Mycotic infection prevalence among patients undergoing bronchoalveolar lavage with search of SARS-CoV-2 after two negative nasopharyngeal swabs

Abstract

The evidence that severe coronavirus disease 2019 (COVID-19) is a risk factor for development of mycotic respiratory infection with an increased mortality is rising. Immunosuppressed are among the most susceptible patients and Aspergillus species is the most feared superinfection. In this study we evaluated mycotic isolation prevalence on bronchoalveolar lavage (BAL) of patients who underwent bronchoscopy in search of severe acute respiratory coronavirus 2 (SARS-CoV-2) RNA. Moreover, we described the clinical characteristics and main outcomes of these patients. We included 118 patients, 35.9% of them were immunosuppressed for different reasons: in 23.7% we isolated SARS-CoV-2 RNA, in 33.1% we identified at least one mycotic agent and both in 15.4%. On BAL we observed in three cases Aspergillus spp, in six cases Pneumocystis and in 32 Candida spp. The prevalence of significant mold infection was 29.3% and 70.7% of cases were false positive or clinically irrelevant infections. In-hospital mortality of patients with fungal infection was 15.3%. The most frequent computed tomography (CT) pattern, evaluated with the Radiological Society of North America consensus statement, among patients with a mycotic pulmonary infection was the atypical one (p < 0.0001). Mycotic isolation on BAL may be interpreted as an innocent bystander, but its identification could influence the prognosis of patients, especially in those who need invasive investigations during the COVID-19 pandemic; BAL plays a fundamental role in resolving clinical complex cases, especially in immunosuppressed patients independently from radiological features, without limiting its role in ruling out SARS-CoV-2 infection.

Trends in the Epidemiology of Pneumocystis Pneumonia in Immunocompromised Patients without HIV Infection

“…There have been approximately 100 reports of coinfection of P. jirovecii in COVID-19 patients, with some of them reviewed recently by Gioia et al [ 226 ] and Khodadadi et al [ 227 ]. The largest number of coinfection cases (in non-HIV/AIDS) was reported from France (34 cases), followed by Italy (22 cases) and Pakistan (10 cases) ( Figure 3 and Table S3 [ 15 , 224 , 225 , 226 , 228 , 229 , 230 , 231 , 232 , 233 , 234 , 235 , 236 , 237 , 238 , 239 , 240 , 241 , 242 , 243 , 244 , 245 , 246 , 247 , 248 , 249 , 250 , 251 , 252 , 253 , 254 , 255 , 256 , 257 , 258 , 259 , 260 , 261 , 262 , 263 , 264 , 265 , 266 , 267 , 268 , 269 , 270 , 271 ]).…”

Limitations and opportunities in breath research in the face of the COVID-19 pandemic

“…The present editorial closes the special issue, Breath Research on COVID-19 and Related Applications: Developments, Discoveries and Deliberations 5 , which consists of three editorials (including this one) [1,4], 12 research papers [10][11][12][13][14][15][16][17][18][19][20][21], four perspectives articles [2,5,7,22], two notes [3,6], and two topical reviews [23,24]; a total of 23 articles. The majority of articles report on efforts towards the diagnosis of COVID-19 using breath, either via detection of viral RNA in exhaled breath condensate (EBC) [7,12,13,23] or through determining the changes that manifest in the volatile organic compound (VOC) profile of breath gas associated with an altered metabolism that accompanies viral infection [5,6,11,18,19].…”

“…Amongst the research articles, the papers by Acar et al and Wood et al examined the phenomenon of 'long COVID' from the viewpoints of respiratory physiology and end-tidal carbon dioxide levels and lung and peripheral muscle performance, respectively [10,20], while Patrucco et al looked at the prevalence of comorbid mycotic infection amongst patients undergoing bronchoalveolar lavage [14]. Evidence for the prospective use of breath volatiles for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was presented in three research articles using different approaches.…”