Disease-specific gaps within fungal respiratory tract infections: clinical features, diagnosis, and management in critically ill patients

Abstract

Purpose of reviewWe aim to examine the most recent findings in the area of invasive pulmonary fungal infections to determine the appropriate/and or lack of prevention measures and treatment of upper fungal respiratory tract infections in the critically ill.Recent findingsThis will be addressed by focusing on the pathogens and prognosis over different bedridden periods in ICU patients, the occurrence of invasive fungal respiratory superinfections in patients with severe coronavirus disease 2019 which has been recently noted following the SARS-CoV-2 pandemic. Relevant reports referenced within include randomized controlled trials, meta-analyses, observational studies, systematic reviews, and international guidelines, where applicable. Of note, it is clear there is a significant gap in our knowledge regarding whether bacterial and fungal infections in coronavirus disease 2019 are directly attributable to SARS-CoV-2 or a consequence of factors such as managing high numbers of critically unwell patients, and the prolonged duration of mechanical ventilation/ICU admission duration of stay.SummaryAn optimal diagnostic algorithm incorporating fungal biomarkers and molecular tools for early and accurate diagnosis of Pneumocystis pneumonia, invasive aspergillosis, candidemia, and endemic mycoses continues to be limited clinically. There is a lack of standardized molecular approach to identify fungal pathogens directly in formalin-fixed paraffin-embedded tissues and suboptimal diagnostic approaches for mould blood cultures, tissue culture processing for Mucorales, and fungal respiratory cultures (i.e., the routine use of bronchoscopic examination in ICU patients with influenza-associated pulmonary aspergillosis) for fungal point-of-care testing to detect and identify new, emerging or underrecognized, rare, or uncommon fungal pathogens.

Editorial: Coronavirus disease 2019 (COVID-19) - advances in epidemiology, diagnostics, treatments, host-directed therapies, pathogenesis, vaccines, and ongoing challenges

“…Ignacio Martin-Loeches et al [9] discuss the most recent findings in the area of diagnosis, treatment, and prevention of fungal infections of the respiratory tract, especially in the critically ill.…”

“…The early and accurate diagnosis of these are being hindered by the absence of optimal diagnostic algorithms for fungal point-of-care testing. Ignacio Martin-Loeches et al [9] discuss the most recent findings in the area of diagnosis, treatment, and prevention of fungal infections of the respiratory tract, especially in the critically ill.…”

Trichoderma spp.-Related Pneumonia: A Case Report in Heart–Lung Transplantation Recipient and a Systematic Literature Review

“…At the same time, the broadened use of systemic antifungal drugs makes them quite a common component of antimicrobial therapy, with the development of resistance now deserving antifungal stewardship strategies [ 8 , 9 ]. Considering the important limitation in terms of diagnostic tools and turn-around time of traditional tests, risk factor evaluation remains pivotal to guide clinical orientation to treatment [ 10 ]. The most common risk factors characterizing ICU admission and predisposing LTx recipients to opportunistic infection are immunosuppressive and immunomodulatory therapy, loss or impairment of cough reflex, CVM co-infection, ischemia of the anastomosis, and ICU-acquired weakness [ 11 , 12 ].…”