%0 Journal Article %T Why are so many cases of invasive aspergillosis missed? %+ Centre d'infectiologie Necker-Pasteur [CHU Necker] %+ Aspergillus %+ Université Paris Descartes - Paris 5 (UPD5) %+ CHU Necker - Enfants Malades [AP-HP] %+ Centre National de Référence Mycoses Invasives et Antifongiques - National Reference Center Invasive Mycoses & Antifungals (CNRMA) %+ Mycologie moléculaire - Molecular Mycology %+ Hopital Saint-Louis [AP-HP] (AP-HP) %A Danion, François %A Rouzaud, Claire %A Duréault, Amélie %A Poirée, Sylvain %A Bougnoux, Marie-Elisabeth %A Alanio, Alexandre %A Lanternier, Fanny %A Lortholary, Olivier %Z F.D. reports speaker fees from Gilead outside the submitted work. M.E.B. has received institutional grant funding from MSD and Astellas and lecture fees or travel grants from MSD, Pfizer, Astellas, and Gilead Sciences. A.A. has received travel grant from MSD, Gilead and Astella and honoraria from Pathoquest and Gilead outside the submitted work. F.L. reports speaker fees from MSD, Gilead and Basilea. O.L. has been a consultant for Gilead Sciences, a member of the speakers’ bureau for Pfeizer, Novartis, Astellas, Merck, and Gilead Sciences, and has received research grants from Gilead Sciences. C.R., A.D., and S.P.: no conflicts to declare %< avec comité de lecture %@ 1369-3786 %J Medical Mycology %I Oxford University Press %V 57 %N Supplement_2 %P S94-S103 %8 2019-04-01 %D 2019 %R 10.1093/mmy/myy081 %M 30816963 %K aspergillosis %K diagnosis %K risk factors %K airway-invasive %K galactomannan %K PCR %Z Life Sciences [q-bio]/Microbiology and Parasitology/MycologyJournal articles %X Invasive aspergillosis (IA) incidence is increasing in several countries like France, and numerous cases are indeed missed and still only diagnosed at autopsy as evidenced by recently published data. Such missed diagnoses are obviously encountered when appropriate diagnostic tools are not available especially in low resource areas or when biologists have not been trained enough in medical mycology (i.e., microscopic examination and culture in most of those areas). Besides logistical issues, which are indeed critical, IA may not be recognized because clinicians failed to consider that risk factors are evolving with the IA burden now observed among patients with chronic lymphoid malignancies or receiving new bio-therapies, with diabetes mellitus or liver cirrhosis and/or acute alcoholic hepatitis, with patients from the intensive care unit (ICU) and among patients with some predisposing primary immune deficiencies now reaching the adult's age. This is also the case for human immunodeficiency virus (HIV)-infected patients who failed to meet the classical definitions of IA. From the radiology perspective, new entities of IA have also emerged which absolutely need to be recognized especially bronchial-based-IA among allogeneic stem cell transplant recipients. Finally, from the laboratory side, contribution and limits of indirect blood biomark-ers should be integrated to the clinical life in order not to miss IA cases. To conclude, several diagnostic tools should be combined and a constant dialog between laboratory and clinics is crucial to appropriately diagnose IA. %G English %L pasteur-02192656 %U https://pasteur.hal.science/pasteur-02192656 %~ PASTEUR %~ UNIV-PARIS5 %~ CNRS %~ APHP %~ USPC %~ CHU-UNIV-PARIS5 %~ UNIV-PARIS %~ TEST3-HALCNRS %~ TEST4-HALCNRS %~ MYCO-MOL %~ PASTEUR_UMR2000 %~ CNRMA %~ MYCO-MOL-CNRMA %~ TEST5-HALCNRS