ABSTRACT
Objective. To study risk factors, clinical and radiological features and effectiveness of the treatment of invasive aspergillosis (IA) in adult patients with COVID-19 (COVID-IA) in intensive care units (ICU). Materials and methods. A total of 60 patients with COVID-IA treated in ICU (median age 62 years, male - 58%) were included in this multicenter prospective study. The comparison group included 34 patients with COVID-IA outside the ICU (median age 62 years, male - 68%). ECMM/ISHAM 2020 criteria were used for diagnosis of CAPA, and EORTC/MSGERC 2020 criteria were used for evaluation of the treatment efficacy. A case-control study (one patient of the main group per two patients of the control group) was conducted to study risk factors for the development and features of CAPA. The control group included 120 adult COVID-19 patients without IA in the ICU, similar in demographic characteristics and background conditions. The median age of patients in the control group was 63 years, male - 67%. Results. 64% of patients with COVID-IA stayed in the ICU. Risk factors for the COVID-IA development in the ICU: chronic obstructive pulmonary disease (OR = 3.538 [1.104-11.337], p = 0.02), and prolonged (> 10 days) lymphopenia (OR = 8.770 [4.177-18.415], p = 0.00001). The main location of COVID-IA in the ICU was lungs (98%). Typical clinical signs were fever (97%), cough (92%), severe respiratory failure (72%), ARDS (64%) and haemoptysis (23%). Typical CT features were areas of consolidation (97%), hydrothorax (63%), and foci of destruction (53%). The effective methods of laboratory diagnosis of COVID-IA were test for galactomannan in BAL (62%), culture (33%) and microscopy (22%) of BAL. The main causative agents of COVID-IA are A. fumigatus (61%), A. niger (26%) and A. flavus (4%). The overall 12-week survival rate of patients with COVID-IA in the ICU was 42%, negative predictive factors were severe respiratory failure (27.5% vs 81%, p = 0.003), ARDS (14% vs 69%, p = 0.001), mechanical ventilation (25% vs 60%, p = 0.01), and foci of destruction in the lung tissue on CT scan (23% vs 59%, p = 0.01). Conclusions. IA affects predominantly ICU patients with COVID-19 who have concomitant medical conditions, such as diabetes mellitus, hematological malignancies, cancer, and COPD. Risk factors for COVID-IA in ICU patients are prolonged lymphopenia and COPD. The majority of patients with COVID-IA have their lungs affected, but clinical signs of IA are non-specific (fever, cough, progressive respiratory failure). The overall 12-week survival in ICU patients with COVID-IA is low. Prognostic factors of poor outcome in adult ICU patients are severe respiratory failure, ARDS, mechanical ventilation as well as CT signs of lung tissue destruction.Copyright © 2022, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.
ABSTRACT
Aim: to asses an opportunity for predicting an unfavorable perinatal and maternal pregnancy outcome in severe novel coronavirus infection (NCI) COVID-19. Materials and Methods. A retrospective comparative study of the course and outcomes of pregnancies was performed in 40 patients with a gestational age of 22-42 weeks who had severe and extremely severe COVID-19 in 2021. The main group included 21 cases with an extremely severe course of the disease resulting in maternal mortality;the comparison group consisted of 19 patients with severe COVID-19 who successfully completed pregnancy. The diagnosis of NCI COVID-19 was confirmed in all cases by identifying SARS-CoV-2 RNA by polymerase chain reaction in a nasopharyngeal swab. During the study, all patients (during hospitalization, at the peak of the disease and before death/discharge from the hospital) underwent a comprehensive anamnestic, clinical and laboratory-instrumental examination. There were analyzed clinical blood test, biochemical parameters - lactate dehydrogenase (LDH), alanine aminotransferase, aspartate aminotransferase, creatinine, glucose, total bilirubin, total protein;coagulation parameters - prothrombin level according to Quick and fibrinogen, activated partial thromboplastin time, international normalized ratio;the level of C-reactive protein, procalcitonin, D-dimer, interleukin-6 (IL-6);ultrasound examination was performed during pregnancy (fetometry, placentometry), dopplerometry of uteroplacental blood flow and ultrasound of the pelvic organs, as well as pathomorphological placenta examination. Results. In patients who died from extremely severe NCI COVID-19 (main group), the course of the infection was accompanied by developing of respiratory distress (RD) degree III (chi2 = 12.84;p <= 0.05), and a progressive deterioration in mother's condition and/or fetal distress was an indication for emergency delivery by caesarean section (CS). The course of severe NCI COVID-19 in patients with a favorable outcome (comparison group), as a rule, was accompanied by the development of RD grade I and/or II;most of them were also delivered by CS on an emergency/urgent basis. Predictors of rapid progression of severe NCI COVID-19 in the main group were identified: subfebrile body temperature at the initial stages skewing to high fever during treatment instead of rapid temperature normalization (chi2 = 5.41;p <= 0.05;odds ratio (OR) = 5.0;95 % confidence interval (CI) = 1.23-20.3);lack of leukocytosis at the initial stages (chi2 = 4.91;p <= 0.05;OR = 50;95 % CI = 5.43-460.54) with rapidly increased leukocyte count with persistent stagnation in dynamics until death (chi2 = 19.79, p <= 0.05, OR = 50;95 % CI = 5.43-460.54);severe lymphopenia (chi2 = 8.09;p <= 0.05;OR = 7.29;95 % CI = 1.74-30.56), neutrophilia (chi2 = 10.17;p <= 0.05;OR = 10.29;95 % CI = 2.21-47.84);high LDH values (chi2 = 17.99;p <= 0.05;OR = 31.88;95 % CI = 5.09-199.49);increased IL-6 level at the peak of the disease (chi2 = 9.66;p <= 0.05;OR = 18;95 % CI = 1.99-162.62) and in dynamics, as well as stably high D-dimer values (chi2 = 9.53, p <= 0.05;OR = 11.33;95 % CI = 2.07-62.11). Conclusion. Significant changes observed in clinical and laboratory examination were identified, which reliably reflect the degree of patients' state, to be interpreted as predictors of adverse pregnancy outcomes during NCI COVID-19 and as a potentially justified serious reason for making a decision in the light of timely delivery aimed at a favorable outcome for mother and child. Timely delivery, carried out within the time limits for enabling adequate compensatory capabilities of the pregnant woman's body, demonstrates a rapid normalization of the main laboratory parameters.Copyright © 2023 IRBIS LLC. Pravo. All rights reserved.
ABSTRACT
Objective. To study risk factors, clinical and radiological features and effectiveness of the treatment of invasive aspergillosis (IA) in adult patients with COVID-19 (COVID-IA) in intensive care units (ICU). Materials and methods. A total of 60 patients with COVID-IA treated in ICU (median age 62 years, male - 58%) were included in this multicenter prospective study. The comparison group included 34 patients with COVID-IA outside the ICU (median age 62 years, male - 68%). ECMM/ISHAM 2020 criteria were used for diagnosis of CAPA, and EORTC/MSGERC 2020 criteria were used for evaluation of the treatment efficacy. A case-control study (one patient of the main group per two patients of the control group) was conducted to study risk factors for the development and features of CAPA. The control group included 120 adult COVID-19 patients without IA in the ICU, similar in demographic characteristics and background conditions. The median age of patients in the control group was 63 years, male - 67%. Results. 64% of patients with COVID-IA stayed in the ICU. Risk factors for the COVID-IA development in the ICU: chronic obstructive pulmonary disease (OR = 3.538 [1.104-11.337], p = 0.02), and prolonged (> 10 days) lymphopenia (OR = 8.770 [4.177-18.415], p = 0.00001). The main location of COVID-IA in the ICU was lungs (98%). Typical clinical signs were fever (97%), cough (92%), severe respiratory failure (72%), ARDS (64%) and haemoptysis (23%). Typical CT features were areas of consolidation (97%), hydrothorax (63%), and foci of destruction (53%). The effective methods of laboratory diagnosis of COVID-IA were test for galactomannan in BAL (62%), culture (33%) and microscopy (22%) of BAL. The main causative agents of COVID-IA are A. fumigatus (61%), A. niger (26%) and A. flavus (4%). The overall 12-week survival rate of patients with COVID-IA in the ICU was 42%, negative predictive factors were severe respiratory failure (27.5% vs 81%, p = 0.003), ARDS (14% vs 69%, p = 0.001), mechanical ventilation (25% vs 60%, p = 0.01), and foci of destruction in the lung tissue on CT scan (23% vs 59%, p = 0.01). Conclusions. IA affects predominantly ICU patients with COVID-19 who have concomitant medical conditions, such as diabetes mellitus, hematological malignancies, cancer, and COPD. Risk factors for COVID-IA in ICU patients are prolonged lymphopenia and COPD. The majority of patients with COVID-IA have their lungs affected, but clinical signs of IA are non-specific (fever, cough, progressive respiratory failure). The overall 12-week survival in ICU patients with COVID-IA is low. Prognostic factors of poor outcome in adult ICU patients are severe respiratory failure, ARDS, mechanical ventilation as well as CT signs of lung tissue destruction.Copyright © 2022, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.
ABSTRACT
The novel coronavirus infection is a global pandemic with a continuing upward trend for global cases. The virus can infect any person;however, pregnant women may be more susceptible due to physiological changes in the body. This paper describes a clinical case of the rapid course of COVID-19 pneumonia in a pregnant patient without substantial risk factors for a severe, complicated form of the disease. Patient Zh. was infected with COVID-19 at 37-38 weeks’ gestation. The first clinical manifestations of the disease were sore throat accompanied by a rise in temperature up to 38° C. Taking into consideration that the patient felt worse, cough and fever appeared, she was admitted to a specialized hospital on day 5 after the onset of the disease. On day 7 of hospitalization, worsening respiratory symptoms and intoxication syndrome led to the development of acute cardiopulmonary failure that was the cause of death in the pregnant woman and her fetus. Despite the relatively small number of maternal deaths due to COVID-19, obstetricians/gynecologists and other health care workers need additional data on the characteristics of the course of the disease and possible adverse maternal and perinatal outcomes. Conclusion. Physicians should be informed about mortality and its associated clinical characteristics in patients mainly because the median time from the onset of symptoms of the infectious process to the fatal outcome can be as little as two weeks. © A group of authors, 2021.