL fluid causes galactomannan (GM) positivity. A total of 89 Candida culture-positive BAL fluid samples from patients without suspicion of invasive aspergillosis (IA) were analyzed. GM results were correlated with Candida species abundance, Candida species quantity, and patient data. Candida species quantities of ≥104/ml and Candida glabrata abundance were significantly associated with positive GM results. The added diagnostic value of GM in BAL fluid for diagnosing IA in critically ill patients is limited.

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Circulation and circulatory support in the critically ill

Oxford Textbook of Medicine ◽

10.1093/med/9780198746690.003.0389 ◽

2020 ◽

pp. 3881-3891

Author(s):

Michael R. Pinsky

Keyword(s):

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Rapid Assessment ◽

Circulatory Support ◽

Critically Ill Patient ◽

Haemodynamic Monitoring ◽

Vast Array ◽

Bedside Echocardiography ◽

Diagnostic Approaches

Cardiovascular dysfunction is common in critically ill patients and is the primary cause of death in a vast array of illnesses. The prompt identification and diagnosis of its probable cause, coupled to appropriate resuscitation and (when possible) specific treatments, are cornerstones of intensive care medicine. Cardiovascular performance can be assessed clinically at the bedside and through haemodynamic monitoring, and with therapeutic or other proactive interventions. Rapid assessment of shocked patients by bedside echocardiography is increasingly used in those institutions where equipment and expertise are available. Diagnostic approaches or therapies based on data derived from invasive haemodynamic monitoring in the critically ill patient assume that specific patterns of derangement reflect specific disease processes, which will respond to appropriate intervention.

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