Journal Article

Invasive Aspergillosis in the Intensive Care Unit

Wouter Meersseman, Katrien Lagrou, Johan Maertens and Eric Van Wijngaerden

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 45, issue 2, pages 205-216
Published in print July 2007 | ISSN: 1058-4838
Published online July 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/518852
Invasive Aspergillosis in the Intensive Care Unit

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Data regarding the incidence of invasive aspergillosis (IA) in the intensive care unit (ICU) are scarce, and the incidence varies. An incidence of 5.8% in a medical ICU has been reported. The majority of patients did not have a hematological malignancy, and conditions such as chronic obstructive pulmonary disease and liver failure became recognized as risk factors. Diagnosis of IA remains difficult. Mechanical ventilation makes it difficult to interpret clinical signs, and radiological diagnoses are clouded by underlying lung pathologies. The significance of a positive respiratory culture result is greatly uncertain, because cultures of respiratory specimens have low sensitivity (50%) and specificity (20%–70%, depending on whether the patient is immunocompromised). The use of serologic markers has never been validated in an ICU population. Limited experience with the detection of galactomannan in bronchoalveolar lavage fluid specimens has yielded promising results. Because of a delay in the diagnosis of IA, the mortality rate exceeds 50%. Recently, our therapeutic armamentarium against IA has improved. Data concerning the safety and efficacy of new antifungal agents in the ICU setting, however, are lacking.

Journal Article.  5738 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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