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Invasive Pulmonary Aspergillosis

Invasive pulmonary aspergillosis is growing in incidence, as patients at risk are growing in diversity. Outside the classical context of neutropenia, new risk factors are emerging or newly identified, such as new anticancer drugs, viral pneumonias and hepatic dysfunctions. Clinical signs remain unsp...

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Autores principales: Ledoux, Marie-Pierre, Herbrecht, Raoul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9962768/
https://www.ncbi.nlm.nih.gov/pubmed/36836246
http://dx.doi.org/10.3390/jof9020131
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author Ledoux, Marie-Pierre
Herbrecht, Raoul
author_facet Ledoux, Marie-Pierre
Herbrecht, Raoul
author_sort Ledoux, Marie-Pierre
collection PubMed
description Invasive pulmonary aspergillosis is growing in incidence, as patients at risk are growing in diversity. Outside the classical context of neutropenia, new risk factors are emerging or newly identified, such as new anticancer drugs, viral pneumonias and hepatic dysfunctions. Clinical signs remain unspecific in these populations and the diagnostic work-up has considerably expanded. Computed tomography is key to assess the pulmonary lesions of aspergillosis, whose various features must be acknowledged. Positron-emission tomography can bring additional information for diagnosis and follow-up. The mycological argument for diagnosis is rarely fully conclusive, as biopsy from a sterile site is challenging in most clinical contexts. In patients with a risk and suggestive radiological findings, probable invasive aspergillosis is diagnosed through blood and bronchoalveolar lavage fluid samples by detecting galactomannan or DNA, or by direct microscopy and culture for the latter. Diagnosis is considered possible with mold infection in lack of mycological criterion. Nevertheless, the therapeutic decision should not be hindered by these research-oriented categories, that have been completed by better adapted ones in specific settings. Survival has been improved over the past decades with the development of relevant antifungals, including lipid formulations of amphotericin B and new azoles. New antifungals, including first-in-class molecules, are awaited.
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spelling pubmed-99627682023-02-26 Invasive Pulmonary Aspergillosis Ledoux, Marie-Pierre Herbrecht, Raoul J Fungi (Basel) Review Invasive pulmonary aspergillosis is growing in incidence, as patients at risk are growing in diversity. Outside the classical context of neutropenia, new risk factors are emerging or newly identified, such as new anticancer drugs, viral pneumonias and hepatic dysfunctions. Clinical signs remain unspecific in these populations and the diagnostic work-up has considerably expanded. Computed tomography is key to assess the pulmonary lesions of aspergillosis, whose various features must be acknowledged. Positron-emission tomography can bring additional information for diagnosis and follow-up. The mycological argument for diagnosis is rarely fully conclusive, as biopsy from a sterile site is challenging in most clinical contexts. In patients with a risk and suggestive radiological findings, probable invasive aspergillosis is diagnosed through blood and bronchoalveolar lavage fluid samples by detecting galactomannan or DNA, or by direct microscopy and culture for the latter. Diagnosis is considered possible with mold infection in lack of mycological criterion. Nevertheless, the therapeutic decision should not be hindered by these research-oriented categories, that have been completed by better adapted ones in specific settings. Survival has been improved over the past decades with the development of relevant antifungals, including lipid formulations of amphotericin B and new azoles. New antifungals, including first-in-class molecules, are awaited. MDPI 2023-01-17 /pmc/articles/PMC9962768/ /pubmed/36836246 http://dx.doi.org/10.3390/jof9020131 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Ledoux, Marie-Pierre
Herbrecht, Raoul
Invasive Pulmonary Aspergillosis
title Invasive Pulmonary Aspergillosis
title_full Invasive Pulmonary Aspergillosis
title_fullStr Invasive Pulmonary Aspergillosis
title_full_unstemmed Invasive Pulmonary Aspergillosis
title_short Invasive Pulmonary Aspergillosis
title_sort invasive pulmonary aspergillosis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9962768/
https://www.ncbi.nlm.nih.gov/pubmed/36836246
http://dx.doi.org/10.3390/jof9020131
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