Invasive aspergillosis (IA) is very serious opportunistic infection that mainly affects immunocompromised patients. The incidence of IA in the intensive care unit (ICU) is difficult to determine for various reasons. Recently, studies based on autopsy methods were published and those studies have revealed the emergence of the Aspergillus species as pathogens in the ICU, as well as in patients without haematological diseases. New risk groups were identified, especially patients with chronic obstructive pulmonary disease and patients with severe liver damage, among others. In the ICU the clinical diagnosis of IA represents a true challenge since standard diagnostic definitions were developed for immunocompromised patients and these cannot necessarily be extrapolated to critically ill patients. The growing number of published studies document that IA is not as rare of a condition as previously considered. On the other hand, in clinical practice, a diagnosis of IA is frequently suspected when Aspergillus is isolated from non-sterile body sites, especially bronchial and tracheal aspirates. It must be emphasized, that Aspergillus spp. are ubiquitous and this represents difficulty in interpreting its clinical relevance. On the other hand, sensitivity of mycological culture from e.g. bronchoalveolar lavage from patients with IA is slightly over 30%. Moreover, non-invasive diagnostic methods, such as galactomanan determination, are developed and validated only for patients with bone marrow transplant and cancer, thus pointing to a need for further studies be conducted for ICU patients. Several studies showed that IA in ICU patients is associated with high mortality and hospital cost. Introduction of early appropriate antifungal therapy has an important influence on patient outcome. Recently published studies underline the importance of knowledge about the epidemiology of invasive aspergilosis in critically ill patients and its influence on therapy. The importance of timely diagnosis leading to early and appropriate treatment and consideration of Aspergillus sp. as a potential etiologic agent of infection in ICU patients needs to be underscored.

Sanja Pleško,
Department for Clinical and Molecular Microbiology,
University Hospital Centre Zagreb, Zagreb, Croatia,

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