Abstract
Nowadays, reports in the literature support that patients with severe chronic obstructive
pulmonary disease (COPD) are at higher risk to develop invasive pulmonary aspergillosis
(IPA). However, the interpretation of Aspergillus-positive cultures from the airways in critically ill COPD is still a challenge. Indeed,
as the patient could be merely colonized, tissue samples are required to ascertain
IPA diagnosis but they are rarely obtained before death. Consequently, diagnosis is
often only suspected on the basis of a combination of three elements: clinical characteristics,
radiological images (mostly thoracic CT scan), and microbiological, and occasionally
serological, results. To facilitate the analysis of these data, several algorithms
have been developed, and the best effectiveness has been demonstrated by the Clinical
algorithm. This is of importance as IPA prognosis in these patients remains presently
very poor and using such an algorithm could promote prompter diagnosis, early initiation
of treatment, and subsequently improved outcome.
While the most classical presentation of IPA in critically ill COPD patients features
a combination of obstructive respiratory failure, antibiotic-resistant pneumonia,
recent or chronic corticosteroid therapy, and positive Aspergillus cultures from the lower respiratory tract, the present article will also address
less typical presentations and discuss the most appropriate treatments which could
alter prognosis.
Keywords
Aspergillus
- invasive pulmonary aspergillosis - COPD - exacerbation
