Which algorithm diagnoses invasive pulmonary aspergillosis best in ICU patients with COPD?

• Published in: The European respiratory journal Vol. 50; no. 3; p. 1700532
• Main Authors: Bulpa, Pierre, Bihin, Benoît, Dimopoulos, George, Taccone, Fabio S, Van den Abeele, Anne-Marie, Misset, Benoît, Meersseman, Wouter, Spapen, Herbert, Cardoso, Teresa, Charles, Pierre-Emmanuel, Rello, Jordi, Vogelaers, Dirk, Blot, Stijn
• Format: Journal Article Web Resource
• Language: English
• Published: England European Respiratory Society Journals Ltd 01.09.2017; European Respiratory Society
• Subjects: Algorithms; Anesthesia & intensive care; Anesthésie & soins intensifs; Aspergillosis; Aspergillus - isolation & purification; Cancer; Chronic obstructive pulmonary disease; Female; Fungal infections; Glucocorticoids - therapeutic use; Human health sciences; Humans; Immunocompromised hosts; Intensive Care Units; Invasive Pulmonary Aspergillosis - complications; Invasive Pulmonary Aspergillosis - diagnosis; Invasive Pulmonary Aspergillosis/complications/diagnosis; Invasiveness; Lung - diagnostic imaging; Lung - microbiology; Lung - pathology; Lung diseases; Lung/diagnostic imaging/microbiology/pathology; Male; Middle Aged; Mycosis; Neutropenia; Obstructive lung disease; Opportunist infection; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - therapy; Pulmonary Disease, Chronic Obstructive/complications/diagnosis/therapy; Radiography, Thoracic - methods; Reproducibility of Results; Respiration, Artificial - methods; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; Respiratory Insufficiency/etiology/therapy; Risk groups; Sciences de la santé humaine
• ISSN: 0903-1936; 1399-3003; 1399-3003
• DOI: 10.1183/13993003.00532-2017

Invasive pulmonary aspergillosis (IPA) is a potentially lethal opportunistic infection, mainly affecting immunocompromised patients, particularly those with prolonged neutropenia [1]. Several reports have shown that Aspergillus spp. can also cause IPA in patients with a priori less severe immune dysfunction, such as those in intensive care units (ICUs) [2–5] or with chronic obstructive pulmonary disease (COPD) [5–8]. In these patients, diagnosis of IPA remains a challenge, because the reference diagnostic criteria (defined by the European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG)) were developed for research in high-risk patients and not specifically for patients in the ICU or patients with COPD [9]. Two alternative algorithms have been proposed for this setting: the COPD algorithm for patients with COPD [6] and the Clinical algorithm for patients in the ICU [10].