Diagnosis of invasive fungal disease in coronavirus disease 2019: approaches and pitfalls

White, P. Lewis

doi:10.1097/qco.0000000000000791

Cited by 12 publications

(7 citation statements)

References 65 publications

(150 reference statements)

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“…The risk of invasive candidiasis is high in patients receiving antibacterials, hemodialysis, parenteral nutrition, undergoing mechanical ventilation and having central venous catheters. All these factors are common in the COVID-19 critical-care patient [ 32 , 33 ]. COVID-19-associated candidiasis (CAC) mostly presents as candidaemia, with Candida albicans and Candida glabrata being the most frequent pathogens.…”

Section: Prevalence Of Invasive Fungal Infections In Critically Ill C...mentioning

confidence: 99%

Fungal Infections in Critically Ill COVID-19 Patients: Inevitabile Malum

Rovina

Koukaki

Romanou

et al. 2022

JCM

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Patients with severe COVID-19 belong to a population at high risk of invasive fungal infections (IFIs), with a reported incidence of IFIs in critically ill COVID-19 patients ranging between 5% and 26.7%. Common factors in these patients, such as multiple organ failure, immunomodulating/immunocompromising treatments, the longer time on mechanical ventilation, renal replacement therapy or extracorporeal membrane oxygenation, make them vulnerable candidates for fungal infections. In addition to that, SARS-CoV2 itself is associated with significant dysfunction in the patient’s immune system involving both innate and acquired immunity, with reduction in both CD4+ T and CD8+ T lymphocyte counts and cytokine storm. The emerging question is whether SARS-CoV-2 inherently predisposes critically ill patients to fungal infections or the immunosuppressive therapy constitutes the igniting factor for invasive mycoses. To approach the dilemma, one must consider the unique pathogenicity of SARS-CoV-2 with the deranged immune response it provokes, review the well-known effects of immunosuppressants and finally refer to current literature to probe possible causal relationships, synergistic effects or independent risk factors. In this review, we aimed to identify the prevalence, risk factors and mortality associated with IFIs in mechanically ventilated patients with COVID-19.

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Section: Prevalence Of Invasive Fungal Infections In Critically Ill C...mentioning

confidence: 99%

Fungal Infections in Critically Ill COVID-19 Patients: Inevitabile Malum

Rovina

Koukaki

Romanou

et al. 2022

JCM

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“…It is because of the immunological imbalances, use of corticosteroids followed by respiratory impairment, and viral-induced or iatrogenic lymphopenia ( 28 ), all are the risk factors for P. jirovecii infection. It is essential to consider PCP alongside COVID-19 as a part of the initial differential diagnosis when screening high-risk populations presenting with a chest infection ( 29 ), however, the clinical overlap with COVID-19 impacts the accuracy of the clinical case definition for PCP ( 15 ). In our patients, the most common clinical presentations were malaise and fatigue, wheezing, fever, dyspnea, cough, and hypoxemia, which were similar to the diagnostic criteria of PCP but are not specific symptoms ( 30 ).…”

Section: Discussionmentioning

confidence: 99%

Molecular and microscopy detection of Pneumocystis jirovecii in hospitalized patients during the COVID-19 pandemic

et al. 2023

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IntroductionEarly detection of Pneumocystis jirovecii as an opportunistic pathogen that may endanger predisposed persons, including COVID-19 patients, may help to choose the optimal management.MethodsIn this study, 585, including 530 COVID-19 patients, with clinical and radiological evidence of respiratory diseases, were investigated for P. jirovecii screening. Clinical specimens were examined by direct microscopy and PCR, and randomly selected positive PCR products were confirmed through DNA sequence analysis.ResultsThirty-one (5.3%) samples were positive in P. jirovecii-specific nested-PCR, while by direct microscopic tests, Pneumocystis was observed in 22 (3.76%) samples. Males (61.7%) and patients over 50 years old (75.6%) were more commonly affected than others, and malaise and fatigue (84%), and wheezing (75%) were the most common symptoms, followed by fever (40.48%) and dyspnea (39.51%). Among the Pneumocystis-positive patients, three cases had coinfection with Aspergillus fumigatus, A. flavus, and A. niger (each n = 1), as documented by direct microscopy, culture, and species identification by PCR-sequencing.ConclusionPneumocystis pneumonia is still a diagnostic challenge; therefore, additional large-scale studies are needed to clarify the epidemiology of the disease in immunocompromised or COVID-19 patients.

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“…The incidence of CAPA is probably overestimated in this study, and also in others recently published [15], due to the denominator of patients with at least three analysed samples even though the population at risk includes all COVID-19 patients receiving invasive mechanical ventilation. Further, some authors outline limitations of the current used definitions [4 ▪▪ ,11], including the false positive galactomannan results, which highlighted an overestimation of CAPA incidence [20–22]. This overestimation was also suggested considering that several patients classified as having CAPA survived without any antifungal treatment.…”

Section: Mouldsmentioning

confidence: 99%

“…,11], including the false positive galactomannan results, which highlighted an overestimation of CAPA incidence [20][21][22]. This overestimation was also suggested considering that several patients classified as having CAPA survived without any antifungal treatment.…”

Section: Andandmentioning

confidence: 99%

Disease-specific gaps within fungal respiratory tract infections: clinical features, diagnosis, and management in critically ill patients

Martín‐Loeches

Nseir

Rodríguez

et al. 2022

Current Opinion in Pulmonary Medicine

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Purpose of reviewWe aim to examine the most recent findings in the area of invasive pulmonary fungal infections to determine the appropriate/and or lack of prevention measures and treatment of upper fungal respiratory tract infections in the critically ill.Recent findingsThis will be addressed by focusing on the pathogens and prognosis over different bedridden periods in ICU patients, the occurrence of invasive fungal respiratory superinfections in patients with severe coronavirus disease 2019 which has been recently noted following the SARS-CoV-2 pandemic. Relevant reports referenced within include randomized controlled trials, meta-analyses, observational studies, systematic reviews, and international guidelines, where applicable. Of note, it is clear there is a significant gap in our knowledge regarding whether bacterial and fungal infections in coronavirus disease 2019 are directly attributable to SARS-CoV-2 or a consequence of factors such as managing high numbers of critically unwell patients, and the prolonged duration of mechanical ventilation/ICU admission duration of stay.SummaryAn optimal diagnostic algorithm incorporating fungal biomarkers and molecular tools for early and accurate diagnosis of Pneumocystis pneumonia, invasive aspergillosis, candidemia, and endemic mycoses continues to be limited clinically. There is a lack of standardized molecular approach to identify fungal pathogens directly in formalin-fixed paraffin-embedded tissues and suboptimal diagnostic approaches for mould blood cultures, tissue culture processing for Mucorales, and fungal respiratory cultures (i.e., the routine use of bronchoscopic examination in ICU patients with influenza-associated pulmonary aspergillosis) for fungal point-of-care testing to detect and identify new, emerging or underrecognized, rare, or uncommon fungal pathogens.

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Diagnosis of invasive fungal disease in coronavirus disease 2019: approaches and pitfalls

Cited by 12 publications

References 65 publications

Fungal Infections in Critically Ill COVID-19 Patients: Inevitabile Malum

Fungal Infections in Critically Ill COVID-19 Patients: Inevitabile Malum

Molecular and microscopy detection of Pneumocystis jirovecii in hospitalized patients during the COVID-19 pandemic

Disease-specific gaps within fungal respiratory tract infections: clinical features, diagnosis, and management in critically ill patients

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