Isolation of aspergillus sp. from the respiratory tract of critically ill non-immunocompromized patients is a rare but increasing event. In this context, the spectrum of the disease varies from colonization to invasive infection, however, patients without prolonged neutropenia or altered lymphocyte functions may die with unrecognized or already diagnosed invasive aspergillosis. The typical picture is encountered in patients with structural lung diseases (such as COPD) receiving or not long term steroids. In addition, some patients who survive the acute phase of severe sepsis and septic shock may present with invasive pulmonary aspergillosis. In this case, ICU acquired immunoparalysis is often advocated as the reason for such infections. Several issues are raised by the evidence that invasive pulmonary aspergillosis may occur in nonimmunocompromized critically ill patients: 1) should we rest on diagnostic criteria that have been proposed for hematological patients? 2) should we better identify patients at risk for the disease to monitor them adequately and maybe implement preemptive strategies in case of non-resolving pulmonary infiltrates? 3) how could we effectively distinguish colonization from acute or subacute invasion? 4) are therapeutic guidelines recommended for hematological patients valid in the ICU context; is there a lace for prophylaxis? Last, given the poor outcome reported in ICU patients with invasive pulmonary aspergillosis, is there a place for immunomodulation in these patients?
Full conference title:
4th Advances Against Aspergillosis
- AAA 4th (2010)