INVASIVE ASPERGILLOSIS IN INTENSIVE-CARE UNIT

Invasive pulmonary aspergilloses occur in patients with antineoplasic chemotherapy, mainly when associated with a prolonged neutropenia, in transplanted patients with continuous corticotherapy and less frequent ly in immunocompetent surgical patients. The clinical features are tho se of an acute infective pneumonia, not responding to antibiotherapy. Radiologic signs are often non specific. Diagnosis is obtained with br onchoalveolar lavage in which Aspergillus is found both at direct exam ination and in culture. Serological tests are of little interest for t he diagnosis of invasive aspergillosis. Extrapulmonary locations such as sinusitis, cutaneous or brain abscesses occur in 20 % of cases. The gold standard of treatment is intravenous amphotericin B which elicit s an acute reaction often followed by a nephrotoxic effect which can b e decreased by fluid loading with saline. Oral itraconazole administra tion can follow the initial treatment with amphotericin B. The mortali ty rate remains high and an early diagnosis and an appropriate treatme nt are essential.