Invasive pulmonary aspergillosis in critically ill immunocompetent patients

Abstract

Invasive pulmonary aspergillosis (IPA) is a severe and well recognized infection in patients with hematological malignancies. However, increasing number of studies has reported the emergence of IPA in critically ill immunocompetent patients, mainly represented by chronic obstructive pulmonary disease (COPD) patients, with an estimated incidence of 2%. These patients are characterized by multifactorial impairments in their local defense. The major risk factors are systemic steroid use and administration of broad-spectrum antibiotics. IPA is responsible for high mortality, and its usual clinical, radiological, and biological specificities are generally absent in the immunocompetent patient. Rapid diagnosis requires histological evidence. Sensitivity of lower respiratory tract cultures and serology remains poor. The detection of galactomannan fungal antigen in the bronchoalveolar lavage may offer an interesting alternative diagnostic tool. The first-line recommended antifungal treatment is voriconazole, but other therapies exist like amphotericin, which was largely used in the past. We conducted a literature review focusing at IPA in the critically ill immunocompetent patients, in order to analyze its epidemiology, physiopathology, prognosis, diagnostic methods, and treatment.