COVID-19 associated pulmonary aspergillosis in ICU patients: Report of five cases from Argentina

Benedetti, María Fernanda; Alava, Katherine Hermida; Sagardía, Judith; Cadena, Roberto Corella; Laplume, Diego; Capece, Paula; Posse, Gladys; Nusblat, Alejandro D.; Cuestas, María Luján

doi:10.1016/j.mmcr.2020.11.003

Cited by 28 publications

(30 citation statements)

References 17 publications

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“…The search yielded a total of 195 articles of which 20 were included 23‐42 . The search strategy and PRISMA flow chart depicting the selection of studies is shown in Figure and Figure 1, respectively.…”

Section: Resultsmentioning

confidence: 99%

Mortality in critically ill patients with coronavirus disease 2019‐associated pulmonary aspergillosis: A systematic review and meta‐analysis

Verma

Kanaujia

Chakrabarti

et al. 2021

Mycoses

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Reports of COVID‐19 associated pulmonary aspergillosis (CAPA) are rising, but the associated mortality and factors affecting it are not well‐characterised. We performed a systematic review including 20 peer‐reviewed English language studies reporting mortality in CAPA published till 18 February 2021from PubMed, Ovid SP, Web of Science, Embase and CINHAL. The pooled mortality in CAPA was 51.2% (95% CI: 43.1–61.1, I2 = 38%). The leave one out sensitivity analysis and influential case diagnostics revealed one outlier and its exclusion resulted in a mortality estimate of 54% (95% CI: 45–62). Higher odds of mortality: 2.83 (95% CI: 1.8–4.5) were seen in CAPA compared to controls. No significant difference in various subgroups according to the country of study, the continent of study, income category of country and quality of the included study was seen. None of the host risk factors, mycological test results, therapy for COVID‐19 and antifungal therapy affected mortality. Thus, patients with CAPA have a high probability of mortality and early diagnosis with prompt therapy must be ensured to optimally manage these patients. However, more prospective studies with global and multi‐centre coordination may help to address CAPA in a better way.

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Section: Resultsmentioning

confidence: 99%

Mortality in critically ill patients with coronavirus disease 2019‐associated pulmonary aspergillosis: A systematic review and meta‐analysis

Verma

Kanaujia

Chakrabarti

et al. 2021

Mycoses

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“…The main diagnostic criteria used were AspICU [103] (seven studies) and modified AspICU (eight studies) [104]. The patients were predominantly male (49, 66.2%) and had a median age of 69 years (inter-quartile range (IQR) [57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74]. The reported major co-morbidities were arterial hypertension (37 patients, 50%), diabetes mellitus (26, 35.1%), chronic pulmonary disease (13, 17.5%), cardiovascular disease (9, 12.2%), and obesity (4, 5.4%).…”

Section: Case Reports and Case Seriesmentioning

confidence: 99%

“…The most frequently isolated Aspergillus species were A. fumigatus (43 cultures, 67.2%) and A. niger (8 cultures, 12.5%), and the most frequent diagnostic samples were bronchoalveolar lavage (BAL) samples (25, 40.3%). Direct examination of respiratory samples showing septate branching hyphae was reported in 11 cases (17.7% of positive cultures) [65][66][67]71,76,[86][87][88][89]92,96,102]. Proven CAPA was reported in five studies: in three cases, the diagnosis was made post portem [69,72,95]; in the remaining two cases, the diagnosis was made using pulmonary tissue (biopsy in one case, lobectomy in the other) [89,92].…”

Section: Case Reports and Case Seriesmentioning

confidence: 99%

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

Casalini

Giacomelli

Ridolfo

et al. 2021

JoF

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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.

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“… Distribution ( a ) and co-occurrence ( b ) of fungal species across randomly selected 50 case studies, prospective and retrospective published reports on fungal co-infections in hospitalized COVID-19 patients [ 5 , 7 , 9 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ] (also see Supplementary Table S1 ). Searches were done on PubMed (Medline) and Google Scholar using query terms such as “Co-infections”, “coinfections”, “fungi” or “Fungal infections” in combination with either “COVID-19” or “SARS-CoV-2”.…”

Section: Figurementioning

confidence: 99%

Risk Factors for Fungal Co-Infections in Critically Ill COVID-19 Patients, with a Focus on Immunosuppressants

Ezeokoli

Gcilitshana

Pohl

2021

JoF

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Severe cases of coronavirus disease 2019 (COVID-19) managed in the intensive care unit are prone to complications, including secondary infections with opportunistic fungal pathogens. Systemic fungal co-infections in hospitalized COVID-19 patients may exacerbate COVID-19 disease severity, hamper treatment effectiveness and increase mortality. Here, we reiterate the role of fungal co-infections in exacerbating COVID-19 disease severity as well as highlight emerging trends related to fungal disease burden in COVID-19 patients. Furthermore, we provide perspectives on the risk factors for fungal co-infections in hospitalized COVID-19 patients and highlight the potential role of prolonged immunomodulatory treatments in driving fungal co-infections, including COVID-19-associated pulmonary aspergillosis (CAPA), COVID-19-associated candidiasis (CAC) and mucormycosis. We reiterate the need for early diagnosis of suspected COVID-19-associated systemic mycoses in the hospital setting.

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COVID-19 associated pulmonary aspergillosis in ICU patients: Report of five cases from Argentina

Cited by 28 publications

References 17 publications

Mortality in critically ill patients with coronavirus disease 2019‐associated pulmonary aspergillosis: A systematic review and meta‐analysis

Mortality in critically ill patients with coronavirus disease 2019‐associated pulmonary aspergillosis: A systematic review and meta‐analysis

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

Risk Factors for Fungal Co-Infections in Critically Ill COVID-19 Patients, with a Focus on Immunosuppressants

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