NIJMEGEN, THE NETHERLANDS — Patients admitted to intensive care units with influenza increasingly are being diagnosed with invasive pulmonary aspergillosis.

A study in Intensive Care Medicine discussed classification of patients with influenza-associated pulmonary aspergillosis (IAPA) using the current definitions for invasive fungal diseases has proven difficult.1

International researchers led by Radboud University Medical Center in The Netherlands and including participation from the VA Pittsburgh Healthcare System and the South Texas Veterans Health Care Center in San Antonio, sought to develop case definitions for IAPA that can facilitate clinical studies.

The group of 29 international experts reviewed current insights into the epidemiology, diagnosis and management of IAPA and proposed a case definition through a process of informal consensus.

One key issue was the IAPA might develop in a wide range of hosts, which led to the proposal of an entry criterion, not host, factors. The entry criterion was defined as a patient requiring ICU admission for respiratory distress with a positive influenza test temporally related to ICU admission.

The group pointed out that proven IAPA required histological evidence of invasive septate hyphae and mycological evidence for Aspergillus, while probable IAPA required the detection of galactomannan or positive Aspergillus culture in bronchoalveolar lavage (BAL) or serum with pulmonary infiltrates or a positive culture in upper respiratory samples with bronchoscopic evidence for tracheobronchitis or cavitating pulmonary infiltrates of recent onset.

“The IAPA case definitions may be useful to classify patients with COVID-19-associated pulmonary aspergillosis (CAPA), while awaiting further studies that provide more insight into the interaction between Aspergillus and the SARS-CoV-2-infected lung,” the authors suggested.

The study group proposed a consensus case definition of IAPA, adding that it will “facilitate research into the epidemiology, diagnosis and management of this emerging acute and severe Aspergillus disease, and may be of use to study CAPA.”


  1. Verweij PE, Rijnders BJA, Brüggemann RJM, Azoulay E, Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion. Intensive Care Med. 2020 Aug;46(8):1524-1535. doi: 10.1007/s00134-020-06091-6. Epub 2020 Jun 22. PMID: 32572532; PMCID: PMC7306567.