scholarly journals Invasive Fungal Infections Complicating COVID-19: A Narrative Review

2021 ◽  
Vol 7 (11) ◽  
pp. 921
Author(s):  
Giacomo Casalini ◽  
Andrea Giacomelli ◽  
Annalisa Ridolfo ◽  
Cristina Gervasoni ◽  
Spinello Antinori
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Observational Studies ◽  
Pulmonary Infection ◽  
Fungal Infections ◽  
Case Reports ◽  
Mortality Rates ◽  
Invasive Fungal Infections ◽  
Narrative Review ◽  
Crude Mortality

Invasive fungal infections (IFIs) can complicate the clinical course of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients admitted to an intensive care unit (ICU). This narrative review concerns 4099 cases of IFIs in 58,784 COVID-19 patients involved in 168 studies. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is a diagnostic challenge because its non-specific clinical/imaging features and the fact that the proposed clinically diagnostic algorithms do not really apply to COVID-19 patients. Forty-seven observational studies and 41 case reports have described a total of 478 CAPA cases that were mainly diagnosed on the basis of cultured respiratory specimens and/or biomarkers/molecular biology, usually without histopathological confirmation. Candidemia is a widely described secondary infection in critically ill patients undergoing prolonged hospitalisation, and the case reports and observational studies of 401 cases indicate high crude mortality rates of 56.1% and 74.8%, respectively. COVID-19 patients are often characterised by the presence of known risk factors for candidemia such as in-dwelling vascular catheters, mechanical ventilation, and broad-spectrum antibiotics. We also describe 3185 cases of mucormycosis (including 1549 cases of rhino-orbital mucormycosis (48.6%)), for which the main risk factor is a history of poorly controlled diabetes mellitus (>76%). Its diagnosis involves a histopathological examination of tissue biopsies, and its treatment requires anti-fungal therapy combined with aggressive surgical resection/debridement, but crude mortality rates are again high: 50.8% in case reports and 16% in observational studies. The presence of other secondary IFIs usually diagnosed in severely immunocompromised patients show that SARS-CoV-2 is capable of stunning the host immune system: 20 cases of Pneumocystis jirovecii pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to Fusarium spp., and 1 case of pulmonary infection due to Scedosporium.

scholarly journals (1, 3)-β-D-glucan assay for diagnosing invasive fungal infections in critically ill patients with hematological malignancies

Oncotarget ◽  
2016 ◽  
Vol 7 (16) ◽  
pp. 21484-21495 ◽  
Author(s):  
Elie Azoulay ◽  
Nicolas Guigue ◽  
Michael Darmon ◽  
Djamel Mokart ◽  
Virginie Lemiale ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Hematological Malignancies ◽  
Fungal Infections ◽  
Invasive Fungal Infections

scholarly journals Invasive Fungal Infections in Critically Ill Patients

Critical Care ◽  
2016 ◽  
pp. 434-434
Author(s):  
Mohan Gurjar ◽  
Afzal Azim ◽  
Armin Ahmed ◽  
AK Baronia ◽  
Rungmei Marak
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Fungal Infections ◽  
Invasive Fungal Infections

scholarly journals Optimal management of acute kidney injury in critically ill patients with invasive fungal infections being treated with liposomal amphotericin B

2020 ◽  
Vol 13 (5) ◽  
pp. e233072 ◽  
Author(s):  
Darius Armstrong-James ◽  
Mickey Koh ◽  
Marlies Ostermann ◽  
Paul Cockwell
Keyword(s):  
Acute Kidney Injury ◽  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Kidney Injury ◽  
Invasive Fungal Infections ◽  
Liposomal Amphotericin B ◽  
Cell Transplant

Critically ill patients are at risk of developing both acute kidney injury (AKI) and invasive fungal infections (IFIs). Prompt and efficient treatment of the IFI is essential for the survival of the patient. This article examines three distinct clinical situations where liposomal amphotericin B, a broad-spectrum antifungal agent, was successfully used in the setting of AKI. The first was Aspergillus infection in a 63-year-old man with bleeding oesophageal varices related to advanced liver disease. The second was gastrointestinal mucormycosis in a 74-year-old man who developed a small bowel obstruction following an autologous stem cell transplant for mantle cell lymphoma. The third was a Fusarium infection in a 32-year-old woman on immunosuppression for a bilateral lung transplant for cystic fibrosis. In all three cases, liposomal amphotericin B was required for urgent management of the patient’s IFI. We discuss the rationale for treatment with a potentially nephrotoxic agent in this setting.

scholarly journals Invasive fungal infections in critically ill patients: A prospective study from a tertiary care hospital in India

2018 ◽  
Vol 12 (6) ◽  
pp. 363-367 ◽  
Author(s):  
Chitikela Sindhura Durga ◽  
Nitin Gupta ◽  
Manish Soneja ◽  
Manasvini Bhatt ◽  
Immaculata Xess ◽  
...  
Keyword(s):  
Prospective Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Tertiary Care Hospital ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Invasive Fungal Infections ◽  
Care Hospital ◽  
A Prospective Study

scholarly journals 1170. Invasive Fungal Infections and Colonization in Critically Ill Patients: Impact of Diagnosis and Management on Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S610-S610
Author(s):  
Anthony Siudela ◽  
Afshin Khan ◽  
Marjorie E Bateman
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
High Mortality ◽  
Critically Ill Patients ◽  
Hospital Admissions ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Fungal Colonization ◽  
Post Discharge ◽  
The Impact

Abstract Background Invasive fungal infections (IFIs), though uncommon, are on the rise and have a high mortality rate. Fungal colonization is common, but its clinical significance is unclear. Our study aims to characterize the impact of these diagnoses and their management on outcomes in a large ICU population. Methods We utilized the Multiparameter Intelligent Monitoring in Intensive Care III database for this retrospective cohort study. Adults with positive fungal cultures were classified as colonized or infected using definitions from the EORTC/MSG guidelines and the Blot protocol for Aspergillus. Outcomes were compared between groups matched by age, SOFA score, admission diagnosis, culture results, and comorbidities. Results There were 595 hospital admissions with IFI (11.7/1000 admissions) and 5789 with colonization (114/1000 admissions). In-hospital mortality was 52% in patients with IFIs and 36% in colonized patients. Mortality post-discharge remained high and was not significantly different in the two groups. 67% of patients with IFIs had the diagnosis documented. 24% of patients with IFIs and 8% of colonized patients received antifungal therapy. Treatment did not significantly impact mortality in infected or colonized patients but was associated with increased length of hospital and ICU stay. Infectious disease (ID) consultation was performed in 39.8% of patients with IFIs and 20% of patients with colonization. In the group of IFI patients with ID consultation, in-hospital mortality was higher, but survival post-discharge increased significantly. There was a significant increase in diagnosis of IFI in the ID group and a trend toward increased treatment. In colonized patients with ID consultation, in-hospital mortality and survival post-discharge improved. Hospital and ICU length of stay were longer for patients with ID consultation. Conclusion Critically ill patients with IFIs have high mortality rates, which were not reduced by treatment. The prevalence of colonization was high, and colonized patients experienced significant in-hospital and post-discharge mortality. This study supports the need for additional investigation into ID consultation, which may improve outcomes in critically ill patients with fungal infection and colonization. Disclosures All Authors: No reported disclosures

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