Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19

Abstract

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

“…Van Biesen et al, reported longer ICU stay with CAPA (37 days in CAPA vs. 19 days in non-CAPA, p < 0.05) without a difference in mortality (22.2% in those with CAPA vs. 15.1% in non-CAPA, p = 0.61) [ 39 ]; however, CAPA was diagnosed earlier in this study as part of active surveillance with serial fungal marker measurement. Alanio et al observed similar mortality between CAPA and non-CAPA COVID-19 patients in the ICU (4/9, 44% vs. 7/18, 39%; p = 0.99) [ 41 ]. Van Arkel et al found higher mortality in CAPA patients (4/6, 66.66% vs. 8/25, 32%); however, the difference was not significant ( p = 0.174) [ 47 ].…”

“…Exceptions included (i) one patient who was a renal transplant recipient on maintenance immunosuppressive therapy (mycophenolate mofetil 1 g twice daily and prednisone 20 mg daily) [ 39 ], (ii) one patient who had a remote history of lung transplant on maintenance immunosuppressive therapy with tacrolimus and prednisone (unspecified doses) [ 40 ], (iii) one patient who was on chronic steroids for pemphigus foliaceus [ 9 ], (iv) one patient who had history of multiple myeloma and was on steroids [ 41 ], (v) one patient with history of rheumatoid arthritis on long-term leflunomide [ 33 ], (vi) one patient with a history of chronic myelomonocytic leukemia [ 40 ] and (vii) one patient with a history of unspecified hematologic malignancy [ 42 ]. For the last two patients, it was not specified in the studies whether their disease was active or in remission, and whether they were neutropenic at baseline or not.…”

Putative invasive pulmonary aspergillosis in critically ill patients with COVID‐19: An observational study from New York City

“…Hence, there is a theoretical risk of IPA in patients with COVID‐19 due to combined known risk factors. However, there are scant data on aspergillosis in patients with COVID‐19 3‐6 . The aim of the study was to describe the clinical features of critically ill COVID‐19‐infected patients with pulmonary aspergillosis at a New York City hospital.…”

The presence of Pneumocystis jirovecii in critically ill patients with COVID-19

“…Of note, among our 10 P. jirovecii carriers, five concomitantly met the criteria for COVID-19-associated pulmonary aspergillosis. 6 Out of these patients, four (40%) received co-trimoxazole as prophylaxis (80/400mg once daily) whereas six including four who rapidly improved did not. One co-trimoxazole-treated and two non-treated patients died while the seven remaining patients were discharged.…”

“… 9 Of note, in two out of our nine tested P. jirovecii RTqPCR-negative patients, higher B-D-glucan concentrations (450 and 500pg/ml) lead to the diagnosis of pulmonary aspergillosis, another fungal infection of risk in COVID-19 patients. 6 Although a recent meta-analysis questioned its sensitivity in non-HIV patients, 10 β-D-glucan has been widely used to rule out pneumocystosis because of its high negative predictive value. This finding may support the hypothesis that our patients were carrying P. jirovecii, yet not being infected per se .…”