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Semin Respir Crit Care Med 2024; 45(01): 069-087
DOI: 10.1055/s-0043-1777769
Review Article

Acute Invasive Pulmonary Aspergillosis: Clinical Presentation and Treatment

Jannes Heylen   *
1   Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
,
Yuri Vanbiervliet   *
1   Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
3   Department of Haematology, University Hospitals Leuven, Leuven, Belgium
,
Johan Maertens
1   Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
3   Department of Haematology, University Hospitals Leuven, Leuven, Belgium
,
Bart Rijnders
4   Department of Internal Medicine and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
,
Joost Wauters
1   Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
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Abstract

Among all clinical manifestations of pulmonary aspergillosis, invasive pulmonary aspergillosis (IPA) is the most acute presentation. IPA is caused by Aspergillus hyphae invading the pulmonary tissue, causing either tracheobronchitis and/or bronchopneumonia. The degree of fungal invasion into the respiratory tissue can be seen as a spectrum, going from colonization to deep tissue penetration with angio-invasion, and largely depends on the host's immune status. Patients with prolonged, severe neutropenia and patients with graft-versus-host disease are at particularly high risk. However, IPA also occurs in other groups of immunocompromised and nonimmunocompromised patients, like solid organ transplant recipients or critically ill patients with severe viral disease. While a diagnosis of proven IPA is challenging and often warranted by safety and feasibility, physicians must rely on a combination of clinical, radiological, and mycological features to assess the likelihood for the presence of IPA. Triazoles are the first-choice regimen, and the choice of the drug should be made on an individual basis. Adjunctive therapy such as immunomodulatory treatment should also be taken into account. Despite an improving and evolving diagnostic and therapeutic armamentarium, the burden and mortality of IPA still remains high. This review aims to give a comprehensive and didactic overview of the current knowledge and best practices regarding the epidemiology, clinical presentation, diagnosis, and treatment of acute IPA.

Keywords

invasive pulmonary aspergillosis - EORTC/MSGERC - intensive care unit - clinical presentation - diagnosis - treatment

* Jannes Heylen and Yuri Vanbiervliet have contributed equally to the manuscript.




Publication History

Article published online:
11 January 2024

© 2024. Thieme. All rights reserved.

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