Critical care

Patients in critical care units are at particularly high risk of invasive fungal infections as they often have more underlying risk factors and are subject to more invasive procedures (e.g. ventilation) and devices (e.g. CVCs).

Speed of diagnosis, source control and initiation of antifungals are particularly important in this setting in order to minimise mortality.

COVID-19-associated pulmonary aspergillosis

See section on Invasive pulmonary aspergillosis.

Did you know?

  • Around 1 in 6 patients admitted to ICU with influenza will go on to develop invasive pulmonary aspergillosis (IAPA), which requires prompt treatment with antifungals
  • COVID-associated pulmonary aspergillosis (CAPA) rates are thought to be lower than IAPA rates. The UK National Mycology Reference Laboratory in Bristol (Borman et al, 2020) tested 1267 samples and found rates of probable (5%) and proven (15%) CAPA.
  • Many antigen tests are now available in a bedside (POCT) format that can give a result in less than 60 minutes and are stable at room temperature for a couple of years
  • IDSA guidelines (Pappas et al, 2016) recommend that candidaemia patients should receive a dilated retinal examination carried out by an ophthalmologist.

Biomarker diagnostics

When an invasive fungal infection is suspected, antigen biomarker tests can give a quick result (especially POCT/bedside tests), but they often need to be confirmed by further laboratory tests and radiology.

Watch our webinars (with Q&A sessions) on galactomannan, beta-D-glucan and CrAg testing

Galactomannan is a useful antigen biomarker produced by Aspergillus, Penicillium, Histoplasma, Fusarium and Talaromyces during invasive infections. But be aware of the following:

  • A. flavus produces less than A. fumigatus
  • Mould-active prophylaxis reduces sensitivity
  • Sensitivity appears to be lower (~40%) in the serum of non-neutropaenic patients

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