ABSTRACT
Background. In March 2020 our Institution was designated a COVID-19 unit, since the start of 2021 conventional medical attention has been reinstalled and it became a hybrid hospital. Our objective was to compare the outcome of patients with Invasive Aspergillosis (IA) without COVID-19 during the COVID-19 pandemic, compared with past controls from a historical cohort, and describe their clinical characteristics. As a secondary objective, we described the characteristics of other Invasive Fungal Infections (IFI) in a similar patient group. Methods. Retrospective and descriptive study. The information was obtained from the electronic file. For IFI diagnosis, the EORTC/MSG criteria for proven and probable infection were considered, including the AspiCU modified criteria. The main outcome was death at 6 weeks, time from symptom onset to diagnosis/treatment, and having received antifungal treatment as secondary outcomes. Outcomes were compared to historical IA controls (2:1) from a pre-COVID-19 cohort. The study was approved by the local research and ethics committee. Results. From March 2020 to December 2021, 50 IFIs were diagnosed in non-COVID-19 patients, of which 27 (54%) were Invasive Aspergillosis, 10 (20%) Cryptococcosis, 8(16%) histoplasmosis, 4 (8%) mucormycosis, and 1 (2%) Fusariosis. The median age was 44 years (IQR 33-58) and 67% were men. Forty three percent (22/51) had immunosuppression and 35% (18/51) had hematological malignancy, the median time from symptom onset to IFI diagnosis was 30 days (IQR 11-90) and 38% died within 6 weeks. During the pandemic, in Invasive Aspergillosis non COVID-19 patients, the median number of days from symptom onset to start antifungal was 21 (IQR 6-68) vs 5 (IQR 3-10) of IA historic controls (p=0.0005), 81.5% (22/ 27) vs 93% (50/54) received antifungal treatment (OR 0.88 , 95% CI 0.72-1.0, p=0.13), and IA cases had a mortality of 44% (12/27) vs 41% (22/54) in the historical cohort (p=0.75). We show the IA characteristics in Table 1. GM: Galactomannan antigen Conclusion. During the COVID-19 pandemic, patients with IA withouth COVID-19 were diagnosed significantly later. Also, a trend towards increased mortality and lower proportion of antifungal treatment was observed. It is likely a consequence of hospital reconversion during the start of the pandemic.
ABSTRACT
Background. Post-COVID-19 syndrome occurs usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis (WHO definition, 2021). Our objective was to describe the prevalence, type, and duration of symptoms and their impact on the quality of life of patients hospitalized for COVID-19. Methods. A cross-sectional descriptive study was done, digital informed consent was obtained. Patients with a history of hospitalization for COVID-19 between March 2020 and October 2021 were invited to answer electronically an adaptation of the questionnaire for the identification of post-COVID-19 syndrome and the instrument EuroQol-5D (quality of life). Both were performed at 3, 6, 9 and 12 months after the initial evaluation for COVID-19. Results. We included 246 patients, of whom 76% (187/246) met the definition of post-COVID-19 syndrome, 54% were men, with a median age of 50 years (IQR 41-63). Sixty-three percent (117/187) of post-COVID-19 syndrome patients described a worse health status (OR 9.2, 95% CI 4.1-22.6, p=< 0.0001). The median time to symptoms onset after hospital discharge was 1 day (IQR 1-20), and the median duration of symptoms was 150 days (IQR 90-225). The most frequent symptoms were dyspnea 75% (141), arthralgia 71% (132), fatigue 68% (127), hair loss 60% (112), myalgia 53% (99), sleep disturbances 52% (97), dizziness 47% (88), and palpitations 41% (76) (Figure 1). Regarding quality of life, the post-COVID-19 syndrome patients presented a lower visual analog scale of the EQ-5D versus the group without syndrome (80mm [IQR 70-90] vs. 89.5mm [IQR 75-90], p=0.05). All five dimensions of the quality of life were affected in the post-COVID-19 syndrome group;and dimensions of pain/ discomfort, usual activities, and anxiety/depression showed a statistical difference (Fig 2). Euroqol (EQ)-5D:Specific instrument to describe and value health-related quality of life. Conclusion. Post-COVID-19 syndrome occurred in 76% of hospitalized patients, with prolonged duration and quality of life impairment. Dyspnea was the most frequent symptom. Timely diagnostic and therapeutic intervention is required.
ABSTRACT
Background. Invasive fungal infections (IFI) are emergent complications in SARS-CoV-2 infection. We aimed to describe the epidemiology, characteristics and outcome of IFI during the pandemic. Methods. Between March 2020 and April 2021, patients admitted to the Intensive Care Unit (ICU) in a COVID-19 center in Mexico City who developed IFI were included. COVID-19 associated pulmonary aspergillosis (CAPA) was defined according to the ECMM/ISHAM criteria. Demographic and clinical data were obtained from the electronic medical record. Descriptive analysis was made. The study was approved by the Institutional Review Board. Results. Sixty-seven (67/743, 9%) patients with COVID-19 developed IFI during ICU stay, of which 37 (55%) had CAPA, 24 (36%) had Invasive Candidiasis (IC), 3 Cryptococcosis and 3 pulmonary Mucormycosis. The median age was 57.5 (IQR 48-68) and 46 (69%) were male. Thirty-six (54%) had obesity and 20 (30%) type 2 diabetes. Sixty-two received COVID-19 directed therapy: 48/67 (72%) steroids, 4/67 (6%) tocilizumab and 8/67 (12%) were included in clinical trials. Among 24 patients with IC, 13 (54%) were fluconazole-resistant C. parapsilosis, 11 (46%) C. albicans and 2 C. glabrata. Twenty-two received antifungal treatment, 20 with echinocandins and 2 fluconazole. Among 37 CAPA, 8 (22%) were probable and 29 (78%) possible. Serum galactomannan was positive in 8 (22%), 33 respiratory cultures grew Aspergillus (31 tracheal aspirates and 2 bronchoalveolar lavage). Aspergillus fumigatus was the most frequent isolate in 18/33 (55%). Chest CT showed ground glass opacities in 21 (57%). Most received voriconazole (26/37, 70%). The median time from ICU admission to IFI was 9.5 (IQR 3-14) days. The median ICU and hospital stay length were 30 days (IQR 16-41) and 40 days (IQR 23-49), respectively. In-hospital mortality was 48%. The incidence rate of IC was higher early in the pandemic, due to Infection Control breaches, while higher CAPA incidence may have occurred later due to ventilation system gaps (Figure 1). Bi-monthly Invasive Fungal Infection incidence rate/100 ICU admissions. Conclusion. We found 9% incidence of IFIs in critically-ill COVID-19 patients with high mortality. The majority received steroids, had obesity and had a prolonged hospital stay. Most had possible CAPA. An outbreak of fluconazole-resistant C. parapsilosis was found.
ABSTRACT
Background: As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has remained in Latin America, Mexico has become the third country with the highest death rate worldwide. Data regarding in-hospital mortality and its risk factors, as well as the impact of hospital overcrowding in Latin America has not been thoroughly explored. Methods and findings: In this prospective cohort study, we enrolled consecutive adult patients hospitalized with severe confirmed COVID-19 pneumonia at a SARS-CoV-2 referral center in Mexico City from February 26th, 2020, to June 5th, 2020. A total of 800 patients were admitted with confirmed diagnosis, mean age was 51.9 +or- 13.9 years, 61% were males, 85% were either obese or overweight, 30% had hypertension and 26% type 2 diabetes. From those 800, 559 recovered (69.9%) and 241 died (30.1%). Among survivors, 101 (18%) received invasive mechanical ventilation (IMV) and 458 (82%) were managed outside the intensive care unit (ICU);mortality in the ICU was 49%. From the non-survivors, 45.6% (n = 110) did not receive full support due to lack of ICU bed availability. Within this subgroup the main cause of death was acute respiratory distress syndrome (ARDS) in 95% of the cases, whereas among the non-survivors who received full (n = 105) support the main cause of death was septic shock (45%) followed by ARDS (29%). The main risk factors associated with in-hospital death were male sex (RR 2.05, 95% CI 1.34-3.12), obesity (RR 1.62, 95% CI 1.14-2.32)-in particular morbid obesity (RR 3.38, 95%CI 1.63-7.00) - and oxygen saturation < 80% on admission (RR 4.8, 95%CI 3.26-7.31). Conclusions: In this study we found similar in-hospital and ICU mortality, as well as risk factors for mortality, compared to previous reports. However, 45% of the patients who did not survive justified admission to ICU but did not receive IMV/ICU care due to the unavailability of ICU beds. Furthermore, mortality rate over time was mainly due to the availability of ICU beds, indirectly suggesting that overcrowding was one of the main factors that contributed to hospital mortality.
ABSTRACT
Introduction: COVID-19 superspreader events have occurred when symptomatic individuals without wearing face masks boarded buses. Objective: To report the risk of superspreader events when presymptomatic individuals boarded buses together with unvaccinated passengers, but with non-pharmacological preventive interventions being maintained. Methods: Prospective study of health personnel transported in buses to a COVID-19 vaccination center for two weeks. Open windows, correct use of face masks and exclusion of symptomatic individuals were mandatory. Prospective surveillance identified workers with COVID-19 within 14 days after vaccination. Each asymptomatic passenger of buses where cases were identified was monitored for a similar time period. Voluntary screening results were available for workers who were tested in the month before or after vaccination. Results: 1,879 workers boarded 65 buses. On-board time ranged from three to eight hours. Twenty-nine cases of COVID-19 and four asymptomatic cases were identified among 613 passengers of 21 buses. Median time between vaccination and COVID-19 symptoms onset was six days. One case of suspected transmission on a bus was identified. Conclusions: Strict nonpharmacological preventive interventions substantially reduced the risk of COVID-19 superspreader events in buses boarded by presymptomatic individuals. © 2022 Academia Nacional de Medicina de México,.