Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Because of the severe immunomodulation and lymphocyte depletion caused by this virus and the subsequent administration of drugs directed at the immune system, we anticipated that patients might experience fungal superinfection. We collected data from 186 patients who had coronavirus disease–associated pulmonary aspergillosis (CAPA) worldwide during March–August 2020. Overall, 182 patients were admitted to the intensive care unit (ICU), including 180 with acute respiratory distress syndrome and 175 who received mechanical ventilation. CAPA was diagnosed a median of 10 days after coronavirus disease diagnosis. Aspergillus fumigatus was identified in 80.3% of patient cultures, 4 of which were azole-resistant. Most (52.7%) patients received voriconazole. In total, 52.2% of patients died; of the deaths, 33.0% were attributed to CAPA. We found that the cumulative incidence of CAPA in the ICU ranged from 1.0% to 39.1%.

In a global world, knowledge of imported infectious diseases is essential in daily practice, both for the microbiologist-parasitologist and the clinician who diagnoses and treats infectious diseases in returned travelers. Tropical and subtropical countries where there is a greater risk of contracting an infectious disease are among the most frequently visited tourist destinations. The SEIMC considers it appropriate to produce a consensus document that will be useful to primary care physicians as well as specialists in internal medicine, infectious diseases and tropical medicine who help treat travelers returning from tropical and sub-tropical areas with infections. Preventive aspects of infectious diseases and infections imported by immigrants are explicitly excluded here, since they have been dealt with in other SEIMC documents. Various types of professionals (clinicians, microbiologists, and parasitologists) have helped produce this consensus document by evaluating the available evidence-based data in order to propose a series of key facts about individual aspects of the topic. The first section of the document is a summary of some of the general aspects concerning the general assessment of travelers who return home with potential infections. The main second section contains the key facts (causative agents, diagnostic procedures and therapeutic measures) associated with the major infectious syndromes affecting returned travelers [gastrointestinal syndrome (acute or persistent diarrhea); febrile syndrome with no obvious source of infection; localized cutaneous lesions; and respiratory infections]. Finally, the characteristics of special traveler subtypes, such as pregnant women and immunocompromised travelers, are described.

Introducción: Las implicaciones clínicas y epidemiológicas de las respuestas inmunitarias anormales observadas en la COVID-19 en el cribado de la infección tuberculosa latente (ITL) no están claras. Método: Revisamos los resultados de QuantiFERON TB Gold Plus (QFT-Plus) desde julio de 2016 hasta octubre de 2021 (36.709 pacientes) en Asturias (España). También estudiamos una cohorte de noventa pacientes hospitalizados con neumonía COVID-19 sospechada/confirmada y un grupo de pacientes ancianos hospitalizados con COVID-19 que se sometieron a pruebas seriadas de QFT-Plus y perfiles inmunitarios. Resultados: La tasa de resultados indeterminados QFT-Plus pasó de 1,4% (julio de 2016 a noviembre de 2019) a 4,2% durante la pandemia COVID-19. La evolución del número de casos con respuesta de interferon-gamma (IFN-gamma) baja/muy baja en el tubo mitógeno de QFT-Plus era paralela a la actividad de la enfermedad y al número de muertes por COVID-19 registradas en nuestra región a lo largo de la pandemia (desde marzo de 2020 a octubre de 2021). El porcentaje de pacientes QFT-plus positivo no cambió significativamente antes y durante la pandemia (13,9% vs. 12,2%). Cuarenta y nueve pacientes de la cohorte con neumonía COVID-19 sospechada/confirmada (54,4%) tenían una respuesta de IFN-gamma baja/muy baja al mitógeno, 22 de ellos (24,4%) tenían neumonía grave y crítica. Ninguno recibió inmunosupresores antes de la prueba. Los hallazgos radiológicos anormales (P = 0,01), pero no la gravedad del COVID-19, se asociaron con una respuesta baja al mitógeno. El perfil inmunológico mostró una reducción de las células T-CD8 + y una correlación directa entre el número de células T-EMRA-CD8 + y la respuesta de IFN-gamma en el tubo mitógeno (P = 0,03). Conclusión: Las respuestas bajas de IFN-gamma al mitógeno en QFT-Plus ocurren a menudo en la neumonía por COVID-19, y se asocia con un número bajo de un subconjunto de células T-CD8 + efectoras, sin embargo no parece afectar la detección de ITL. Esta anomalía parece ser paralela a la dinámica de la COVID-19 a nivel poblacional y a su mortalidad.

Background First-line antifungal treatment for invasive mucormycosis (IM) consists of liposomal amphotericin B. Salvage treatment options are limited and often based on posaconazole oral suspension. With the approval of posaconazole new formulations, patients could benefit from improved pharmacokinetics, safety and tolerability. Objectives Our aim was to assess the effectiveness of posaconazole new formulations for IM treatment. Methods We performed a case-matched analysis with proven or probable IM patients from the FungiScope® Registry. First-line posaconazole new formulations (1st-POSnew) and first-line amphotericin B plus posaconazole new formulations (1st-AMB+POSnew) cases were matched with first-line amphotericin B-based (1st-AMB) treatment controls. Salvage posaconazole new formulations (SAL-POSnew) cases were matched with salvage posaconazole oral suspension (SAL-POSsusp) controls. Each case was matched with up to three controls (based on severity, haematological/oncological malignancy, surgery and/or renal dysfunction). Results Five patients receiving 1st-POSnew, 18 receiving 1st-AMB+POSnew and 22 receiving SAL-POSnew were identified. By day 42, a favourable response was reported for 80.0% (n = 4/5) of patients receiving 1st-POSnew, for 27.8% (n = 5/18) receiving 1st-AMB+POSnew and for 50.0% (n = 11/22) receiving SAL-POSnew. Day 42 all-cause mortality of patients receiving posaconazole new formulations was lower compared with controls [20.0% (n = 1/5) in 1st-POSnew versus 53.3% (n = 8/15) in 1st-AMB; 33.3% (n = 6/18) in 1st-AMB+POSnew versus 52.0% (n = 26/50) in 1st-AMB; and 0.0% (n = 0/22) in SAL-POSnew versus 4.4% (n = 2/45) in SAL-POSsusp]. Conclusions Posaconazole new formulations were effective in terms of treatment response and associated mortality of IM. While posaconazole new formulations may be an alternative for treatment of IM, the limited sample size of our study calls for a cautious interpretation of these observations.