Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 19 de 19
Filter
1.
Int J Environ Res Public Health ; 19(12)2022 06 09.
Article in English | MEDLINE | ID: covidwho-1884188

ABSTRACT

Aspergillosis is a disease caused by Aspergillus, and invasive pulmonary aspergillosis (IPA) is the most common invasive fungal infection leading to death in severely immuno-compromised patients. The literature reports Aspergillus co-infections in patients with COVID-19 (CAPA). Diagnosing CAPA clinically is complex since the symptoms are non-specific, and performing a bronchoscopy is difficult. Generally, the microbiological diagnosis of aspergillosis is based on cultural methods and on searching for the circulating antigens galactomannan and 1,3-ß-D-glucan in the bronchoalveolar lavage fluid (bGM) or serum (sGM). In this study, to verify whether the COVID-19 period has stimulated clinicians to pay greater attention to IPA in patients with respiratory tract infections, we evaluated the number of requests for GM-Ag research and the number of positive tests found during the pre-COVID-19 and COVID-19 periods. Our data show a significant upward trend in GM-Ag requests and positivity from the pre-COVID to COVID period, which is attributable in particular to the increase in IPA risk factors as a complication of COVID-19. In the COVID period, parallel to the increase in requests, the number of positive tests for GM-Ag also increased, going from 2.5% in the first period of 2020 to 12.3% in the first period of 2021.


Subject(s)
COVID-19 , Invasive Pulmonary Aspergillosis , Pulmonary Aspergillosis , Aspergillus , Bronchoalveolar Lavage Fluid , COVID-19/epidemiology , Humans , Invasive Pulmonary Aspergillosis/complications , Invasive Pulmonary Aspergillosis/diagnosis , Invasive Pulmonary Aspergillosis/epidemiology , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/epidemiology , Sensitivity and Specificity
2.
Korean J Intern Med ; 37(4): 851-863, 2022 07.
Article in English | MEDLINE | ID: covidwho-1862980

ABSTRACT

BACKGROUND/AIMS: The risk factors and clinical impacts of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) remain controversial, and no data have been reported in Korea. This study aimed to investigate the epidemiology and importance of CAPA diagnostic efforts and to identify the predictors of CAPA and the impacts on clinical outcomes. METHODS: Between January 2020 and May 2021, data of severely to critically ill COVID-19 patients were extracted from seven hospitals of the Catholic Medical Center through a clinical data warehouse. Corticosteroid use was subcategorized into total cumulative dose, early 7-day dose, mean daily dose, and duration of use. RESULTS: A total of 2,427 patients were screened, and 218 patients were included. CAPA was diagnosed in 4.6% (10/218) of all hospitalized and 11.2% (10/89) of intensive care unit patients. Total cumulative dose (over 1,000 mg as methylprednisolone) and daily high-dose corticosteroid use (over 60 mg/day) were independent predictors but not early 7-day high-dose corticosteroid use (over 420 mg/week) (odds ratio [OR], 1.731; 95% confidence interval [CI], 0.350 to 8.571) nor prolonged use (OR, 2.794; 95% CI, 0.635 to 13.928). In-hospital overall mortality was 11.9% (26 of 218). CAPA itself did not affect the outcome; rather, daily high-dose steroid use significantly increased the 30-day mortality (hazard ratio, 5.645; 95% CI, 1.225 to 26.091). CONCLUSION: CAPA was not uncommon, especially in critically ill patients. Daily high-dose corticosteroid use was the predictor of CAPA and associated with high mortality rates. High-dose corticosteroids use after early inflammatory phase should be avoided, and active surveillance methods for CAPA are essential for those high-risk patients.


Subject(s)
COVID-19 , Pulmonary Aspergillosis , Adrenal Cortex Hormones/adverse effects , COVID-19/complications , Critical Illness , Humans , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/drug therapy , Pulmonary Aspergillosis/epidemiology , Retrospective Studies , Risk Factors
3.
Ann Palliat Med ; 11(7): 2202-2209, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1743090

ABSTRACT

BACKGROUND: We aimed to identify studies systematically that describe the incidence and outcome of COVID-19-related pulmonary aspergillosis (CAPA). METHODS: We searched ScienceDirect, PubMed, CNKI, and MEDLINE (OVID) from December 31, 2019 to November 20, 2021 for all eligible studies. Random-model was used to reported the incidence, all-cause case fatality rate (CFR) and 95% confidence intervals (CIs). The meta-analysis was registered with PROSPERO (CRD42021242179). RESULTS: In all, thirty-one cohort studies were included in this study. A total of 3,441 patients with severe COVID-19 admitted to an intensive care unit (ICU) were investigated and 442 cases of CAPA were reported (30 studies). The pooled incidence rate of CAPA was 0.14 (95% CI: 0.11-0.17, I2=0.0%). Twenty-eight studies reported 287 deceased patients and 269 surviving patients. The pooled CFR of CAPA was 0.52 (95% CI: 0.47-0.56, I2=3.9%). Interestingly, patients with COVID19 would develop CAPA at 7.28 days after mechanical ventilation (range, 5.48-9.08 days). No significant publication bias was detected in this meta-analysis. DISCUSSION: Patients with COVID-19 admitted to an ICU might develop CAPA and have high all-cause CFR. We recommend conducting prospective screening for CAPA among patients with severe COVID-19, especially for those who receive mechanical ventilation over 7 days.


Subject(s)
COVID-19 , Pulmonary Aspergillosis , Humans , Incidence , Intensive Care Units , Prospective Studies , Pulmonary Aspergillosis/epidemiology
4.
Mycoses ; 65(4): 458-465, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1691477

ABSTRACT

BACKGROUND: COVID-19-associated invasive pulmonary aspergillosis (CAPA) is associated with increased mortality. Cases of CAPA caused by azole-resistant Aspergillus fumigatus strains have been reported. OBJECTIVES: To analyse the twelve-month CAPA prevalence in a German tertiary care hospital and to characterise clinical A. fumigatus isolates from two German hospitals by antifungal susceptibility testing and microsatellite genotyping. PATIENTS/METHODS: Retrospective observational study in critically ill adults from intensive care units with COVID-19 from 17 February 2020 until 16 February 2021 and collection of A. fumigatus isolates from two German centres. EUCAST broth microdilution for four azole compounds and microsatellite PCR with nine markers were performed for each collected isolate (N = 27) and additional for three non-COVID A. fumigatus isolates. RESULTS: welve-month CAPA prevalence was 7.2% (30/414), and the rate of azole-resistant A. fumigatus isolates from patients with CAPA was 3.7% with detection of one TR34/L98H mutation. The microsatellite analysis revealed no major clustering of the isolates. Sequential isolates mainly showed the same genotype over time. CONCLUSIONS: Our findings demonstrate similar CAPA prevalence to other reports and a low azole-resistance rate. Genotyping of A. fumigatus showed polyclonal distribution except for sequential isolates.


Subject(s)
COVID-19 , Pulmonary Aspergillosis , Adult , Antifungal Agents/pharmacology , Aspergillus fumigatus , Azoles/pharmacology , Drug Resistance, Fungal/genetics , Fungal Proteins/genetics , Humans , Intensive Care Units , Microbial Sensitivity Tests , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/epidemiology
5.
Clin Microbiol Infect ; 28(7): 920-927, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1670359

ABSTRACT

BACKGROUND: Pulmonary aspergillosis may complicate coronavirus disease 2019 (COVID-19) and contribute to excess mortality in intensive care unit (ICU) patients. The disease is poorly understood, in part due to discordant definitions across studies. OBJECTIVES: We sought to review the prevalence, diagnosis, treatment, and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA) and compare research definitions. DATA SOURCES: PubMed, Embase, Web of Science, and MedRxiv were searched from inception to October 12, 2021. STUDY ELIGIBILITY CRITERIA: ICU cohort studies and CAPA case series including ≥3 patients were included. PARTICIPANTS: Adult patients in ICUs with COVID-19. INTERVENTIONS: Patients were reclassified according to four research definitions. We assessed risk of bias with an adaptation of the Joanna Briggs Institute cohort checklist tool for systematic reviews. METHODS: We calculated CAPA prevalence using the Freeman-Tukey random effects method. Correlations between definitions were assessed with Spearman's rank test. Associations between antifungals and outcome were assessed with random effects meta-analysis. RESULTS: Fifty-one studies were included. Among 3297 COVID-19 patients in ICU cohort studies, 313 were diagnosed with CAPA (prevalence 10%; 95% CI 8%-13%). Two hundred seventy-seven patients had patient-level data allowing reclassification. Definitions had limited correlation with one another (ρ = 0.268-0.447; p < 0.001), with the exception of Koehler and Verweij (ρ = 0.893; p < 0.001); 33.9% of patients reported to have CAPA did not fulfill any research definitions. Patients were diagnosed after a median of 8 days (interquartile range 5-14) in ICUs. Tracheobronchitis occurred in 3% of patients examined with bronchoscopy. The mortality rate was high (59.2%). Applying CAPA research definitions did not strengthen the association between mould-active antifungals and survival. CONCLUSIONS: The reported prevalence of CAPA is significant but may be exaggerated by nonstandard definitions.


Subject(s)
COVID-19 , Pulmonary Aspergillosis , Adult , Antifungal Agents/therapeutic use , COVID-19/complications , COVID-19/epidemiology , Critical Care , Humans , Intensive Care Units , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/epidemiology
6.
Am J Trop Med Hyg ; 106(2): 571-573, 2022 01 07.
Article in English | MEDLINE | ID: covidwho-1614118

ABSTRACT

Between April and July 2020, and, therefore, prior to the broad recommendation of corticosteroids for severe COVID-19, a total of 50 full autopsies were performed in Manaus. We confirmed two invasive cases of aspergillosis through histopathology and gene sequencing (4%) in our autopsy series. The confirmed invasive aspergillosis incidence seems much lower than expected based on the "probable and possible" definitions, and an individualized approach should be considered for each country scenario. Interestingly, a prolonged length of stay in the intensive care unit was not observed in any of the cases. Timely diagnosis and treatment of fungal infection can reduce mortality rates.


Subject(s)
COVID-19/complications , COVID-19/microbiology , Pulmonary Aspergillosis/epidemiology , Pulmonary Aspergillosis/etiology , SARS-CoV-2 , Adult , Aged , Autopsy , Brazil/epidemiology , Confidence Intervals , Humans , Incidence , Male
7.
J Infect Public Health ; 15(2): 222-227, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1611866

ABSTRACT

OBJECTIVES: The severe coronavirus disease 2019 (COVID-19) is characterized by acute respiratory distress syndrome (ARDS) and risk of fungal co-infection, pulmonary aspergillosis in particular. However, COVID-19 associated pulmonary aspergillosis (CAPA) cases remain limited due to the difficulty in diagnosis. METHODS: We describe presumptive invasive aspergillosis in eight patients diagnosed with COVID-19 in a single center in Shenzhen, China. Data collected include underlying conditions, mycological findings, immunodetection results, therapies and outcomes. RESULTS: Four of the eight patients had tested positive for Aspergillus by either culture or Next-generation sequencing analysis of sputum or bronchoalveolar lavage fluid (BALF), while the rest of patients had only positive results in antigen or antibody detection. Although all patients received antifungal therapies, six of these eight patients (66.7%) died. CONCLUSION: Due to the high mortality rate of CAPA, clinical care in patients with CAPA deserves more attention.


Subject(s)
COVID-19 , Invasive Pulmonary Aspergillosis , Pulmonary Aspergillosis , Humans , Invasive Pulmonary Aspergillosis/diagnosis , Invasive Pulmonary Aspergillosis/drug therapy , Invasive Pulmonary Aspergillosis/epidemiology , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/drug therapy , Pulmonary Aspergillosis/epidemiology , SARS-CoV-2 , Tertiary Care Centers
8.
Curr Opin Infect Dis ; 35(2): 163-169, 2022 04 01.
Article in English | MEDLINE | ID: covidwho-1606008

ABSTRACT

PURPOSE OF REVIEW: Invasive pulmonary aspergillosis (IPA) can affect patients with severe coronavirus disease 2019 (COVID-19), but many questions remain open about its very variable incidence across the world, the actual link between the viral infection and the fungal superinfection, the significance of Aspergillus recovery in a respiratory sample, and the management of such cases. This review addresses these questions and aims at providing some clues for the practical diagnostic and therapeutic approaches of COVID-19-associated pulmonary aspergillosis (CAPA) in a clinical perspective. RECENT FINDINGS: Definitions have been proposed for possible/probable/proven CAPA, but distinction between colonization and invasive fungal infection is difficult and not possible in most cases in the absence of histopathological proof or positive galactomannan in serum. Most importantly, the recovery of an Aspergillus by a direct (culture, PCR) or indirect (galactomannan) test in a respiratory sample is an indicator of worse outcome, which justifies a screening for early detection and initiation of preemptive antifungal therapy in such cases. SUMMARY: The COVID-19 pandemic has increased our awareness of IPA among ICU patients. Although current recommendations are mainly based on experts' opinions, prospective studies are needed to get more evidence-based support for the diagnostic approach and management of CAPA.


Subject(s)
COVID-19 , Invasive Pulmonary Aspergillosis , Pulmonary Aspergillosis , COVID-19/complications , Humans , Invasive Pulmonary Aspergillosis/diagnosis , Invasive Pulmonary Aspergillosis/drug therapy , Invasive Pulmonary Aspergillosis/epidemiology , Pandemics , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/drug therapy , Pulmonary Aspergillosis/epidemiology , SARS-CoV-2
10.
Microbiol Spectr ; 9(2): e0113821, 2021 10 31.
Article in English | MEDLINE | ID: covidwho-1476402

ABSTRACT

The aim of this study was to evaluate diagnostic means, host factors, delay of occurrence, and outcome of patients with COVID-19 pneumonia and fungal coinfections in the intensive care unit (ICU). From 1 February to 31 May 2020, we anonymously recorded COVID-19-associated pulmonary aspergillosis (CAPA), fungemia (CA-fungemia), and pneumocystosis (CA-PCP) from 36 centers, including results on fungal biomarkers in respiratory specimens and serum. We collected data from 154 episodes of CAPA, 81 of CA-fungemia, 17 of CA-PCP, and 5 of other mold infections from 244 patients (male/female [M/F] ratio = 3.5; mean age, 64.7 ± 10.8 years). CA-PCP occurred first after ICU admission (median, 1 day; interquartile range [IQR], 0 to 3 days), followed by CAPA (9 days; IQR, 5 to 13 days), and then CA-fungemia (16 days; IQR, 12 to 23 days) (P < 10-4). For CAPA, the presence of several mycological criteria was associated with death (P < 10-4). Serum galactomannan was rarely positive (<20%). The mortality rates were 76.7% (23/30) in patients with host factors for invasive fungal disease, 45.2% (14/31) in those with a preexisting pulmonary condition, and 36.6% (34/93) in the remaining patients (P = 0.001). Antimold treatment did not alter prognosis (P = 0.370). Candida albicans was responsible for 59.3% of CA-fungemias, with a global mortality of 45.7%. For CA-PCP, 58.8% of the episodes occurred in patients with known host factors of PCP, and the mortality rate was 29.5%. CAPA may be in part hospital acquired and could benefit from antifungal prescription at the first positive biomarker result. CA-fungemia appeared linked to ICU stay without COVID-19 specificity, while CA-PCP may not really be a concern in the ICU. Improved diagnostic strategy for fungal markers in ICU patients with COVID-19 should support these hypotheses. IMPORTANCE To diagnose fungal coinfections in patients with COVID-19 in the intensive care unit, it is necessary to implement the correct treatment and to prevent them if possible. For COVID-19-associated pulmonary aspergillosis (CAPA), respiratory specimens remain the best approach since serum biomarkers are rarely positive. Timing of occurrence suggests that CAPA could be hospital acquired. The associated mortality varies from 36.6% to 76.7% when no host factors or host factors of invasive fungal diseases are present, respectively. Fungemias occurred after 2 weeks in ICUs and are associated with a mortality rate of 45.7%. Candida albicans is the first yeast species recovered, with no specificity linked to COVID-19. Pneumocystosis was mainly found in patients with known immunodepression. The diagnosis occurred at the entry in ICUs and not afterwards, suggesting that if Pneumocystis jirovecii plays a role, it is upstream of the hospitalization in the ICU.


Subject(s)
COVID-19/epidemiology , Coinfection/mortality , Fungemia/epidemiology , Pneumonia, Pneumocystis/epidemiology , Pulmonary Aspergillosis/epidemiology , Aged , Antifungal Agents/therapeutic use , COVID-19/mortality , COVID-19/pathology , Coinfection/epidemiology , Critical Care , Female , France/epidemiology , Fungemia/drug therapy , Fungemia/mortality , Galactose/analogs & derivatives , Galactose/blood , Humans , Intensive Care Units/statistics & numerical data , Male , Mannans/blood , Middle Aged , Pneumonia, Pneumocystis/drug therapy , Pneumonia, Pneumocystis/mortality , Pulmonary Aspergillosis/drug therapy , Pulmonary Aspergillosis/mortality , Retrospective Studies , SARS-CoV-2 , Treatment Outcome
13.
Clin Microbiol Infect ; 28(4): 580-587, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1375916

ABSTRACT

OBJECTIVES: Coronavirus disease 2019 (COVID-19) -associated pulmonary aspergillosis (CAPA) has emerged as a complication in critically ill COVID-19 patients. The objectives of this multinational study were to determine the prevalence of CAPA in patients with COVID-19 in intensive care units (ICU) and to investigate risk factors for CAPA as well as outcome. METHODS: The European Confederation of Medical Mycology (ECMM) conducted a multinational study including 20 centres from nine countries to assess epidemiology, risk factors and outcome of CAPA. CAPA was defined according to the 2020 ECMM/ISHAM consensus definitions. RESULTS: A total of 592 patients were included in this study, including 11 (1.9%) patients with histologically proven CAPA, 80 (13.5%) with probable CAPA, 18 (3%) with possible CAPA and 483 (81.6%) without CAPA. CAPA was diagnosed a median of 8 days (range 0-31 days) after ICU admission predominantly in older patients (adjusted hazard ratio (aHR) 1.04 per year; 95% CI 1.02-1.06) with any form of invasive respiratory support (HR 3.4; 95% CI 1.84-6.25) and receiving tocilizumab (HR 2.45; 95% CI 1.41-4.25). Median prevalence of CAPA per centre was 10.7% (range 1.7%-26.8%). CAPA was associated with significantly lower 90-day ICU survival rate (29% in patients with CAPA versus 57% in patients without CAPA; Mantel-Byar p < 0.001) and remained an independent negative prognostic variable after adjusting for other predictors of survival (HR 2.14; 95% CI 1.59-2.87, p ≤ 0.001). CONCLUSION: Prevalence of CAPA varied between centres. CAPA was significantly more prevalent among older patients, patients receiving invasive ventilation and patients receiving tocilizumab, and was an independent strong predictor of ICU mortality.


Subject(s)
COVID-19 , Invasive Pulmonary Aspergillosis , Pulmonary Aspergillosis , Aged , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , Critical Illness , Humans , Intensive Care Units , Invasive Pulmonary Aspergillosis/diagnosis , Invasive Pulmonary Aspergillosis/drug therapy , Invasive Pulmonary Aspergillosis/epidemiology , Mycology , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/epidemiology , Risk Factors , SARS-CoV-2
14.
Intensive Care Med ; 47(8): 819-834, 2021 08.
Article in English | MEDLINE | ID: covidwho-1279405

ABSTRACT

PURPOSE: Invasive pulmonary aspergillosis (IPA) is increasingly reported in patients with severe coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU). Diagnosis and management of COVID-19 associated pulmonary aspergillosis (CAPA) are challenging and our aim was to develop practical guidance. METHODS: A group of 28 international experts reviewed current insights in the epidemiology, diagnosis and management of CAPA and developed recommendations using GRADE methodology. RESULTS: The prevalence of CAPA varied between 0 and 33%, which may be partly due to variable case definitions, but likely represents true variation. Bronchoscopy and bronchoalveolar lavage (BAL) remain the cornerstone of CAPA diagnosis, allowing for diagnosis of invasive Aspergillus tracheobronchitis and collection of the best validated specimen for Aspergillus diagnostics. Most patients diagnosed with CAPA lack traditional host factors, but pre-existing structural lung disease and immunomodulating therapy may predispose to CAPA risk. Computed tomography seems to be of limited value to rule CAPA in or out, and serum biomarkers are negative in 85% of patients. As the mortality of CAPA is around 50%, antifungal therapy is recommended for BAL positive patients, but the decision to treat depends on the patients' clinical condition and the institutional incidence of CAPA. We recommend against routinely stopping concomitant corticosteroid or IL-6 blocking therapy in CAPA patients. CONCLUSION: CAPA is a complex disease involving a continuum of respiratory colonization, tissue invasion and angioinvasive disease. Knowledge gaps including true epidemiology, optimal diagnostic work-up, management strategies and role of host-directed therapy require further study.


Subject(s)
COVID-19 , Invasive Pulmonary Aspergillosis , Pulmonary Aspergillosis , Humans , Intensive Care Units , Invasive Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/drug therapy , Pulmonary Aspergillosis/epidemiology , SARS-CoV-2
15.
Mycopathologia ; 186(4): 499-505, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1274891

ABSTRACT

Pulmonary aspergillosis has been reported at high rates in patients with coronavirus disease 2019 (COVID-19) and is associated with high morbidity and mortality. We retrospectively assessed all patients admitted to an intensive care unit during the early COVID-19 surge (3/17/20-5/10/20) at our medical center in the midwestern USA for the presence of COVID-19-associated pulmonary aspergillosis (CAPA). Patients were not routinely screened for CAPA; diagnostic work-up for fungal infections was pursued when clinically indicated. Among 256 patients admitted to the ICU with severe COVID-19, 188 (73%) were intubated and 62 (24%) ultimately expired within 30 days of admission to the ICU. Only three patients (1%) were found to have CAPA; diagnosis was made by tracheal aspirate cultures in two cases and by bronchoalveolar lavage fluid Aspergillus galactomannan in one case. None of the patients who developed CAPA had classic risk factors for invasive fungal infection. The occurrence of CAPA was much lower than that reported at other centers, likely reflecting the local epidemiology.


Subject(s)
COVID-19 , Pulmonary Aspergillosis , Academic Medical Centers , Adult , Aged , Aged, 80 and over , COVID-19/complications , Female , Humans , Intensive Care Units , Male , Middle Aged , Midwestern United States/epidemiology , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/epidemiology , Retrospective Studies , Young Adult
16.
Mycoses ; 64(4): 457-464, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1079004

ABSTRACT

BACKGROUND: COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as an invasive fungal disease, often affecting previously immunocompetent, mechanically ventilated, intensive care unit (ICU) patients. Incidence rates of 3.8%-33.3% have been reported depending on the geographic area, with high (47%) mortality. OBJECTIVES: Here, we describe a single-centre prospective case series with CAPA cases from both the first (March-May, n = 5/33) and second (mid-September through mid-December, n = 8/33) COVID-19 wave at a 500-bed teaching hospital in the Netherlands. PATIENTS/METHODS: In the first COVID-19 wave, a total of 265 SARS-CoV-2 PCR-positive patients were admitted to our hospital of whom 33 needed intubation and mechanical ventilation. In the second wave, 508 SARS-CoV-2 PCR-positive patients were admitted of whom 33 needed mechanical ventilation. Data were prospectively collected. RESULTS: We found a significant decrease in COVID-19 patients needing mechanical ventilation in the ICU in the second wave (p < .01). From these patients, however, a higher percentage were diagnosed with CAPA (24.2% vs 15.2%), although not significant (p = .36). All CAPA patients encountered in the second wave received dexamethasone. Mortality between both groups was similarly high (40%-50%). Moreover, we found environmental TR34 /L98H azole-resistant Aspergillus fumigatus isolates in two separate patients. CONCLUSIONS: In this series, 19.7% (n = 13/66) of mechanically ventilated SARS-CoV-2 patients were diagnosed with CAPA. In addition, we found a significant reduction in COVID-19 patients needing mechanical ventilation on the ICU in the second wave. Numbers are too small to determine whether there is a true difference in CAPA incidence in mechanically ventilated patients between the two waves, and whether it could be attributed to dexamethasone SARS-CoV-2 therapy.


Subject(s)
COVID-19/complications , Pulmonary Aspergillosis/epidemiology , SARS-CoV-2/isolation & purification , Aged , COVID-19/diagnosis , Cohort Studies , Female , Humans , Intensive Care Units , Male , Netherlands/epidemiology , Polymerase Chain Reaction , Prospective Studies , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/etiology , Pulmonary Aspergillosis/mortality , Respiration, Artificial , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , SARS-CoV-2/genetics
19.
Mycopathologia ; 185(4): 607-611, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-691056

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic emerged in Wuhan, China, in late 2109, and has rapidly spread around the world. Until May 25, 2020, there were 133,521 confirmed COVID-19 cases and 7359 deaths in Iran. The role of opportunistic fungal infections in the morbidity and mortality of COVID-19 patients remains less defined. Based on our multicenter experiences, we categorized the risks of opportunistic fungal infections in COVID-19 patients in Iran. The COVID-19 patients at high risk included those with acute respiratory distress syndrome, in intensive care units, receiving broad-spectrum antibiotics, immunosuppressants or corticosteroid, and supported by invasive or noninvasive ventilation. The patients were most likely to develop pulmonary aspergillosis, oral candidiasis, or pneumocystis pneumonia. Most diagnoses were probable as the accurate diagnosis of opportunistic fungal infections remains challenging in resource-poor settings. We summarize the clinical signs and laboratory tests needed to confirm candidiasis, aspergillosis, or pneumocystosis in our COVID-19 patients.


Subject(s)
Coronavirus Infections/complications , Mycoses/complications , Opportunistic Infections/complications , Pneumonia, Viral/complications , COVID-19 , Candidiasis, Oral/complications , Candidiasis, Oral/diagnosis , Candidiasis, Oral/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Humans , Iran/epidemiology , Mycoses/diagnosis , Mycoses/epidemiology , Opportunistic Infections/diagnosis , Opportunistic Infections/epidemiology , Pandemics , Pharyngeal Diseases/complications , Pharyngeal Diseases/diagnosis , Pharyngeal Diseases/epidemiology , Pharyngeal Diseases/microbiology , Pneumocystis carinii , Pneumonia, Pneumocystis/complications , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/epidemiology , Pneumonia, Pneumocystis/microbiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/epidemiology
SELECTION OF CITATIONS
SEARCH DETAIL