All right, so welcome back to the internet book of critical care. I'm here with Adam Thomas.

We're going to talk about invasive pulmonary aspergyllosis. And we're kicking an old school for you.

Josh, bringing you back to your pulmonary days. I know that's like tooth and nail sometimes.

You don't want to talk about the puffers, but you're back to doing pulmonary consults, so you're in it. I don't know, man. I've mixed feelings about this. Okay, so today

we'll talk about the definition diagnosis of invasive pulmonary aspergillosis, the evaluation and

treatment. Let's go down to the basics, because I'm a non-palmonary guy. Speak to me slowly in my emerge ways. What is this fungus? Where is it? Why can it

cause so much trouble? Yeah, so this is pretty interesting. When you think about fungal pathogens,

most of them are somewhat restricted to like specific environments or pigeons or weird locations.

Aspergillus is basically everywhere. Maybe increase in certain situations like instruction,

but it's basically everywhere. So this makes it essentially like a classic opportunistic infection. We're all constantly

being exposed to aspergillus and most of us are fighting it off. I like to think about this in

roughly two different ways. So one situation where we see it is like a primary pneumonia where

someone is presenting to the hospital with aspergillus or they're getting chemotherapy on

the oncology unit and they develop an aspergillus or they're getting chemotherapy on the oncology unit

and they develop an aspergillus pneumonia. Another situation that we will encounter in the ICU

is more of a secondary situation where somebody comes in with some other cause of respiratory

failure like influenza. Perhaps they get intubated and it kind of causes like a super

infection, essentially like a ventilator associated or hospital associated infection.

And those can present in different ways, and we'll talk about that a minute. And the signal for

that's growing and growing like you'll get into later, but that's something, the biggest thing

out of this post, is that I need to think about this as a secondary cause more and more.

Yeah, I think we all probably do. And this is really honestly... I don't know, Josh, you're smarter than me. I don't know if I

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