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

Apostolopoulou, Anna; Garrigos, Zerelda Esquer; Vijayvargiya, Priya; Lerner, Alexis Hope; Farmakiotis, Dimitrios

doi:10.3390/diagnostics10100807

Cited by 56 publications

(80 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Some studies have reported the early use of antifungal therapies (like voriconazole) as likely factors associated with an increased survival rate in these patients. 20 All these factors emphasize the importance of constant re-evaluation and prompt detection of complications by the involved medical team.…”

Section: Discussionmentioning

confidence: 99%

COVID-19-associated invasive pulmonary aspergillosis in a tertiary care center in Mexico City

et al. 2021

View full text Add to dashboard Cite

Invasive pulmonary aspergillosis (IPA) is a severe infection caused by aspergillus sp. that usually develops in patients with severe immunosuppression. IPA has been recently described in critically ill COVID-19 patients (termed as COVID-associated pulmonary aspergillosis, or CAPA) that are otherwise immunocompetent. In order to describe the characteristics of patients with CAPA, we conducted a retrospective cohort study in a tertiary care center in Mexico City. We included all patients with confirmed COVID-19 admitted to the intensive care unit that had serum or bronchoalveolar lavage galactomannan measurements. We used the criteria proposed by Koehler et al. to establish the diagnosis of CAPA. Main outcomes were the need for invasive mechanical ventilation (IMV) and in-hospital mortality. Out of a total of 83 hospitalized patients with COVID-19 in the ICU, 16 (19.3%) met the criteria for CAPA. All patients diagnosed with CAPA required IMV whereas only 84% of the patients in the non-IPA group needed this intervention (P = 0.09). In the IPA group, 31% (n = 5) of the patients died, compared to 13% (n = 9) in the non-CAPA group (P = 0.08). We conclude that CAPA is a frequent co-infection in critically ill COVID-19 patients and is associated with a high mortality rate. The timely diagnosis and treatment of IPA in these patients is likely to improve their outcome. Lay Summary We studied the characteristics of patients with COVID-19-associated invasive pulmonary aspergillosis (CAPA). Patients with CAPA tended to need invasive mechanical ventilation more frequently and to have a higher mortality rate. Adequate resources for its management can improve their outcome

show abstract

Section: Discussionmentioning

confidence: 99%

COVID-19-associated invasive pulmonary aspergillosis in a tertiary care center in Mexico City

et al. 2021

View full text Add to dashboard Cite

show abstract

“…A fungal component seems to be rare since it was found only in one case although. COVID-19–associated pulmonary aspergillosis has recently received increasing attention [ 2 ]. Apart from advancing our understanding of the pathogenesis of COVID-19, the autopsies have provided important feedback for the clinicians, in particular the presence of pulmonary thrombosis, which has resulted in adaptation of clinical anticoagulation guidelines [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 autopsies: Procedure, technical aspects and cause of fatal course. Experiences from a single-center

Skok

Vander

Setaffy

et al. 2021

Pathology - Research and Practice

View full text Add to dashboard Cite

Autopsies on COVID-19 have provided deep insights into a novel disease with unpredictable and potentially fatal outcome. A standardized autopsy procedure preferably with an in-situ technique and systematic tissue processing is important. Strict safety measures include personal protective equipment with a standardized protocol for dressing and undressing, usage of FFP-3 masks and minimization of aerosol production. The use of an airborne infection isolation (AIIR) room is preferred. Viral RNA analysis using swabs from throat, both lungs and other organs provides information on cross-organ viral dynamics. To correctly determine the full extent of pathological organ changes an adequate processing procedure is of the utmost importance. Systematic dissection and processing of the lungs revealed pulmonary infarction caused by thrombosis and thromboembolism and subsequent bacterial bronchopneumonia as the most frequent cause of death. Fungal pneumonia (aspergillus) was found in one case. The quality of the tissue was sufficient for histopathological and immunohistochemistry analyses in all cases. Viral RNA from throat or lung swabs was detectable post mortem in 89% of the cases and could also be detected from paraffin-embedded tissue by real-time PCR. Complete COVID-19 autopsies including extensive histopathological studies and viral RNA analysis require approximately three times more human and technical resources and time compared to standard non-COVID autopsies. Autopsies on COVID-19 are feasible, present a manageable risk, while following a strict protocol, and provide novel insights into disease pathogenesis and the clinician with important feedback.

show abstract

“…Soon after the start of the COVID-19 pandemic, clinicians reported a high incidence of Aspergillus findings, i.e., positive Aspergillus culture or positive galactomannan index from any type of respiratory sample in patients admitted to the ICU with COVID-19. It started with case reports or small case series, that subsequently were summarized in reviews [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Aspergillus in Critically Ill COVID-19 Patients: A Scoping Review

Yusuf

Seghers

Hoek

et al. 2021

JCM

View full text Add to dashboard Cite

Several reports have been published on Aspergillus findings in COVID-19 patients leading to a proposition of new disease entity COVID-19-associated pulmonary aspergillosis. This scoping review is designed at clarifying the concepts on how the findings of Aspergillus spp. in COVID-19 patients were interpreted. We searched Medline to identify the studies on Aspergillus spp. findings in COVID-19 patients. Included were observational studies containing the following information: explicit mention of the total number of the study population, study period, reason for obtaining respiratory samples, case definition, and clinical outcomes. Excluded were case series, case reports and reviews. Identified were 123 publications, and 8 observational studies were included. From the included studies the following issues were identified. The proportion of immunocompromised patients considered as host factors varied from 0 to 17%. Most of the studies did not mention radiographic findings explicitly. Respiratory samples were mostly obtained to investigate clinical deterioration. Aspergillus culture, antigen or PCR testing on bronchoalveolar lavage (BAL) fluid were performed in between 23.3% and 66.3% of the study population. Two studies performed periodic samples of BAL. Galactomannan index (GI) positivity in BAL was between 10% and 28%. GI in blood was found in 0.9% to 6.7% of the available samples. The prevalence of COVID-19-associated pulmonary aspergillosis ranged from 2.7% to 27.7%. Studies compared the mortality between defined cases and non-cases, and all showed increased mortality in cases. No studies showed that antifungal treatment reduced mortality. Concluding, this review showed how studies defined the clinical entity COVID-19-associated pulmonary aspergillosis where positive Aspergillus test in the respiratory sample was the main driver for the diagnosis. There were many differences between studies in terms of test algorithm and Aspergillus test used that largely determined the prevalence. Whether antifungal therapy, either as prophylaxis, pre-emptive or targeted therapy will lead to better outcomes of COVID-19-associated pulmonary aspergillosis patients is still need to be answered.

show abstract

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

Cited by 56 publications

References 62 publications

COVID-19-associated invasive pulmonary aspergillosis in a tertiary care center in Mexico City

COVID-19-associated invasive pulmonary aspergillosis in a tertiary care center in Mexico City

COVID-19 autopsies: Procedure, technical aspects and cause of fatal course. Experiences from a single-center

Aspergillus in Critically Ill COVID-19 Patients: A Scoping Review

Contact Info

Product

Resources

About