Pulmonary Aspergillosis

COVID-Associated

Screening

• Serum galactomannan
• Sputum aspergillus culture
• Sputum aspergillus PCR

BAL

Why do a BAL? In event of respiratory deterioration

What counts as respiratory deterioration?

- Worsening PF ratio after stability
- Worsening CXR changes

High risk on admission Positive screening tests

So what to do?

• On admission do screening galactomannans and sputum aspergillus

  • Unless high risk: do BAL

• If screening positive or gets worse, do a BAL.

Treatment

• If high clinical suspicion - Empirical voriconazole
• If positive - Voriconazole