scholarly journals COVID-19-Associated Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Series in a Portuguese Hospital

2021 ◽  
Vol 7 (10) ◽  
pp. 881
Author(s):  
David Ranhel ◽  
Ana Ribeiro ◽  
Judite Batista ◽  
Maria Pessanha ◽  
Elisabete Cristovam ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Distress Syndrome ◽  
Invasive Pulmonary Aspergillosis ◽  
Case Series ◽  
Invasive Disease ◽  
Sensu Stricto ◽  
Pulmonary Aspergillosis ◽  
Strict Interpretation ◽  
Low Threshold

Invasive pulmonary aspergillosis (IPA) has become a recognizable complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs). Alveolar damage in the context of acute respiratory distress syndrome (ARDS) appears to be the culprit in facilitating fungal invasion in COVID-19 patients, leading to a COVID-19-associated pulmonary aspergillosis (CAPA) phenomenon. From November 2020 to 15 February 2021, 248 COVID-19 patients were admitted to our ICUs, of whom ten patients (4% incidence) were classified as either probable (six) or possible (four) CAPA cases. Seven patients had positive cultural results: Aspergillus fumigatus sensu stricto (five), A. terreus sensu stricto (one), and A. welwitschiae (one). Five patients had positive bronchoalveolar lavage (BAL) and galactomannan (GM), and two patients had both positive cultural and GM criteria. All but two patients received voriconazole. Mortality rate was 30%. Strict interpretation of classic IPA definition would have resulted in eight overlooked CAPA cases. Broader diagnostic criteria are essential in this context, even though differentiation between Aspergillus colonization and invasive disease might be more challenging. Herein, we aim to raise awareness of CAPA in view of its potential detrimental outcome, emphasizing the relevance of a low threshold for screening and early antifungal treatment in ARDS patients.

scholarly journals Influenza- and COVID-19-Associated Pulmonary Aspergillosis: Are the Pictures Different?

2021 ◽  
Vol 7 (5) ◽  
pp. 388
Author(s):  
Florian Reizine ◽  
Kieran Pinceaux ◽  
Mathieu Lederlin ◽  
Brice Autier ◽  
Hélène Guegan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Retrospective Study ◽  
Distress Syndrome ◽  
Invasive Pulmonary Aspergillosis ◽  
Radiological Findings ◽  
Pulmonary Aspergillosis ◽  
Invasive Fungal Diseases ◽  
Kaplan Meier

Invasive pulmonary aspergillosis (IPA) in intensive care unit patients is a major concern. Influenza-associated acute respiratory distress syndrome (ARDS) and severe COVID-19 patients are both at risk of developing invasive fungal diseases. We used the new international definitions of influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) to compare the demographic, clinical, biological, and radiological aspects of IAPA and CAPA in a monocentric retrospective study. A total of 120 patients were included, 71 with influenza and 49 with COVID-19-associated ARDS. Among them, 27 fulfilled the newly published criteria of IPA: 17/71 IAPA (23.9%) and 10/49 CAPA (20.4%). Kaplan–Meier curves showed significantly higher 90-day mortality for IPA patients overall (p = 0.032), whereas mortality did not differ between CAPA and IAPA patients. Radiological findings showed differences between IAPA and CAPA, with a higher proportion of features suggestive of IPA during IAPA. Lastly, a wide proportion of IPA patients had low plasma voriconazole concentrations with a higher delay to reach concentrations > 2 mg/L in CAPA vs. IAPA patients (p = 0.045). Severe COVID-19 and influenza patients appeared very similar in terms of prevalence of IPA and outcome. The dramatic consequences on the patients’ prognosis emphasize the need for a better awareness in these particular populations.

scholarly journals A novel diagnosis scoring model to predict invasive pulmonary aspergillosis in the intensive care unit

2019 ◽  
Vol 40 (2) ◽  
pp. 140-146 ◽  
Author(s):  
Anna Rozaliyani ◽  
Rudyanto Sedono ◽  
Anwar Jusuf ◽  
Cleopas Rumende ◽  
Wahju Aniwidyaningsih ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis ◽  
Scoring Model

scholarly journals Invasive pulmonary aspergillosis in a COVID-19 recovered patient: unravelling an infective sequalae of the SARS-CoV-2 virus

2021 ◽  
Vol 91 (2) ◽  
Author(s):  
Benhur Joel Shadrach ◽  
Rishabh Goel ◽  
Kunal Deokar ◽  
Anukool Jain
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Emergency Room ◽  
Lung Disease ◽  
Invasive Pulmonary Aspergillosis ◽  
Morbidly Obese ◽  
Pulmonary Aspergillosis ◽  
The Past

Dear Editor, A 55-year-female, house wife, non-smoker, morbidly obese (BMI>35) with no other co-morbidities or pre-existing lung disease presented to the emergency room with complaints of highgrade fever, cough with minimal sputum, progressive breathlessness, streaky haemoptysis, and anorexia for the past 5 days. She was admitted in intensive care unit (ICU) for severe COVID-19 pneumonia three months back and had successfully recovered after 24 days of hospitalization....

Invasive Pulmonary Aspergillosis in Patients With Severe Fever With Thrombocytopenia Syndrome

2019 ◽  
Author(s):  
Seongman Bae ◽  
Hye Jeon Hwang ◽  
Mi Young Kim ◽  
Min Jae Kim ◽  
Yong Pil Chong ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antifungal Therapy ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis ◽  
Severe Fever

Abstract Sixteen of 45 patients with severe fever with thrombocytopenia (36%) were admitted to an intensive care unit; 9 (56%) developed invasive pulmonary aspergillosis (IPA) within a median of 8 days (range, 2–11). Mortality was higher in the IPA vs non-IPA patients and in those without vs with antifungal therapy.

scholarly journals Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 807 ◽  
Author(s):  
Anna Apostolopoulou ◽  
Zerelda Esquer Garrigos ◽  
Prakhar Vijayvargiya ◽  
Alexis Hope Lerner ◽  
Dimitrios Farmakiotis
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Significant Proportion ◽  
Invasive Pulmonary Aspergillosis ◽  
Organ Transplant ◽  
Clinical Manifestations ◽  
Case Series ◽  
Case Fatality ◽  
Invasive Disease ◽  
Pulmonary Aspergillosis

In this systematic review, we investigate the epidemiology, pathogenesis, risk factors, clinical manifestations, diagnosis and treatment of COVID-19-associated pulmonary aspergillosis (CAPA). We identified 85 cases from 22 studies. The frequency of CAPA is currently unknown but ranges between <5% to >30% in different case series; the possibility of colonization rather than invasive disease is the most important confounder. The vast majority of patients with CAPA did not have any of the classic host risk factors, such as immunosuppression from organ transplant or neutropenia, although a significant proportion (46%) had received corticosteroids. Age, pulmonary comorbidities and male sex were associated with higher mortality. Patients treated with voriconazole had numerically lower case-fatality rate. Clinical vigilance for CAPA is advisable in critically ill patients with COVID-19 who are not improving, even those who do not meet classic host criteria for invasive mycoses, especially if they are receiving corticosteroids. A thorough, multi-faceted diagnostic work-up and early initiation of a mold-active triazole may be lifesaving. Further research studies using standardized, uniform definitions of invasive disease and colonization are urgently needed.

scholarly journals Invasive pulmonary aspergillosis in COVID-19. A case series at Gregorio Maranon University General Hospital

2021 ◽  
Author(s):  
Alba Burgos Santamaría ◽  
María Lema T. ◽  
Ana Gloria Pizarro C.
Keyword(s):  
At Risk ◽  
General Hospital ◽  
Chart Review ◽  
Distress Syndrome ◽  
Invasive Pulmonary Aspergillosis ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Single Center ◽  
Secondary Complications ◽  
Pulmonary Aspergillosis

Purpose: Patients with acute respiratory distress syndrome (ARDS) due to viral infection admitted at ICU are at risk for secondary complications like invasive pulmonary aspergillosis. Our study evaluates severe ARDS due to COVID-19 associated invasive pulmonary aspergillosis at a single center in Madrid, Spain. Materials and Methods: A retrospective chart review of patients with COVID-19 associated ARDS admitted to two of the five ICUs that were available at the Gregorio Maranon University General Hospital, Madrid, Spain. Results: COVID-19 associated invasive pulmonary aspergillosis was found in 4 of 79 critically ill patients with severe ARDS. Conclusion: Patients with ARDS triggered by COVID-19 seem to be at risk of developing invasive pulmonary aspergillosis, being necessary the early diagnosis and treatment in order to improve their prognosis.

scholarly journals Risk factors for invasive aspergillosis in ICU patients with COVID-19: current insights and new key elements

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
G. Montrucchio ◽  
T. Lupia ◽  
D. Lombardo ◽  
G. Stroffolini ◽  
S. Corcione ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Influenza Infection ◽  
Invasive Pulmonary Aspergillosis ◽  
Diagnostic Category ◽  
Pulmonary Aspergillosis ◽  
Related Factors ◽  
Epidemiological Characteristics ◽  
The Impact

AbstractInvasive pulmonary aspergillosis (IPA) has always been a challenging diagnosis and risk factors an important guide to investigate specific population, especially in Intensive Care Unit. Traditionally recognized risk factors for IPA have been haematological diseases or condition associated with severe immunosuppression, lately completed by chronic conditions (such as obstructive pulmonary disease, liver cirrhosis, chronic kidney disease and diabetes), influenza infection and Intensive Care Unit (ICU) admission. Recently, a new association with SARS-CoV2 infection, named COVID-19-associated pulmonary aspergillosis (CAPA), has been reported worldwide, even if its basic epidemiological characteristics have not been completely established yet. In this narrative review, we aimed to explore the potential risk factors for the development of CAPA and to evaluate whether previous host factors or therapeutic approaches used in the treatment of COVID-19 critically ill patients (such as mechanical ventilation, intensive care management, corticosteroids, broad-spectrum antibiotics, immunomodulatory agents) may impact this new diagnostic category. Reviewing all English-language articles published from December 2019 to December 2020, we identified 21 papers describing risk factors, concerning host comorbidities, ICU management, and COVID-19 therapies. Although limited by the quality of the available literature, data seem to confirm the role of previous host risk factors, especially respiratory diseases. However, the attention is shifting from patients’ related risk factors to factors characterizing the hospital and intensive care course, deeply influenced by specific features of COVID treatment itself. Prolonged invasive or non-invasive respiratory support, as well as the impact of corticosteroids and/or immunobiological therapies seem to play a pivotal role. ICU setting related factors, such as environmental factors, isolation conditions, ventilation systems, building renovation works, and temporal spread with respect to pandemic waves, need to be considered. Large, prospective studies based on new risk factors specific for CAPA are warranted to guide surveillance and decision of when and how to treat this particular population.

Invasive Pulmonary Aspergillosis in Nonimmunocompromised Hosts

2019 ◽  
Vol 40 (04) ◽  
pp. 540-547 ◽  
Author(s):  
Jean-Jacques Tudesq ◽  
Olivier Peyrony ◽  
Virginie Lemiale ◽  
Elie Azoulay
Keyword(s):  
Critically Ill ◽  
Distress Syndrome ◽  
Invasive Pulmonary Aspergillosis ◽  
Invasive Disease ◽  
Chronic Obstructive ◽  
Pulmonary Aspergillosis ◽  
Obstructive Pulmonary Disease ◽  
Factors Associated ◽  
Immune Alterations ◽  
Organ Dysfunctions

AbstractInvasive pulmonary aspergillosis (IPA) is a fungal infection that is the hallmark of severe cellular or complex immune alterations. Evidence that IPA can occur in nonimmunocompromised hosts is increasing. Actually, up to 1% of general intensive care unit (ICU) patients present positive samples with Aspergillus spp. Both colonization and invasive disease are associated with poor outcome. Unexpected IPA has also been reported in approximately 1% of critically ill patients who underwent postmortem biopsies. In nonimmunocompromised patients with acute respiratory distress syndrome (ARDS), IPA prevalence can reach up to 15% of patients in both clinical and autopsy studies. Factors associated with IPA in nonimmunocompromised critically ill hosts include short and long courses of steroids, broad antibiotic therapy, chronic obstructive pulmonary disease, ARDS, liver failure, and the severity of organ dysfunctions.This review aims to appraise the prevalence of IPA in nonimmunocompromised hosts, address diagnostic challenges, and outcomes.

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