Invasive pulmonary aspergillosis in critically Ill apparently immunocompetent patients

Invasive pulmonary aspergillosis (IPA) is increasingly being recognized as an important infection in critically ill patients who do not have the classic risk factors of immunodeficiency. Background pulmonary disease such as chronic obstructive pulmonary disease and the administration of corticosteroids, even in the short term, may be the most important risk factors in this population. The diagnosis of IPA is extremely difficult in critically ill patients because standard guidelines for the diagnosis of IPA had been developed for immunocompromised patients and have not been validated in immunocompetent critically ill patients. A new algorithm for the diagnosis of IPA has been validated in critically ill patients, which may be useful, but is not without limitations. A high index of suspicion is therefore required. The detection of IPA on the basis of serum galactomannan antigen and the β-Dglucan assay is of little value in non-neutropenic critically ill patients. However, the lateral-flow device test may be a useful diagnostic test in critically ill patients for the diagnosis of IPA. Voriconazole remains the first-line treatment of suspected IPA and should be administered even without confirmed histologic diagnosis, which is usually not possible in critically ill patients due to the overall status of such patients.