Invasive aspergillosis in critically ill patients: Review of definitions and diagnostic approaches

Abstract

Invasive aspergillosis (IA) is an increasingly recognised phenomenon in critically ill patients in the intensive care unit, including in patients with severe influenza and severe coronavirus disease 2019 (COVID-19) infection. To date, there are no consensus criteria on how to define IA in the ICU population, although several criteria are used, including the AspICU criteria and new consensus criteria to categorise COVID-19-associated pulmonary aspergillosis (CAPA). In this review, we describe the epidemiology of IA in critically ill patients, most common definitions used to define IA in this population, and most common clinical specimens obtained for establishing a mycological diagnosis of IA in the critically ill. We also review the most common diagnostic tests used to diagnose IA in this population, and lastly discuss the most common clinical presentation and imaging findings of IA in the critically ill and discuss areas of further needed investigation.

Keywords: AspICU criteria; Aspergillus galactomannan lateral flow assay; Aspergillus-specific lateral flow device; COVID-associated invasive pulmonary aspergillosis; EORTC; Galactomannan; Invasive aspergillosis; MSG criteria; critically ill patients; influenza-associated invasive aspergillosis; intensive care unit; polymerase chain reaction.