Disseminated Aspergillosis in Intensive Care Unit Patients: An Autopsy Study

Dimοpoulos, George; Piagnerelli, Michaël; Berré, Jacques; Eddafali, Brahim; Salmon, Isabelle; Vincent, Jean‐Louis

doi:10.1179/joc.2003.15.1.71

Cited by 92 publications

(69 citation statements)

References 21 publications

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“…The methods available to diagnose fungal infections in patients do not reliably differentiate colonization from systemic infection, and blood cultures (indicating invasive infection) are negative in 50% of patients with invasive candidiasis [16]. The often rapid fatal outcome after ICU admission suggests that colonization with fungi can occur before ICU admission [12].…”

Section: Discussionmentioning

confidence: 99%

Comparison of clinical and post-mortem findings in intensive care unit patients

Maris

Martin

Créteur³

et al. 2007

Virchows Arch

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The autopsy has long been regarded as an important tool for clinical confrontation, education and quality assurance. The aims of this study were to examine the correlation between the clinical diagnosis and autopsy findings in adult patients who died in an intensive care unit (ICU) and to identify the types of errors in diagnosis to improve quality of care. Autopsies from 289 patients who died in the ICU during a 2-year period were studied. Post-mortem examination revealed unexpected findings in 61 patients (21%) including malignancy, pulmonary embolism, aspergillosis, myocardial or mesenteric infarction and unsuspected bacterial, viral or fungal infection. These unexpected findings were classified as Goldman class I errors in 17 (6%), class II in 38 (13%) and class III in six (2%) cases. Although the incidence of unexpected findings with clinical significance was low, post-mortem examination remains a valuable source of pertinent information that may improve the management of ICU patients.

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Section: Discussionmentioning

confidence: 99%

Comparison of clinical and post-mortem findings in intensive care unit patients

Maris

Martin

Créteur³

et al. 2007

Virchows Arch

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“…Aspergillus spp. are isolated from lower respiratory patients, and in about half of these patients, this finding represents IPA [44][45][46][47][48]. In one retrospective study in a medical ICU, an incidence of invasive aspergillosis of 5.8% was found with pulmonary involvement in most cases.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Critically ill patients are prone to developing disturbances in immunoregulation during their stay in the ICU, which renders them more vulnerable to fungal infections. Risk factors such as COPD, systemic corticosteroid therapy, non-haematological malignancy, chronic renal disease, liver failure, diabetes mellitus, near-drowning, HIV infection, autoimmune diseases, malnutrition and extensive burns have been described [44][45][46][47]49].…”

Section: Risk Factorsmentioning

confidence: 99%

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

564

596

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Aspergillus is a mould which may lead to a variety of infectious, allergic diseases depending on the host's immune status or pulmonary structure. Invasive pulmonary aspergillosis occurs primarily in patients with severe immunodeficiency. The significance of this infection has dramatically increased with growing numbers of patients with impaired immune state associated with the management of malignancy, organ transplantation, autoimmune and inflammatory conditions; critically ill patients and those with chronic obstructive pulmonary disease appear to be at an increased risk. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has resulted in lower mortality rates associated with this infection. Chronic necrotising aspergillosis is a locally invasive disease described in patients with chronic lung disease or mild immunodeficiency. Aspergilloma is usually found in patients with previously formed cavities in the lung, whereas allergic bronchopulmonary aspergillosis, a hypersensitivity reaction to Aspergillus antigens, is generally seen in patients with atopy, asthma or cystic fibrosis. This review provides an update on the evolving epidemiology and risk factors of the major manifestations of Aspergillus lung disease and the clinical manifestations that should prompt the clinician to consider these conditions. Current approaches for the diagnosis and management of these syndromes are discussed.

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“…However, some studies indicate that the population at risk for pulmonary or disseminated IA can be expanded to patients with chronic obstructive pulmonary disease (COPD) as well as to nontransplant intensive care patients (11,17). Aspergillus fumigatus is the main causative agent of IA, although the number of other Aspergillus species able to produce fungal disease is on the rise, increasing the complexity of this infection (24,45).…”

mentioning

confidence: 99%

Role of Aspergillus lentulus 14-α Sterol Demethylase (Cyp51A) in Azole Drug Susceptibility

Mellado

Alcàzar-Fuoli

Cuenca‐Estrella

et al. 2011

Antimicrob Agents Chemother

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Recent studies have demonstrated that some morphologically atypical Aspergillus fumigatus strains are different species belonging to the section Fumigati. Aspergillus lentulus, one of these sibling species, is increasingly reported in patients under corticosteroid treatment. MICs of most antifungals in clinical use are elevated against A. lentulus, and it shows primary resistance to azole drugs. Two A. lentulus cytochrome P450 14-␣ sterol demethylases, encoded by A. lentulus cyp51A (Alcyp51A) and Alcyp51B genes, were identified. Targeted cyp51A gene knockout in A. lentulus showed that the intrinsic azole resistance of this species is cyp51A dependent. The ⌬cyp51A strain was morphologically indistinguishable from the A. lentulus wild-type strain, retaining the ability to cause pulmonary disease in neutropenic mice. The heterologous expression of A. lentulus cyp51A was performed in an A. fumigatus cyp51A-deficient strain, confirming that Cyp51A is responsible for the differences in A. lentulus-azole drug interaction.

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Disseminated Aspergillosis in Intensive Care Unit Patients: An Autopsy Study

Cited by 92 publications

References 21 publications

Comparison of clinical and post-mortem findings in intensive care unit patients

Comparison of clinical and post-mortem findings in intensive care unit patients

Pulmonary aspergillosis: a clinical review

Role of Aspergillus lentulus 14-α Sterol Demethylase (Cyp51A) in Azole Drug Susceptibility

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