scholarly journals High prevalence of putative invasive pulmonary aspergillosis in critically ill COVID-19 patients

2020 ◽  
Author(s):  
Alexandre Alanio ◽  
Sarah Dellière ◽  
Sofiane Fodil ◽  
Stéphane Bretagne ◽  
Bruno Mégarbane
Keyword(s):  
Invasive Aspergillosis ◽  
Critically Ill ◽  
Lung Inflammation ◽  
Invasive Pulmonary Aspergillosis ◽  
High Dose ◽  
Pulmonary Aspergillosis ◽  
High Prevalence ◽  
Almost All ◽  
Immunomodulatory Therapies ◽  
To Receive

AbstractWe are currently facing a frightening increase in COVID-19 patients admitted to the ICU. Aiming at screening for fungal secondary pneumonia, we collected the data of our first 27 ICU patients, who underwent bronchoalveolar lavage or bronchial aspirates. We classified the patients based on the recently published study on invasive aspergillosis in influenza patients (Schauwvlinghe et al., 2018.) and found 33% of our COVID-19 patients with putative invasive pulmonary aspergillosis. Observing such a high prevalence in COVID-infected patients was somehow unexpected since the 30% prevalence of invasive aspergillosis in influenza patients has been attributed to the action of oseltamivir on anti-Aspergillus immunity. Almost all critically ill COVID-19 patients develop ARDS and are likely to receive high-dose steroids or immunomodulatory therapies to prevent worsening as suggested by reports from China. In the COVID-19 patients with putative invasive aspergillosis, antifungal prophylactic therapy may be questioned to avoid increased lung inflammation that may compromise the outcome. This issue remains to be addressed in future clinical trials. We are strongly convinced that testing deep lung specimens for Aspergillus in severe COVID-19 patients should be recommended.

scholarly journals High Prevalence of Putative Invasive Pulmonary Aspergillosis in Critically Ill COVID-19 Patients

2020 ◽  
Author(s):  
Alexandre Alanio ◽  
Sarah Dellière ◽  
Sofiane Fodil ◽  
Stéphane Bretagne ◽  
Bruno Mégarbane
Keyword(s):  
Critically Ill ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis ◽  
High Prevalence

scholarly journals Fungal Infections Other Than Invasive Aspergillosis in COVID-19 Patients

2022 ◽  
Vol 8 (1) ◽  
pp. 58
Author(s):  
Kerri Basile ◽  
Catriona Halliday ◽  
Jen Kok ◽  
Sharon C-A. Chen
Keyword(s):  
Invasive Aspergillosis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fungal Infections ◽  
Invasive Pulmonary Aspergillosis ◽  
Delayed Diagnosis ◽  
Invasive Fungal Disease ◽  
Pulmonary Aspergillosis ◽  
Poor Outcomes ◽  
Endemic Mycoses

Invasive fungal disease (IFD) associated with Coronavirus Disease 2019 (COVID-19) has focussed predominantly on invasive pulmonary aspergillosis. However, increasingly emergent are non-Aspergillus fungal infections including candidiasis, mucormycosis, pneumocystosis, cryptococcosis, and endemic mycoses. These infections are associated with poor outcomes, and their management is challenged by delayed diagnosis due to similarities of presentation to aspergillosis or to non-specific features in already critically ill patients. There has been a variability in the incidence of different IFDs often related to heterogeneity in patient populations, diagnostic protocols, and definitions used to classify IFD. Here, we summarise and address knowledge gaps related to the epidemiology, risks, diagnosis, and management of COVID-19-associated fungal infections other than aspergillosis.

scholarly journals Do COVID-19 patients admitted to the ICU require anti-Pneumocystis jirovecii prophylaxis?

2020 ◽  
Author(s):  
Alexandre Alanio ◽  
Sebastian Voicu ◽  
sarah Delliere ◽  
Bruno Megarbane ◽  
Stephane Bretagne
Keyword(s):  
Lung Inflammation ◽  
Pneumocystis Jirovecii ◽  
High Dose ◽  
Type I ◽  
Icu Patients ◽  
Dna And Rna ◽  
High Prevalence ◽  
Life Threatening ◽  
Per Se ◽  
Almost All

We are currently facing a frightening increase in COVID-19 patients admitted to the ICU. Aiming at screening for secondary pneumonia, we collected the data of our first twelve ICU patients who underwent bronchoalveolar lavage (BAL). Surprisingly, four were detected with Pneumocystis jirovecii (Pj) DNA and RNA, resulting in Pj prevalence of 17%. Pj is a ubiquitous ascomycetes fungus that thrives at the surface of type-I pneumocytes, specifically in human alveoli, leading to pneumocystosis in immunocompromised patients. Interestingly, none of our patients was immunocompromised per se before admission, while all presented the recognized risk factors for life-threatening COVID-19 infection. Observing such high prevalence in COVID-infected patients was unexpected. Almost all patients developed ARDS and received high-dose steroids to prevent worsening, as suggested by reports from China. In Pj-positive patients requiring steroids, prophylaxis was given to avoid the risk of pneumocystosis and increased lung inflammation that may compromise the outcome. We are strongly convinced that testing deep lung specimens for Pj in severe COVID-19 patients should be recommended and Pj-positive patients treated with steroids, and given anti-Pj prophylaxis. This message is important, given the high mortality rate of COVID-19 patients in the ICU.

scholarly journals 1175. Pulmonary Aspergillosis in Critically Ill Patients with COVID-19: A Case Series

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S613-S613
Author(s):  
Hayato Mitaka ◽  
David C Perlman ◽  
Waleed Javaid ◽  
Nadim Salomon
Keyword(s):  
Aspergillus Fumigatus ◽  
Critically Ill ◽  
Antifungal Therapy ◽  
Critically Ill Patients ◽  
Invasive Pulmonary Aspergillosis ◽  
Case Series ◽  
Tracheal Aspirate ◽  
High Dose ◽  
Clinical Predictors ◽  
Pulmonary Aspergillosis

Abstract Background Invasive pulmonary aspergillosis (IPA) has been reported in critically ill patients without pre-existing immunocompromising conditions. However, there are scant data on pulmonary aspergillosis in patients with COVID-19. Methods We performed a retrospective review of pharmacy records of antifungal use during 3/21-4/22, 2020, and collect longitudinal clinical data. Cases were then classified by the clinical algorithm for IPA in the ICU (AspICU). Results 7 out of 18 (39%) patients who received antifungal therapy had Aspergillus fumigatus in tracheal aspirate specimens while mechanically ventilated in the ICU. None of the patients had EORTC/MSG host factors. Median time from admission to the date of positive respiratory culture was 9 days (range: 2-15). High-dose glucocorticoids were started a mean of 5.6 days (range 3-8) before the positive respiratory culture in 5 and on the day of the culture in 2. Six received 583-1000 mg equivalent of prednisone. Two received Tocilizumab. By AspICU criteria, 4 had putative IPA. Radiographic abnormalities included cavitary pneumonia, opacities with dense consolidation, worsening infiltrates, and diffuse interstitial and patchy hazy opacities. Compatible signs included worsening respiratory failure in 3 and fever after 3 days of antibacterial agents in 1. Associated findings were leukocytosis in 4, > 1 positive cultures in 3, high procalcitonin in 2, and positive serum galactomannan in 1. The remaining three were classified as colonization as they lacked compatible signs. One had concomitant Klebsiella aerogenes pneumonia with bacteremia, and two later developed Candidemia and Stenotrophomonas maltophilia pneumonia, respectively. All 3 had fever with leukocytosis. One had elevated procalcitonin. Six received antifungal therapy; one did not due to goals of care. All 7 patients expired despite ICU care. Conclusion The critically ill patients with severe COVID-19 in whom respiratory culture grew Aspergillus fumigatus showed very high mortality despite antifungal treatment. By AspICU algorithm, 4 patients had putative IPA. Further data on risk factors and clinical predictors of IPA in COVID-19 are needed. Disclosures All Authors: No reported disclosures

scholarly journals Invasive aspergillosis with disseminated skin ınvolvement in a patient with acute myeloid leukemia: a rare case

2017 ◽  
Vol 9 (2) ◽  
Author(s):  
Duygu Mert ◽  
Gülşen Iskender ◽  
Fazilet Duygu ◽  
Alparslan Merdin ◽  
Mehmet Sinan Dal ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Invasive Aspergillosis ◽  
Myeloid Leukemia ◽  
Rare Case ◽  
Invasive Pulmonary Aspergillosis ◽  
Skin Lesions ◽  
Immunocompromised Patients ◽  
Skin Involvement ◽  
Pulmonary Aspergillosis ◽  
Acute Myeloid

Invasive pulmonary aspergillosis is most commonly seen in immunocompromised patients. Besides, skin lesions may also develop due to invasive aspergillosis in those patients. A 49-year-old male patient was diagnosed with acute myeloid leukemia. The patient developed bullous and zosteriform lesions on the skin after the 21st day of hospitalization. The skin biopsy showed hyphae. Disseminated skin aspergillosis was diagnosed to the patient. Voricanazole treatment was initiated. The patient was discharged once the lesions started to disappear.

Risks Of Ventilator-Associated Pneumonia And Invasive Pulmonary Aspergillosis In Patients With Viral Acute Respiratory Distress Syndrome Related or Not To Coronavirus 19 Disease

2020 ◽  
Author(s):  
Keyvan Razazi ◽  
Romain ARRESTIER ◽  
Anne-Fleur Haudebourg ◽  
Brice Benelli ◽  
Guillaume Carteaux ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Invasive Aspergillosis ◽  
Distress Syndrome ◽  
Invasive Pulmonary Aspergillosis ◽  
Resistant Bacteria ◽  
Ventilator Associated Pneumonia ◽  
Retrospective Case ◽  
Pulmonary Aspergillosis

Abstract Background The goal of this study was to assess risk factors of ventilator-associated pneumonia (VAP) and invasive pulmonary aspergillosis in patients with SARS-CoV-2 infection.Methods. We conducted a monocenter retrospective study comparing the prevalence of VAP and invasive aspergillosis between patients with COVID-19 related acute respiratory distress syndrome (C-ARDS) and those with non-SARS-CoV-2 viral ARDS (NC-ARDS).Results. We assessed 90 C-ARDS and 82 NC-ARDS patients, who were mechanically ventilated for more than 48 hours. At ICU admission, there were significantly fewer bacterial coinfections documented in C-ARDS than in NC-ARDS: 14 (16%) vs 38 (48%), p<0.01. Conversely, significantly more patients developed at least one VAP episode in C-ARDS as compared with NC-ARDS : 58 (64%) vs. 36 (44%), p=0.007. The probability of VAP was significantly higher in C-ARDS after adjusting on death and ventilator weaning [sub-hazard ratio = 1.72 (1.14-2.52), p<0.01].The prevalence of multi-drug resistant bacteria (MDR) related VAP was significantly higher in C-ARDS than in NC-ARDS: 21 (23%) vs. 9 (11%), p=0.03. Carbapenem was more used in C-ARDS than in NC-ARDS: 48 (53%), vs 21 (26%), p<0.01. According to AspICU algorithm, there were fewer cases of putative aspergillosis in C-ARDS than in NC-ARDS [2 (2%) vs. 12 (15%), p=0.003], but there was no difference in Aspergillus colonization.Conclusions. In this retrospective case-control study, we evidenced a higher prevalence of VAP and MDR-VAP in C-ARDS than in NC-ARDS, and a lower risk for invasive aspergillosis in the former group.

scholarly journals Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19

2020 ◽  
Vol 8 (6) ◽  
pp. e48-e49 ◽  
Author(s):  
Alexandre Alanio ◽  
Sarah Dellière ◽  
Sofiane Fodil ◽  
Stéphane Bretagne ◽  
Bruno Mégarbane
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis

scholarly journals Efficacy of Ambruticin Analogs in a Murine Model of Invasive Pulmonary Aspergillosis

2006 ◽  
Vol 50 (10) ◽  
pp. 3464-3466 ◽  
Author(s):  
Lisa Y. Chiang ◽  
Daniele E. Ejzykowicz ◽  
Zong-Qiang Tian ◽  
Leonard Katz ◽  
Scott G. Filler
Keyword(s):  
Antifungal Activity ◽  
Mouse Model ◽  
Invasive Aspergillosis ◽  
Murine Model ◽  
Antifungal Agents ◽  
Invasive Pulmonary Aspergillosis ◽  
Vehicle Control ◽  
Pulmonary Aspergillosis

ABSTRACT Ambruticins are a family of polyketides. The antifungal activity of an ambruticin, KOSN-2079, was tested in the mouse model of invasive aspergillosis. KOSN-2079 significantly reduced pulmonary fungal burdens and improved survival over that with the vehicle control. These results support the continued development of ambruticins as antifungal agents.

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