scholarly journals Invasive Aspergillosis as an Under-recognized Superinfection in COVID-19

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
George R Thompson III ◽  
Oliver A Cornely ◽  
Peter G Pappas ◽  
Thomas F Patterson ◽  
Martin Hoenigl ◽  
...  
Keyword(s):  
At Risk ◽  
Invasive Aspergillosis ◽  
Viral Infections ◽  
Pulmonary Aspergillosis ◽  
Large Numbers ◽  
Patients At Risk ◽  
Respiratory Viral Infections

Pulmonary aspergillosis has been increasingly reported following severe respiratory viral infections. Millions have been infected by SARS-CoV-2, placing large numbers of patients at-risk for COVID-19 associated pulmonary aspergillosis (CAPA). Prompt recognition of this syndrome and is paramount to improve outcomes.

scholarly journals Aspergillus fumigatus Antigen Detection in Sera from Patients at Risk for Invasive Aspergillosis

2000 ◽  
Vol 38 (1) ◽  
pp. 438-443
Author(s):  
Bernabé F. F. Chumpitazi ◽  
Claudine Pinel ◽  
Bernadette Lebeau ◽  
Pierre Ambroise-Thomas ◽  
Renee Grillot
Keyword(s):  
At Risk ◽  
Invasive Aspergillosis ◽  
Aspergillus Fumigatus ◽  
Polyclonal Antibodies ◽  
Latex Agglutination ◽  
Control Group ◽  
Molecular Weights ◽  
Circulating Antigens ◽  
Patients At Risk ◽  
Sensitivity Specificity

ABSTRACT We have developed an inhibition enzyme immunoassay (inhibition-EIA) to monitor for the occurrence of invasive aspergillosis (IA) in sera from 45 immunocompromised (IC) patients. The test uses rabbit polyclonal antibodies and a mixture of components from Aspergillus fumigatus , containing three predominant antigens with molecular weights of 18,000, 33,000, and 56,000. Circulating antigens were found in five of seven proven cases of IA due to A. fumigatus . In two of the five positive cases, antigenemia was detected with inhibition-EIA earlier than with X ray or other biological methods. No antigens were detected in the sera from two patients with proven IA due to Aspergillus flavus and Aspergillus terreus nor in the sera from four patients with probable IA. Circulating antigens were not detected in the control group, composed of 30 healthy adult blood donors. Four of the 32 at-risk patients examined, though they displayed no definite evidence of IA, gave a positive result in this test. The sensitivity, specificity, and positive predictive value of inhibition-EIA were 71.4, 94.4, and 71.2%, respectively. The data were compared with those obtained by a latex agglutination assay of galactomannan (GM) that was positive in only one patient with probable IA. The higher sensitivity obtained by inhibition-EIA may well be due to its ability to detect circulating antigens other than GM in the sera of IC patients with IA. Detecting these antigens may improve the diagnosis of IA, as they may serve as markers of this infection.

scholarly journals Invasive pulmonary aspergillosis complicating non-influenza respiratory viral infections in solid organ transplant recipients

2021 ◽  
Author(s):  
Anna Apostolopoulou ◽  
Cornelius J Clancy ◽  
Abigail Skeel ◽  
M Hong Nguyen
Keyword(s):  
Small Bowel ◽  
Viral Infections ◽  
Invasive Pulmonary Aspergillosis ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Pulmonary Aspergillosis ◽  
Small Bowel Transplant ◽  
Respiratory Viral Infections

Abstract Invasive pulmonary aspergillosis (IPA) is increasingly recognized as a complication of severe influenza and coronavirus disease-2019. The extent to which other respiratory viral infections (RVIs) predispose to IPA is unclear. We performed a retrospective review of IPA occurring within 90-days of respiratory syncytial virus (RSV), parainfluenza or adenovirus infections (non-influenza respiratory viral infections; NI-RVI) in patients who underwent solid organ transplant between 1/15/2011 and 12/19/2017. At median post-transplant follow-up of 43.4 months, 221 of 2986 patients (7.4%) developed 255 RSV, parainfluenza or adenovirus infections. IPA complicating these NI-RVIs was exclusively observed in lung and small bowel transplant recipients, in whom incidence was 5% and 33%, respectively. Cumulative prednisone doses >140 mg within 7 days and pneumonia at time of NI-RVI were independent risk factors for IPA (odds ratios: 22.6 (4.5-112) and 7.2 (1.6-31.7), respectively). Mortality at 180-days following NI-RVI was 27% and 7% among patients with and without IPA, respectively (p=0.04). In conclusion, IPA can complicate RSV, parainfluenza and adenovirus infection in lung and small bowel transplant recipients. Future research is needed on the epidemiology of IPA complicating various RVIs. In the interim, physicians should be aware of this complication.

Validation of Serum Aspergillus Galactomannan Index as a Surrogate Endpoint for Outcome of Invasive Aspergillosis: Clinical and Research Implications.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2861-2861 ◽  
Author(s):  
Gail Woods ◽  
Marisa Miceli ◽  
Monica Grazziutti ◽  
Somashekar Krishna ◽  
Nayyar Syed ◽  
...  
Keyword(s):  
At Risk ◽  
Clinical Outcome ◽  
Invasive Aspergillosis ◽  
Composite Endpoint ◽  
Surrogate Endpoint ◽  
Laboratory Findings ◽  
Hematological Cancer ◽  
Non Invasive ◽  
Patients At Risk ◽  
Neutropenic Patients

Abstract Background: Assessing clinical outcome of aspergillosis with conventional clinical and laboratory criteria is difficult. A composite “global outcome response” (clinical, radiologic, pathologic and microbiologic criteria) is frequently used but suffers from poor sensitivity and specificity, and has not been standardized or validated. A reliable, quantitative, non-invasive, and easy to measure laboratory test than can substitute for this composite endpoint, i.e. serve as a surrogate endpoint for aspergillosis outcome is highly desirable. Galactomannan (GM) is an Aspergillus-specific polysaccharide released during aspergillosis and detected by the serum GM test. The test which is reported as an index of optical density (OD) is an accepted diagnostic marker for aspergillosis and preliminary data suggest a correlation between GM index (GMI) and outcome. Purpose: To evaluate serum GMI as a surrogate endpoint for outcome of invasive aspergillosis in patients with hematological cancer. Patients and Methods: patients at risk for aspergillosis (11/03-2/06) underwent GMI screening during periods at risk. The clinical and laboratory findings of patients with ≥ 2 (+) GMI (OD ≥ 0.5) were reviewed. To validate GMI as a surrogate endpoint for aspergillosis, a k correlation concordance coefficient test between GMI and an objective clinical outcome of aspergillosis (death) was applied. The correlation is considered perfect when k is 1.0; excellent when ≥ 0.75. Results: 30 patients had GMI (+) aspergillosis of the respiratory tract [myeloma 92%; median age: 59 years (27–75); 15 males]. Aspergillosis developed following stem cell transplantation [autologous (11), allogeneic (1)], or after conventional chemotherapy (18). Among 25 neutropenic patients (<1000/ml), persistent GMI elevation was associated with death (5/5 patients) while return to negative values predicted survival (20/20 patients). Among 5 non-neutropenic patients, 1 with persistently elevated GMI died compared to no death among the remaining 4 whose GMI became negative. Overall, the GMI correlated with clinical outcome in all 30 patients with a perfect 1.0 k correlation concordance coefficient. Conclusion: we have validated GMI as an excellent surrogate endpoint for the outcome of invasive aspergillosis among patients with hematological cancer. This FDA-approved test is reproducible, quantitative, non-invasive, easy to measure and widely available. These findings have important implications for patient care and for the design of clinical trials of mould-active antifungal agents.

scholarly journals Outcomes in Invasive Pulmonary Aspergillosis Infections Complicated by Respiratory Viral Infections in Patients With Hematologic Malignancies: A Case-Control Study

2019 ◽  
Vol 6 (7) ◽  
Author(s):  
Eleni E Magira ◽  
Roy F Chemaly ◽  
Ying Jiang ◽  
Jeffrey Tarrand ◽  
Dimitrios P Kontoyiannis
Keyword(s):  
Median Time ◽  
Case Control Study ◽  
Viral Infections ◽  
Invasive Pulmonary Aspergillosis ◽  
Case Control ◽  
Pulmonary Aspergillosis ◽  
Allogeneic Hsct ◽  
Rsv Infection ◽  
Respiratory Viral Infections ◽  
Control Study

Abstract Background Data regarding invasive pulmonary aspergillosis (IPA) following respiratory viral infections (RVIs) in patients with leukemia and/or hematopoietic stem cell transplantation (LHSCT) are limited. Methods We conducted a retrospective case-control study of post-RVI IPA (2006–2016). Cases were patients who underwent LHSCT and had RVI due to respiratory syncytial virus (RSV), influenza virus (INF), or parainfluenza virus (PIV) followed by culture-documented IPA within 6 weeks. Controls had IPA only. Results We identified 54 cases and 142 controls. Among cases, 29 (54%) had PIV infection, 14 (26%) had INF infection, and 11 (20%) had RSV infection. The median time to IPA after RVI was 7 days. A greater percentage of cases (37 [69%]) than controls (52 [37%]) underwent allogeneic HSCT (P &lt; .0001). Cases were more likely to be nonneutropenic (33 [61%] vs 56 [39%]; P = .009) and in hematologic remission (27 [50%] vs 39 [27%]; P = .003) before IPA. Cases were more likely to have monocytopenia (45 [83%] vs 99 [70%]; P = .05) and less likely to have severe neutropenia (21 [39%] vs 86 [61%]; P = .007) at IPA diagnosis. Prior use of an Aspergillus-active triazole was more common in cases (27 of 28 [96%] vs 50 of 74 [68%]; P = .0017). Median time to empirical antifungal therapy initiation was 2 days in both groups. Crude 42-day mortality rates did not differ between cases (22%) and controls (27%), but the 42-day mortality rate was higher among cases with IPA after RSV infection (45%) than among those with IPA following INF or PIV infection (13%; P = .05). Conclusions IPA had comparable outcomes when it followed RVI in patients who underwent LHSCT, and post-RVI IPA occurred more frequently in patients with prior allogeneic HSCT and was associated with leukemia relapse and neutropenia.

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