International survey on influenza-associated pulmonary aspergillosis (IAPA) in intensive care units: responses suggest low awareness and potential underdiagnosis outside Europe

Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion

“…IAPA has emerged as a severe complication of influenza, especially in ICU patients, and this secondary infection may occur in any patient, including those considered to be at low risk of developing IPA. The global epidemiology of IAPA may be variable, which might be partly due to underdiagnosis [24]. The clinical presentation of IAPA includes invasive Aspergillus tracheobronchitis, which requires bronchoscopic visualization of plaques in the airways to make a diagnosis.…”

“…Studies have shown considerable variation in rates of IAPA in different countries, with high rates in the Netherlands, Belgium and Taiwan, but lower rates in other countries [19], and in some we do not know the incidence (e.g., USA) [20][21][22]. Potential reasons for these regional differences are related to the underlying conditions, concomitant exposure to corticosteroids, environmental factors, including exposure to Aspergillus, use of non-culture-based diagnostic tests for Aspergillus (e.g., galactomannan (GM)) and differences in awareness of IAPA [23][24][25]. Autopsy rates are very low, which results in a considerable underdiagnosis in many countries [26].…”

“…Furthermore, patients are often given steroids in the first few days preceding or after ICU admission for a variety of reasons including COPD exacerbation or complications such as sepsis. With surveys suggesting that approximately half of the physicians are not aware of IAPA [24], many physicians may additionally not be aware of the potential drawbacks of corticosteroids. Whenever the use of corticosteroids is unavoidable, more efforts (bronchoscopy with GM detection in BAL fluid or serum β-D-glucan test) should be made to exclude or diagnose IAPA [41].…”

Impact of negative air pressure in ICU rooms on the risk of pulmonary aspergillosis in COVID-19 patients

“…This high risk of pulmonary aspergillosis was also seen in patients with severe influenza (19%). Thevissen et al reported that the rate of influenza-associated pulmonary aspergillosis (IAPA) varied according to country and that variation in IAPA prevalence might be related to underdiagnosis due to lower use of galactomannan testing on broncho-alveolar lavage or serum in some areas [6].…”

Detecting influenza-associated pulmonary aspergillosis by determination of galactomannan in broncho-alveolar lavage fluid and in serum: should we add (1,3)-beta-D-glucan to improve efficacy

“…We read with great interest the recent research letter by Thevissen et al who reported the findings of their international survey regarding the detection of influenzaassociated pulmonary aspergillosis (IAPA), with a focus on the use of galactomannan (GM) in broncho-alveolar lavage (BAL) fluid and serum [1]. They note that greater awareness of IAPA is needed, as are rapid diagnostic tests [1]. We would like to make some comments.…”