LitCovid-sentences  

PMC:7306567 / 19219-26142 JSONTXT 13 Projects

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Id Subject Object Predicate Lexical cue
T128 0-34 Sentence denotes Consensus case definition for IAPA
T129 35-366 Sentence denotes The expert panel discussed which case definition of IAPA would be appropriate to use in clinical studies, initially considering various aspects regarding four main areas of focus: entry criteria of the consensus definition, host, clinical features and mycological evidence similar to the currently used EORTC/MSGERC classification.
T130 368-383 Sentence denotes Entry criterion
T131 384-559 Sentence denotes In addition to having a positive diagnostic test for influenza, patients would require to have a clinical syndrome compatible with influenza disease as part of the definition.
T132 560-648 Sentence denotes This criterion should be termed the ‘entry criterion’ and not ‘host factor’ for clarity.
T133 649-954 Sentence denotes To avoid the risk of missing patients who initially tested negative with a rapid influenza antigen test but subsequently tested positive (by PCR) for influenza when admitted to hospital, a recommendation on a timescale, such as between 1 week before ICU admission and 72–96 h post-admission, was included.
T134 955-1138 Sentence denotes The consensus on the entry criterion was: a patient requiring ICU admission for respiratory distress with a positive influenza PCR or antigen test temporally related to ICU admission.
T135 1140-1152 Sentence denotes Host factors
T136 1153-1449 Sentence denotes Host factors are considered in the EORTC/MSGERC definition and AspICU algorithm [10, 11], but the system of taking host factors into account was a necessity because the risk of a false-positive Aspergillus test increases substantially when the test is done in patients at low risk of the disease.
T137 1450-1592 Sentence denotes Clinicians had to take into account the type of host in order to increase the pretest probability of an invasive fungal disease being present.
T138 1593-1775 Sentence denotes However, for IAPA the key question is whether the disease is present or not, and not whether the patient group has a higher risk than other patient groups for developing the disease.
T139 1776-1901 Sentence denotes More importantly, the incidence of IAPA in patients admitted to the ICU with influenza may be higher in some centers [9, 21].
T140 1902-2000 Sentence denotes No further host factors are needed to increase the pretest probability in this patient population.
T141 2001-2147 Sentence denotes Although most IAPA cases have at least one underlying condition or steroid use, host factors were not be included in the case definition for IAPA.
T142 2149-2201 Sentence denotes Criteria to define proven and probable cases of IAPA
T143 2202-2379 Sentence denotes The distinction between proven and probable IAPA is important for clinical trials, while in clinical practice, people should not distinguish between proven and probable disease.
T144 2380-2626 Sentence denotes The criteria for proven disease include a patient fulfilling the entry criterion plus histological evidence of invasive fungal elements and mycological evidence for the presence of Aspergillus (obtained by Aspergillus PCR or culture from tissue).
T145 2627-2829 Sentence denotes Tracheobronchitis (tracheal and/or bronchial ulcerations or nodules, pseudomembranes or plaques visualized at bronchoscopy), as also described in the EORTC/MSGERC definitions [10], is a separate entity.
T146 2830-3107 Sentence denotes Although a tissue biopsy would normally be required to prove a case of IAPA, in tracheobronchitis cases hyphal elements suggestive of Aspergillus seen on sloughed-off pseudomembrane, and Aspergillus identified on culture or PCR, can also be considered proven disease (Table 1).
T147 3108-3165 Sentence denotes Table 1 Proposed case definition for IAPA in ICU patients
T148 3166-3266 Sentence denotes Entry criteria: influenza-like illness + positive influenza PCR or antigen + temporally relationship
T149 3267-3362 Sentence denotes Aspergillus tracheobronchitis IAPA in patients without documented Aspergillus tracheobronchitis
T150 3363-3649 Sentence denotes Proven Biopsy or brush specimen of airway plaque, pseudomembrane or ulcer showing hyphal elements and Aspergillus growth on culture or positive Aspergillus PCR in tissue Lung biopsy showing invasive fungal elements and Aspergillus growth on culture or positive Aspergillus PCR in tissue
T151 3650-3697 Sentence denotes Probable Airway plaque, pseudomembrane or ulcer
T152 3698-3732 Sentence denotes and at least one of the following:
T153 3733-3753 Sentence denotes Serum GM index > 0.5
T154 3754-3756 Sentence denotes or
T155 3757-3775 Sentence denotes BAL GM index ≥ 1.0
T156 3776-3778 Sentence denotes or
T157 3779-3799 Sentence denotes Positive BAL culture
T158 3800-3802 Sentence denotes or
T159 3803-3837 Sentence denotes Positive tracheal aspirate culture
T160 3838-3840 Sentence denotes or
T161 3841-3864 Sentence denotes Positive sputum culture
T162 3865-3867 Sentence denotes or
T163 3868-3905 Sentence denotes Hyphae consistent with Aspergillus A:
T164 3906-3926 Sentence denotes Pulmonary infiltrate
T165 3927-3961 Sentence denotes and at least one of the following:
T166 3962-3982 Sentence denotes Serum GM index > 0.5
T167 3983-3985 Sentence denotes or
T168 3986-4004 Sentence denotes BAL GM index ≥ 1.0
T169 4005-4007 Sentence denotes or
T170 4008-4028 Sentence denotes Positive BAL culture
T171 4029-4031 Sentence denotes OR
T172 4032-4034 Sentence denotes B:
T173 4035-4090 Sentence denotes Cavitating infiltrate (not attributed to another cause)
T174 4091-4125 Sentence denotes and at least one of the following:
T175 4126-4149 Sentence denotes Positive sputum culture
T176 4150-4152 Sentence denotes or
T177 4153-4187 Sentence denotes Positive tracheal aspirate culture
T178 4188-4289 Sentence denotes A patient fulfilling the case definition of probable IAPA is required to fulfill the entry criterion.
T179 4290-4513 Sentence denotes A positive serum GM (GM index > 0.5) is important evidence for the diagnosis of IAPA, in patients with pulmonary infiltrates on chest X-ray or other imaging modality or bronchoscopic evidence of tracheobronchitis (Table 1).
T180 4514-4580 Sentence denotes In patients with tracheobronchitis, an infiltrate is not required.
T181 4581-4773 Sentence denotes In patients with endobronchial plaques or pulmonary infiltrates, a positive BAL GM or culture of a tracheal aspirate is considered mycological evidence that supports a probable IAPA diagnosis.
T182 4774-4929 Sentence denotes In patients with bacterial pneumonia where Aspergillus is cultured only from a sputum sample, there may be a risk of overdiagnosis and thus over-treatment.
T183 4930-5134 Sentence denotes For clinical practice, clinicians should take into account that a positive culture of an upper airway sample may indicate IAPA, but that confirmation with serum or BAL GM or BAL culture should be pursued.
T184 5135-5293 Sentence denotes However, one problem is that the background incidence varies in different regions, making it difficult to develop generalized guidelines that apply uniformly.
T185 5294-5400 Sentence denotes The significance of a positive sputum culture thus depends on the background incidence in a specific unit.
T186 5401-5620 Sentence denotes Although any Aspergillus-positive respiratory sample is in itself insufficient to classify patients as probable IAPA, a new pulmonary cavitating infiltrate is indicative of IAPA in patients who meet the entry criterion.
T187 5621-5814 Sentence denotes Therefore, any Aspergillus-positive respiratory sample is sufficient evidence to classify patients as probable IAPA provided that a pulmonary cavitating infiltrate is present (Table 1; Fig. 1).
T188 5815-6061 Sentence denotes Fig. 1 Flowchart of probable IAPA classification. (*)If hyphae consistent with Aspergillus are documented in a biopsy of an airway lesion AND Aspergillus is grown from sputum or a tracheal aspirate, the case fulfills the definition of proven IAPA
T189 6062-6275 Sentence denotes A BAL GM index cutoff of ≥ 1.0 is recommended as this cutoff value ensures high specificity, without decreasing sensitivity significantly, which is also in line with other definitions and recommendations [10, 57].
T190 6276-6437 Sentence denotes Aspergillus PCR is not recommended as a primary diagnostic tool because of concerns about its reliability and positive predictive value for the diagnosis of IPA.
T191 6438-6565 Sentence denotes However, Aspergillus PCR is recommended in the proven category because it enables Aspergillus identification in tissue samples.
T192 6566-6676 Sentence denotes In some patients, discordant results are obtained, for instance a positive sputum culture but negative BAL GM.
T193 6677-6923 Sentence denotes For most situations, IAPA classification relies on a positive GM test, as a positive sputum culture with a negative GM result would be interpreted as a lower probability of IAPA (unless a pulmonary cavity or tracheobronchitis is present)(Fig. 1).