Universität zu Köln

Koehler, P., Bassetti, M., Kochanek, M., Shimabukuro-Vornhagen, A. and Cornely, O. A. (2019). Intensive care management of influenza-associated pulmonary aspergillosis. Clin. Microbiol. Infect., 25 (12). S. 1501 - 1510. OXFORD: ELSEVIER SCI LTD. ISSN 1469-0691

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Abstract

Background: Severe pulmonary infections are among the most common reasons for admission to intensive care units (ICU). Within the last decade, increasing reports of severe influenza pneumonia resulting in acute respiratory distress syndrome (ARDS) complicated by Aspergillus infection were published. Objectives: To provide a comprehensive review of management of influenza-associated pulmonary aspergillosis in patients with ARDS. Sources: Review of the literature pertaining to severe influenza-associated pulmonary aspergillosis. PubMed database was searched for publications from the database inception to January 2019. Content: In patients with lower respiratory symptoms, development of respiratory insufficiency should trigger rapid and thorough clinical evaluation, in particular in cases of suspected ARDS, including electrocardiography and echocardiography to exclude cardiac dysfunction, arrhythmias and ischaemia. Bronchoalveolar lavage should obtain lower respiratory tract samples for galactomannan assay, direct microscopy, culture, and bacterial, fungal and viral PCR. In case of positive Aspergillus testing, chest CT is the imaging modality of choice. If influenza pneumonia is diagnosed, neuraminidase inhibitors are the preferred approved drugs. When invasive aspergillosis is confirmed, first-line therapy consists of isavuconazole or voriconazole. Isavuconazole is an alternative in case of intolerance to voriconazole, drug edrug interactions, renal impairment, or if a spectrum of activity including the majority of Mucorales is desired. Primary anti-mould prophylaxis with posaconazole is recommended in haematology patients at high-risk. It may be considered in newly diagnosed influenza and ARDS, but ideally in clinical trials. (C) 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Koehler, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bassetti, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kochanek, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Shimabukuro-Vornhagen, A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, O. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-126241
DOI:	10.1016/j.cmi.2019.04.031
Journal or Publication Title:	Clin. Microbiol. Infect.
Volume:	25
Number:	12
Page Range:	S. 1501 - 1510
Date:	2019
Publisher:	ELSEVIER SCI LTD
Place of Publication:	OXFORD
ISSN:	1469-0691
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RESPIRATORY-DISTRESS-SYNDROME; FUNGAL-INFECTIONS; INVASIVE ASPERGILLOSIS; PRIMARY PROPHYLAXIS; VIRUS-INFECTION; MORTALITY; DISEASES; PATHOGENESIS; DEFINITIONS; ISAVUCONAZOLE Multiple languages Infectious Diseases; Microbiology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/12624