PUESTA AL DÍA EN MEDICINA INTENSIVA: EL ENFERMO CRÍTICO CON INFECCIÓN GRAVEAspergilosis pulmonar invasiva en el paciente hematooncológico en las unidades de cuidados intensivos. Revisión de la literatura médicaInvasive pulmonary aspergillosis in a hematooncological patient in the intensive care units. A review of the literature
Section snippets
Introducción
Las infecciones aspergilares invasivas presentan un aumento constante de su incidencia entre los pacientes hematooncológicos. Este hecho está vinculado a la depresión inmunitaria propia de estas enfermedades, a la posibilidad de realizar tratamientos mieloablativos cada vez más potentes en pacientes cada vez más añosos y a la introducción de nuevas moléculas capaces de generar inmunosupresión.
Los métodos diagnósticos han evolucionado y los nuevos tratamientos han logrado modificar la
Epidemiología
En los servicios de hematooncología la incidencia de la aspergilosis invasiva ha aumentado en forma muy significativa. En pocos años se ha multiplicado por 10 en algunos centros1. Entre los pacientes hematooncológicos la aspergilosis corresponde a más del 60% de las micosis invasivas2. Entre el 10 y el 15% de los pacientes a los que se les realizó un alotransplante de médula ósea sin profilaxis antifúngica desarrolla esta infección3, 4.
El 70% de los pacientes hematooncológicos ingresa a la
Clínica
Si bien la frecuencia de esta enfermedad se ha incrementado en los pacientes inmunocompetentes, debe quedar claro que esta enfermedad se presenta mayoritariamente en enfermos con alteraciones inmunitarias graves. Debe plantearse su diagnóstico en pacientes con determinados factores de riesgo como: neutropenia prolongada, alotransplante de precursores hematopoyéticos, enfermedad de injerto contra huésped y uso crónico de corticoides o inmunosupresores12, 13.
La sintomatología al ser poco
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Cited by (3)
Strategies for the management of invasive fungal infections due to filamentous fungi in high-risk hemato-oncological patients
2019, Revista Espanola de QuimioterapiaFive-years surveillance of invasive aspergillosis in a university hospital
2011, BMC Infectious Diseases