The Experts below are selected from a list of 22779 Experts worldwide ranked by ideXlab platform
Donald C Vinh - One of the best experts on this subject based on the ideXlab platform.
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Defining and managing COVID-19-associated pulmonary Aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance
The Lancet Infectious Diseases, 2020Co-Authors: Philipp Koehler, Matteo Bassetti, Arunaloke Chakrabarti, Sharon C A Chen, Arnaldo Lopes Colombo, Martin Hoenigl, Nikolay Klimko, Cornelia Lass-flörl, Rita O Oladele, Donald C VinhAbstract:Severe acute respiratory syndrome coronavirus 2 causes direct damage to the airway epithelium, enabling aspergillus invasion. Reports of COVID-19-associated pulmonary Aspergillosis have raised concerns about it worsening the disease course of COVID-19 and increasing mortality. Additionally, the first cases of COVID-19-associated pulmonary Aspergillosis caused by azole-resistant aspergillus have been reported. This article constitutes a consensus statement on defining and managing COVID-19-associated pulmonary Aspergillosis, prepared by experts and endorsed by medical mycology societies. COVID-19-associated pulmonary Aspergillosis is proposed to be defined as possible, probable, or proven on the basis of sample validity and thus diagnostic certainty. Recommended first-line therapy is either voriconazole or isavuconazole. If azole resistance is a concern, then liposomal amphotericin B is the drug of choice. Our aim is to provide definitions for clinical research and up-to-date recommendations for clinical management of the diagnosis and treatment of COVID-19-associated pulmonary Aspergillosis.
Shahid Husain - One of the best experts on this subject based on the ideXlab platform.
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a strategy for prevention of fungal infections in lung transplantation role of bronchoalveolar lavage fluid galactomannan and fungal culture
Journal of Heart and Lung Transplantation, 2018Co-Authors: Shahid Husain, Archana Bhaskaran, Alyajahan Bhimji, Coleman Rotstein, Shaf Keshavjee, R Pavan, Deepali Kumar, Atul Humar, L G SingerAbstract:Background The optimal strategy for prevention of invasive fungal infections in lung transplant recipients remains undetermined. We studied strategies based on bronchoalveolar lavage fungal culture and galactomannan for prevention of invasive Aspergillosis in lung transplant recipients. Methods Consecutive lung transplant recipients were evaluated during the period January 2010 to September 2014. Rates of invasive Aspergillosis and all-cause mortality were recorded at 1 year. Criteria established by the International Society for Heart and Lung Transplantation were used to define invasive fungal infections . Multivariate Cox regression analyses were performed to assess the outcomes of mortality and invasive Aspergillosis. Results A total of 519 lung transplant recipients with 3,077 bronchoscopies were included in our study. The cumulative incidence of fungal infections was 14% (75 of 519). Of these patients, 10.6% (54 of 519) developed Aspergillus -related clinical syndromes. Using multivariate analysis , pre-emptive therapy was associated with significantly lower rates of invasive Aspergillosis at 1 year post-transplantation compared with no pre-emptive therapy (hazard ratio [HR] 0.23, 95% confidence interval [CI] 0.09 to 0.58). Pre-emptive therapy and invasive Aspergillosis had similar mortality rates compared with no invasive Aspergillosis, or negative culture and galactomannan at 1 year (HR 0.54, 95% CI 0.23 to 1.28; and HR 0.99, 95% CI 0.44 to 2.25, respectively). During follow-up, 50% (259 of 519) of patients were negative for galactomannan and Aspergillus culture in bronchoalveolar lavage, and did not receive anti-fungal treatment . Only 2 patients developed invasive Aspergillosis in this cohort. Conclusions Our study suggests that use of bronchoalveolar lavage culture and a galactomannan-directed pre-emptive approach significantly decreased the risk of invasive Aspergillosis, allowing a 50% reduction in anti-fungal exposure compared with a universal prophylaxis approach, without affecting mortality at 1 year.
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pentraxin 3 levels in bronchoalveolar lavage fluid of lung transplant recipients with invasive Aspergillosis
Journal of Heart and Lung Transplantation, 2017Co-Authors: Dima Kabbani, Archana Bhaskaran, L G Singer, Alyajahan Bhimji, Coleman Rotstein, Shaf Keshavjee, Conrad W Liles, Shahid HusainAbstract:Background Invasive Aspergillosis is the most common invasive fungal infection in lung transplant recipients. The use of galactomannan testing in bronchoalveolar lavage (BAL) fluid has improved diagnosis of invasive Aspergillosis; however, false-positive results can lead to overdiagnosis and unnecessary treatment. The use of proinflammatory markers such as pentraxin 3 (PTX3) may help differentiate between Aspergillus colonization and disease. Methods BAL PTX3 concentrations were measured by enzyme-linked immunosorbent assay in 151 lung transplant recipients and 9 healthy control subjects. Patients were characterized as having Aspergillus colonization or invasive disease according to International Society of Heart and Lung Transplantation criteria. Concomitant PTX3values were compared using Mann-Whitney U and Kruskal-Wallis tests. Results We analyzed 322 BAL stored samples and identified 15 invasive Aspergillosis events, 38 Aspergillus colonizations, and 17 positive galactomannan with negative Aspergillus cultures. Median BAL PTX3 level was significantly higher in patients with invasive Aspergillosis compared with patients with Aspergillus colonization and healthy control subjects (439.20 pg/ml [interquartile range (IQR) 168.18–778.90], 68.93 pg/ml [IQR 13.67–156.74], and 13.67 pg/ml [IQR 13.67–121.18]; p 319 pg/ml with positive galactomannan and patients with BAL PTX3 value >312 pg/ml with positive Aspergillus culture were 4.5 and 5.5 times more likely to have invasive pulmonary Aspergillosis, respectively. Conclusions Our study shows that PTX3 measurements in BAL samples were significantly higher among patients with invasive Aspergillosis and may help to identify patients with Aspergillus colonization and false-positive galactomannan in BAL samples.
A Durocher - One of the best experts on this subject based on the ideXlab platform.
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invasive pulmonary Aspergillosis in chronic obstructive pulmonary disease an emerging fungal pathogen
Clinical Microbiology and Infection, 2005Co-Authors: Florence Ader, Saad Nseir, Le R Berre, Sylvie Leroy, Isabelle Tillieleblond, Charleshugo Marquette, A DurocherAbstract:Acute invasive pulmonary Aspergillosis occurs predominantly in immunocompromised hosts, with increasing numbers of cases of invasive Aspergillosis among patients with chronic obstructive pulmonary disease (COPD) being reported. Among 13 cases of invasive Aspergillosis diagnosed in COPD patients admitted to the intensive care unit with acute respiratory distress, the only risk factor for invasive fungal infection was corticosteroid treatment. Invasive Aspergillosis should be suspected in COPD patients receiving steroid treatment who have extensive pulmonary infiltrates. Survival depends on rapid diagnosis and early appropriate treatment. A decrease or interruption of steroid treatment should be considered as part of the overall therapeutic strategy.
L G Singer - One of the best experts on this subject based on the ideXlab platform.
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a strategy for prevention of fungal infections in lung transplantation role of bronchoalveolar lavage fluid galactomannan and fungal culture
Journal of Heart and Lung Transplantation, 2018Co-Authors: Shahid Husain, Archana Bhaskaran, Alyajahan Bhimji, Coleman Rotstein, Shaf Keshavjee, R Pavan, Deepali Kumar, Atul Humar, L G SingerAbstract:Background The optimal strategy for prevention of invasive fungal infections in lung transplant recipients remains undetermined. We studied strategies based on bronchoalveolar lavage fungal culture and galactomannan for prevention of invasive Aspergillosis in lung transplant recipients. Methods Consecutive lung transplant recipients were evaluated during the period January 2010 to September 2014. Rates of invasive Aspergillosis and all-cause mortality were recorded at 1 year. Criteria established by the International Society for Heart and Lung Transplantation were used to define invasive fungal infections . Multivariate Cox regression analyses were performed to assess the outcomes of mortality and invasive Aspergillosis. Results A total of 519 lung transplant recipients with 3,077 bronchoscopies were included in our study. The cumulative incidence of fungal infections was 14% (75 of 519). Of these patients, 10.6% (54 of 519) developed Aspergillus -related clinical syndromes. Using multivariate analysis , pre-emptive therapy was associated with significantly lower rates of invasive Aspergillosis at 1 year post-transplantation compared with no pre-emptive therapy (hazard ratio [HR] 0.23, 95% confidence interval [CI] 0.09 to 0.58). Pre-emptive therapy and invasive Aspergillosis had similar mortality rates compared with no invasive Aspergillosis, or negative culture and galactomannan at 1 year (HR 0.54, 95% CI 0.23 to 1.28; and HR 0.99, 95% CI 0.44 to 2.25, respectively). During follow-up, 50% (259 of 519) of patients were negative for galactomannan and Aspergillus culture in bronchoalveolar lavage, and did not receive anti-fungal treatment . Only 2 patients developed invasive Aspergillosis in this cohort. Conclusions Our study suggests that use of bronchoalveolar lavage culture and a galactomannan-directed pre-emptive approach significantly decreased the risk of invasive Aspergillosis, allowing a 50% reduction in anti-fungal exposure compared with a universal prophylaxis approach, without affecting mortality at 1 year.
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pentraxin 3 levels in bronchoalveolar lavage fluid of lung transplant recipients with invasive Aspergillosis
Journal of Heart and Lung Transplantation, 2017Co-Authors: Dima Kabbani, Archana Bhaskaran, L G Singer, Alyajahan Bhimji, Coleman Rotstein, Shaf Keshavjee, Conrad W Liles, Shahid HusainAbstract:Background Invasive Aspergillosis is the most common invasive fungal infection in lung transplant recipients. The use of galactomannan testing in bronchoalveolar lavage (BAL) fluid has improved diagnosis of invasive Aspergillosis; however, false-positive results can lead to overdiagnosis and unnecessary treatment. The use of proinflammatory markers such as pentraxin 3 (PTX3) may help differentiate between Aspergillus colonization and disease. Methods BAL PTX3 concentrations were measured by enzyme-linked immunosorbent assay in 151 lung transplant recipients and 9 healthy control subjects. Patients were characterized as having Aspergillus colonization or invasive disease according to International Society of Heart and Lung Transplantation criteria. Concomitant PTX3values were compared using Mann-Whitney U and Kruskal-Wallis tests. Results We analyzed 322 BAL stored samples and identified 15 invasive Aspergillosis events, 38 Aspergillus colonizations, and 17 positive galactomannan with negative Aspergillus cultures. Median BAL PTX3 level was significantly higher in patients with invasive Aspergillosis compared with patients with Aspergillus colonization and healthy control subjects (439.20 pg/ml [interquartile range (IQR) 168.18–778.90], 68.93 pg/ml [IQR 13.67–156.74], and 13.67 pg/ml [IQR 13.67–121.18]; p 319 pg/ml with positive galactomannan and patients with BAL PTX3 value >312 pg/ml with positive Aspergillus culture were 4.5 and 5.5 times more likely to have invasive pulmonary Aspergillosis, respectively. Conclusions Our study shows that PTX3 measurements in BAL samples were significantly higher among patients with invasive Aspergillosis and may help to identify patients with Aspergillus colonization and false-positive galactomannan in BAL samples.
Philipp Koehler - One of the best experts on this subject based on the ideXlab platform.
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Defining and managing COVID-19-associated pulmonary Aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance
The Lancet Infectious Diseases, 2020Co-Authors: Philipp Koehler, Matteo Bassetti, Arunaloke Chakrabarti, Sharon C A Chen, Arnaldo Lopes Colombo, Martin Hoenigl, Nikolay Klimko, Cornelia Lass-flörl, Rita O Oladele, Donald C VinhAbstract:Severe acute respiratory syndrome coronavirus 2 causes direct damage to the airway epithelium, enabling aspergillus invasion. Reports of COVID-19-associated pulmonary Aspergillosis have raised concerns about it worsening the disease course of COVID-19 and increasing mortality. Additionally, the first cases of COVID-19-associated pulmonary Aspergillosis caused by azole-resistant aspergillus have been reported. This article constitutes a consensus statement on defining and managing COVID-19-associated pulmonary Aspergillosis, prepared by experts and endorsed by medical mycology societies. COVID-19-associated pulmonary Aspergillosis is proposed to be defined as possible, probable, or proven on the basis of sample validity and thus diagnostic certainty. Recommended first-line therapy is either voriconazole or isavuconazole. If azole resistance is a concern, then liposomal amphotericin B is the drug of choice. Our aim is to provide definitions for clinical research and up-to-date recommendations for clinical management of the diagnosis and treatment of COVID-19-associated pulmonary Aspergillosis.
