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1.
Mycoses ; 65(4): 411-418, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1685386

ABSTRACT

BACKGROUND: The diagnosis of invasive pulmonary aspergillosis (IPA) in intensive care unit (ICU) patients is challenging, and the role of Aspergillus-PCR in bronchoalveolar lavage (BAL) is unknown. OBJECTIVES: This study evaluated diagnostic accuracy of Aspergillus-PCR in BAL in IPA in three different cohorts: ICU-admitted patients with COVID-19, ICU-admitted patients without COVID-19 and immunocompromised patients. METHODS: All stored available BAL samples collected from three patient groups were tested with Aspergillus-PCR (AsperGenius® ). IPA was diagnosed according to appropriate criteria for each patient group. RESULTS: We included 111 BAL samples from 101 patients: 52 (51%) patients admitted to ICU for COVID-19, 24 (24%) admitted to ICU for other reasons and 25 (25%) immunocompromised. There were 31 cases of IPA (28%). Aspergillus-PCR sensitivity was 64% (95% CI 47-79) and specificity 99% (95% CI 93-100). Aspergillus-PCR sensitivity was 40% (95%CI 19-64) in ICU COVID-19, 67% (95% CI 21-93) in non-COVID-19 ICU patients and 92% (95%CI 67-98) in the immunocompromised. The concordance between positive BAL-GM and BAL-PCR in patients with and without IPA was significantly lower in ICU patients (32%; 43% in COVID-19, 18% in non-COVID-19) than in the immunocompromised (92%), p < .001. CONCLUSIONS: Aspergillus-PCR in BAL improves the diagnostic accuracy of BAL-GM in ICU patients.


Subject(s)
COVID-19 , Invasive Pulmonary Aspergillosis , Aspergillus/genetics , Bronchoalveolar Lavage , Bronchoalveolar Lavage Fluid , COVID-19/diagnosis , Critical Illness , Galactose , Humans , Invasive Pulmonary Aspergillosis/diagnosis , Mannans/analysis , Polymerase Chain Reaction , Sensitivity and Specificity
2.
Clin Infect Dis ; 72(Suppl 2): S95-S101, 2021 03 12.
Article in English | MEDLINE | ID: covidwho-1338678

ABSTRACT

Aspergillus polymerase chain reaction testing of blood and respiratory samples has recently been included in the second revision of the EORTC/MSGERC definitions for classifying invasive fungal disease. This is a result of considerable efforts to standardize methodology, the availability of commercial assays and external quality control programs, and additional clinical validation. This supporting article provides both clinical and technical justifications for its inclusion while also summarizing recent advances and likely future developments in the molecular diagnosis of invasive aspergillosis.


Subject(s)
Aspergillosis , Invasive Fungal Infections , Aspergillosis/diagnosis , Aspergillus/genetics , DNA, Fungal/genetics , Humans , Invasive Fungal Infections/diagnosis , Polymerase Chain Reaction , Sensitivity and Specificity
3.
Mycoses ; 64(9): 1002-1014, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1148083

ABSTRACT

Invasive aspergillosis (IA) is an increasingly recognised phenomenon in critically ill patients in the intensive care unit, including in patients with severe influenza and severe coronavirus disease 2019 (COVID-19) infection. To date, there are no consensus criteria on how to define IA in the ICU population, although several criteria are used, including the AspICU criteria and new consensus criteria to categorise COVID-19-associated pulmonary aspergillosis (CAPA). In this review, we describe the epidemiology of IA in critically ill patients, most common definitions used to define IA in this population, and most common clinical specimens obtained for establishing a mycological diagnosis of IA in the critically ill. We also review the most common diagnostic tests used to diagnose IA in this population, and lastly discuss the most common clinical presentation and imaging findings of IA in the critically ill and discuss areas of further needed investigation.


Subject(s)
Aspergillus/genetics , COVID-19/complications , Diagnostic Techniques and Procedures/standards , Intensive Care Units/standards , Invasive Pulmonary Aspergillosis/classification , Invasive Pulmonary Aspergillosis/diagnosis , Practice Guidelines as Topic , Adult , Aged , Aged, 80 and over , Aspergillus/isolation & purification , COVID-19/microbiology , Critical Illness/classification , Female , Humans , Invasive Pulmonary Aspergillosis/physiopathology , Male , Mannans/blood , Middle Aged , Polymerase Chain Reaction , SARS-CoV-2
4.
Mycoses ; 64(6): 641-650, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1091024

ABSTRACT

BACKGROUND: A high prevalence of COVID-19 associated pulmonary aspergillosis (CAPA) has been reported, though histopathological evidence is frequently lacking. To assess the clinical significance of Aspergillus species in respiratory samples of mechanically ventilated COVID-19 patients, we implemented routine screening for Aspergillus in tracheal aspirate (TA). PATIENTS/METHODS: From all adult COVID-19 patients admitted to the intensive care unit (ICU), TA samples were collected twice a week for Aspergillus screening by PCR and or culture. Bronchoalveolar lavage (BAL) sampling was performed in patients with a positive screening result if possible. Clinical information was obtained from the electronic patient record and patients were categorised according to the recently published consensus case definition for CAPA. RESULTS: Our study population consisted of 63 predominantly (73%) male patients, with a median age of 62 years and total median ICU stay of 18 days. Aspergillus species were present in TA screening samples from 15 patients (24%), and probable CAPA was diagnosed in 11 (17%) patients. Triazole resistance was detected in one patient (14%). Concordance between TA and BAL was 86%, and all TA culture positives were confirmed in BAL. We were able to withhold treatment in three of fifteen patients with positive screening (20%) but negative BAL results. CONCLUSIONS: Positive culture, molecular detection and or antigen detection of Aspergillus species do not equal infection. Until we understand the clinical relevance of Aspergillus species detected in respiratory samples of COVID-19 patients, minimal-invasive screening by TA is a feasible method to monitor patients. Positive screening results should be an indication to perform a BAL to rule out upper airway colonisation.


Subject(s)
COVID-19 Testing/methods , COVID-19/diagnosis , COVID-19/microbiology , Invasive Pulmonary Aspergillosis/diagnosis , Invasive Pulmonary Aspergillosis/virology , Aged , Aspergillus/genetics , Aspergillus/isolation & purification , Female , Humans , Intensive Care Units , Invasive Pulmonary Aspergillosis/drug therapy , Male , Middle Aged , Polymerase Chain Reaction/methods , SARS-CoV-2
5.
Mycoses ; 64(2): 144-151, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-939797

ABSTRACT

BACKGROUND: As the global coronavirus pandemic (COVID-19) spreads across the world, new clinical challenges emerge in the hospital landscape. Among these challenges, the increased risk of coinfections is a major threat to the patients. Although still in a low number, due to the short time of the pandemic, studies that identified a significant number of hospitalised patients with COVID-19 who developed secondary fungal infections that led to serious complications and even death have been published. OBJECTIVES: In this scenario, we aim to determine the prevalence of invasive fungal infections (IFIs) and describe possible associated risk factors in patients admitted due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. PATIENTS/METHODS: We designed an open prospective observational study at the Rey Juan Carlos University Hospital (Mostoles, Spain), during the period from February 1 to April 30, 2020. RESULTS: In this article, we reported seven patients with COVID-19-associated pulmonary aspergillosis (CAPA) who had a poor prognosis. Severely ill patients represent a high-risk group; therefore, we must actively investigate the possibility of aspergillosis in all of these patients. Larger cohort studies are needed to unravel the role of COVID-19 immunosuppressive therapy as a risk factor for aspergillosis. CONCLUSIONS: As the pandemic continues to spread across the world, further reports are needed to assess the frequency of emergent and highly resistant reemergent fungal infections during severe COVID-19. These coinfections are leading a significant number of patients with COVID-19 to death due to complications following the primary viral disease.


Subject(s)
COVID-19/complications , Invasive Pulmonary Aspergillosis/etiology , Opportunistic Infections/microbiology , Adult , Aged , Aspergillus/genetics , Aspergillus/isolation & purification , Aspergillus/physiology , COVID-19/virology , Female , Hospitalization , Humans , Intermediate Care Facilities/statistics & numerical data , Invasive Pulmonary Aspergillosis/microbiology , Male , Middle Aged , Opportunistic Infections/etiology , Prevalence , Prospective Studies , SARS-CoV-2/physiology , Spain
6.
J Mycol Med ; 30(4): 101039, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-723228

ABSTRACT

As aspergillosis is a well-known complication of severe influenza, we suggest that SARS-CoV-2 might be a risk factor for invasive aspergillosis (IA). We report the case of an 87 year-old woman, with no history of immune deficit, admitted in our emergency room for severe respiratory distress. Coronavirus disease 2019 (COVID-19) diagnosis was confirmed by a SARS-CoV-2 reverse transcriptase polymerase chain reaction (PCR) on nasal swab. On day 14, pulmonary examination deteriorated with haemoptysis and a major increase of inflammatory response. A computed tomography (CT) scan revealed nodules highly suggestive of IA. Aspergillus antigen was found highly positive in sputum and blood, as was Aspergillusspp PCR on serum. Sputum cultures remained negative for Aspergillus. This patient died rapidly from severe respiratory failure, despite the addition of voriconazole. Considering SARS-CoV-2 acute respiratory distress syndrome (ARDS) as an acquired immunodeficiency, we report here a new case of "probable" IA based on clinical and biological arguments, in accordance with the last consensus definition of invasive fungal disease. On a routine basis, we have detected 30% of aspergillosis carriage (positive culture and antigen in tracheal secretions) in critically ill patients with COVID-19 in our centre. Further studies will have to determine whether sputum or tracheal secretions should be systematically screened for fungal investigations in intensive care unit (ICU) COVID-19 patients to early diagnose and treat aspergillosis.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Invasive Pulmonary Aspergillosis/complications , Pneumonia, Viral/diagnosis , Aged, 80 and over , Antigens, Fungal/analysis , Antigens, Fungal/blood , Aspergillus/genetics , Aspergillus/immunology , Aspergillus/isolation & purification , Betacoronavirus/enzymology , Betacoronavirus/genetics , COVID-19 , Coronavirus Infections/complications , Fatal Outcome , Female , Humans , Invasive Pulmonary Aspergillosis/diagnosis , Nasal Mucosa/virology , Pandemics , Pneumonia, Viral/complications , Respiratory Distress Syndrome/etiology , Reverse Transcriptase Polymerase Chain Reaction , Risk Factors , SARS-CoV-2 , Sputum/microbiology
7.
Rev. Soc. Bras. Med. Trop ; 53: e20200401, 2020. graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-636312

ABSTRACT

Abstract We present postmortem evidence of invasive pulmonary aspergillosis (IPA) in a patient with severe COVID-19. Autopsies of COVID-19 confirmed cases were performed. The patient died despite antimicrobials, mechanical ventilation, and vasopressor support. Histopathology and peripheral blood galactomannan antigen testing confirmed IPA. Aspergillus penicillioides infection was confirmed by nucleotide sequencing and BLAST analysis. Further reports are needed to assess the occurrence and frequency of IPA in SARS-CoV-2 infections, and how they interact clinically.


Subject(s)
Humans , Male , Aged , Pneumonia, Viral/pathology , Aspergillus/isolation & purification , Coronavirus Infections/pathology , Invasive Pulmonary Aspergillosis/pathology , Betacoronavirus , Pneumonia, Viral/complications , Aspergillus/genetics , Autopsy , Fatal Outcome , Coronavirus Infections , Coronavirus Infections/complications , Invasive Pulmonary Aspergillosis/complications , Pandemics , Lung/microbiology
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