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1.
Front Cell Infect Microbiol ; 12: 895329, 2022.
Article in English | MEDLINE | ID: covidwho-1987471

ABSTRACT

Background: Due to more attentions paid to melanized fungi over the past few decades and under the background of the global coronavirus disease 2019 pandemic (COVID-19) the fact that the virus itself and the immunosuppressive agents such as glucocorticoids can further increase the risk of infections of deep mycoses, the number of patients with phaeohyphomycosis (PHM) has a substantial increase. Their spectrum is broad and the early diagnosis and treatments are extremely sticky. This study aims to more comprehensively understand the clinical features of phaeohyphomycosis in China over 35 years and to establish a more applicable systematical classification and severity grades of lesions to guide treatments and prognosis. Methods: We reviewed 174 cases of proven phaeohyphomycosis reported in Chinese and English language literature from 1987 to 2021 and we also made the accurate classification definitions and detailed information about the epidemiology, species of clinical dematiaceous fungi, minimum inhibitory concentration values, clinical features, treatments, and prognosis. Results: The mortality of cerebral, disseminated and pulmonary phaeohyphomycosis are 55%, 36%, and 25%. Nearly 19% of patients had poor quality of life caused by the complications such as disability, disfigurements, and blindness. The overall misdiagnosis rate of phaeohyphomycosis was 74%. Moderate to severe rashes are accounting for 82% of subcutaneous phaeohyphomycosis. The areas of the head and face are mostly affected accounting for 16% of severe rashes. Nearly 30% of invasive infections of phaeohyphomycosis are triggered by recurrent lesions. Voriconazole, itraconazole, amphotericin B deoxycholate (AmB-DOC), and terbinafine were most commonly used but diagnosis and treatments of phaeohyphomycosis remain challenging in reality. Conclusions: Our classifications are likely to be more practical and easier to popularize, and there are still also plenty of characteristics in these non-specific lesions. There're no significant variations in cure rates, or death rates between three grades of lesions. But patients with severe rashes have longer courses and lower effective rates.


Subject(s)
COVID-19 , Phaeohyphomycosis , Antifungal Agents/therapeutic use , Fungi , Humans , Phaeohyphomycosis/diagnosis , Phaeohyphomycosis/drug therapy , Phaeohyphomycosis/epidemiology , Quality of Life , Voriconazole
2.
Intern Med J ; 51 Suppl 7: 143-176, 2021 11.
Article in English | MEDLINE | ID: covidwho-1961593

ABSTRACT

Invasive aspergillosis (IA) in haematology/oncology patients presents as primary infection or breakthrough infection, which can become refractory to antifungal treatment and has a high associated mortality. Other emerging patient risk groups include patients in the intensive care setting with severe respiratory viral infections, including COVID-19. These guidelines present key diagnostic and treatment recommendations in light of advances in knowledge since the previous guidelines in 2014. Culture and histological-based methods remain central to the diagnosis of IA. There is increasing evidence for the utility of non-culture methods employing fungal biomarkers in pre-emptive screening for infection, as well as for IA diagnosis when used in combination. Although azole resistance appears to be uncommon in Australia, susceptibility testing of clinical Aspergillus fumigatus complex isolates is recommended. Voriconazole remains the preferred first-line antifungal agent for treating primary IA, including for extrapulmonary disease. Recommendations for paediatric treatment broadly follow those for adults. For breakthrough and refractory IA, a change in class of antifungal agent is strongly recommended, and agents under clinical trial may need to be considered. Newer immunological-based imaging modalities warrant further study, while surveillance for IA and antifungal resistance remain essential to informing the relevance of current treatment recommendations.


Subject(s)
Aspergillosis , COVID-19 , Adult , Antifungal Agents/therapeutic use , Aspergillosis/diagnosis , Aspergillosis/drug therapy , Aspergillus fumigatus , Child , Drug Resistance, Fungal , Humans , SARS-CoV-2 , Voriconazole/therapeutic use
3.
Med Mycol ; 60(5)2022 May 06.
Article in English | MEDLINE | ID: covidwho-1831252

ABSTRACT

Studies demonstrated the impact of the COVID-19 pandemic in the prevalence and susceptibility profiles of bacterial and fungal organisms. We analyzed 4821 invasive fungal isolates collected during 2018, 2019, and 2020 in 48 hospitals worldwide to evaluate the impact of this event in the occurrence and susceptibility rates of common fungal species. Isolates were tested using the CLSI broth microdilution method. While the percentage of total isolates that were C. glabrata (n = 710 isolates) or C. krusei (n = 112) slightly increased in 2020, the percentage for C. parapsilosis (n = 542), A. fumigatus (n = 416), and C. lusitaniae (n = 84) significantly decreased (P < .05). Fluconazole resistance in C. glabrata decreased from 5.8% in 2018-2019 to 2.0% in 2020, mainly due to fewer hospitals in the US having these isolates (5 vs. 1 hospital). Conversely, higher fluconazole-resistance rates were noted for C. parapsilosis (13.9 vs. 9.8%) and C. tropicalis (3.5 vs. 0.7%; P < .05) during 2020. Voriconazole resistance also increased for these species. Echinocandin resistance was unchanged among Candida spp. Voriconazole susceptibility rates in A. fumigatus were similar in these two periods (91.7% in 2018 and 2019 vs. 93.0% in 2020). Changes were also noticed in the organisms with smaller numbers of collected isolates. We observed variations in the occurrence of organisms submitted to a global surveillance and the susceptibility patterns for some organism-antifungal combinations. As the COVID-19 pandemic is still ongoing, the impact of this event must continue to be monitored to guide treatment of patients affected by bacterial and fungal infections. LAY SUMMARY: Secondary infections were documented in COVID-19 patients. We compared the prevalence of invasive fungal isolates consecutively collected in 48 worldwide hospitals and their susceptibility patterns between 2020, the year of the global COVID-19 pandemic, and the two prior years.


Subject(s)
COVID-19 , Invasive Fungal Infections , Animals , Antifungal Agents/pharmacology , COVID-19/veterinary , Candida glabrata , Candida parapsilosis , Candida tropicalis , Drug Resistance, Fungal , Fluconazole/pharmacology , Invasive Fungal Infections/veterinary , Microbial Sensitivity Tests/veterinary , Pandemics , Voriconazole/pharmacology , Voriconazole/therapeutic use
4.
Chest ; 161(1): e5-e11, 2022 01.
Article in English | MEDLINE | ID: covidwho-1595933

ABSTRACT

CASE PRESENTATION: A 67-year-old obese man (BMI 38.0) with type 2 diabetes mellitus (DM), chronic atrial fibrillation, and chronic lymphocytic leukemia stage II, stable for 8 years after chemotherapy, and a history of smoking presented to the ED with progressive dyspnea and fever due to SARS-CoV-2 infection. He was admitted to a general ward and treated with dexamethasone (6 mg IV once daily) and oxygen. On day 3 of hospital admission, he became progressively hypoxemic and was admitted to the ICU for invasive mechanical ventilation. Dexamethasone treatment was continued, and a single dose of tocilizumab (800 mg) was administered. On day 9 of ICU admission, voriconazole treatment was initiated after tracheal white plaques at bronchoscopy, suggestive of invasive Aspergillus tracheobronchitis, were noticed. However, his medical situation dramatically deteriorated.


Subject(s)
Acute Kidney Injury/virology , Antifungal Agents/therapeutic use , COVID-19/complications , Mucormycosis/diagnosis , Mucormycosis/drug therapy , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/drug therapy , Aged , Amphotericin B/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Atrial Fibrillation/complications , Bronchoscopy , Dexamethasone/therapeutic use , Diabetes Mellitus, Type 2/complications , Fatal Outcome , Humans , Leukemia, Lymphocytic, Chronic, B-Cell/complications , Male , Nitriles/therapeutic use , Obesity/complications , Oxygen Inhalation Therapy , Pyridines/therapeutic use , Respiration, Artificial , SARS-CoV-2 , Smoking/adverse effects , Tomography, X-Ray Computed , Triazoles/therapeutic use , Voriconazole/therapeutic use
5.
Mycoses ; 65(1): 57-64, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1570935

ABSTRACT

BACKGROUND: Though invasive pulmonary aspergillosis is a well known complication of COVID-19 pneumonia, indolent forms of aspergillosis have been rarely described. METHODS: We prospectively collected the clinico-radio-microbiological data of 10 patients of subacute invasive pulmonary aspergillosis (SAIA), who presented to our hospital with recent history of COVID-19 pneumonia along with cavitary lung disease, positive IgG (against Aspergillus) with or without positive respiratory samples for Aspergillus spp. RESULT: The mean age of presentation of SAIA was 50.7 ± 11.8 years. All the patients had recently recovered from severe COVID-19 illness with a mean duration of 29.2 ± 12 days from COVID-19 positivity. Cough was the predominant symptom seen in 8/10 (80%) patients followed by haemoptysis. 7/10 (70%) patients were known diabetic. While serum galactomannan was positive in 5/9 patients (55.5%), fungal culture was positive in 2/7 patients (28.5%) and polymerase chain reaction (PCR) for Aspergillus was positive in three patients. Eight (80%) patients presented with a single cavitary lesion; pseudoaneurysm of pulmonary artery was seen in two patients and post-COVID-19 changes were seen in all patients. All patients were treated with voriconazole, out of which four (40%) patients died during the follow-up period. CONCLUSION: SAIA should be considered in the differential diagnosis of cavitating lung lesions in patients with recent history of COVID-19 in the background of steroid use with or without pre-existing diabetes.


Subject(s)
COVID-19 , Invasive Pulmonary Aspergillosis , Adult , Antibodies, Fungal/blood , Aspergillus , COVID-19/complications , Humans , Immunoglobulin G/blood , Invasive Pulmonary Aspergillosis/diagnosis , Invasive Pulmonary Aspergillosis/drug therapy , Middle Aged , Voriconazole
6.
Indian J Ophthalmol ; 69(12): 3759-3761, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1538649

ABSTRACT

We present a case of endogenous fungal endophthalmitis in a nondiabetic, nonhypertensive patient who recovered from COVID-19 infection. Endogenous fungal endophthalmitis in an immunocompetent individual is quite uncommon. The organism in our patient was resistant to amphotericin and voriconazole and was successfully treated with intravitreal caspofungin. The rarity of an opportunistic nosocomial infection in an immunocompetent person with a drug-resistant organism prompted us to write this report.


Subject(s)
COVID-19 , Endophthalmitis , Eye Infections, Fungal , Antifungal Agents/therapeutic use , Caspofungin/therapeutic use , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Eye Infections, Fungal/diagnosis , Eye Infections, Fungal/drug therapy , Humans , Intravitreal Injections , SARS-CoV-2 , Voriconazole
7.
PLoS One ; 16(11): e0260656, 2021.
Article in English | MEDLINE | ID: covidwho-1533423

ABSTRACT

Therapeutic drug monitoring (TDM) is essential for voriconazole to ensure optimal drug exposure, mainly in critically ill patients for whom voriconazole demonstrated a large variability. The study aimed at describing factors associated with trough voriconazole concentrations in critically ill patients and evaluating the impact of voriconazole concentrations on adverse effects. A 2-year retrospective multicenter cohort study (NCT04502771) was conducted in six intensive care units. Adult patients who had at least one voriconazole TDM were included. Univariable and multivariable linear regression analyses were performed to identify predictors of voriconazole concentrations, and univariable logistic regression analysis, to study the relationship between voriconazole concentrations and adverse effects. During the 2-year study period, 70 patients were included. Optimal trough voriconazole concentrations were reported in 37 patients (52.8%), subtherapeutic in 20 (28.6%), and supratherapeutic in 13 (18.6%). Adverse effects were reported in six (8.6%) patients. SOFA score was identified as a factor associated with an increase in voriconazole concentration (p = 0.025), mainly in the group of patients who had SOFA score ≥ 10. Moreover, an increase in voriconazole concentration was shown to be a risk factor for occurrence of adverse effects (p = 0.011). In that respect, critically ill patients who received voriconazole treatment must benefit from a TDM, particularly if they have a SOFA score ≥ 10. Indeed, identifying patients who are overdosed will help to prevent voriconazole related adverse effects. This result is of utmost importance given the recognized COVID-19-associated pulmonary aspergillosis in ICU patients for whom voriconazole is among the recommended first-line treatment.


Subject(s)
Antifungal Agents/administration & dosage , Critical Illness/therapy , Drug Monitoring/methods , Drug-Related Side Effects and Adverse Reactions/epidemiology , Intensive Care Units/statistics & numerical data , Voriconazole/administration & dosage , Antifungal Agents/adverse effects , Female , France/epidemiology , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Voriconazole/adverse effects
8.
Mycoses ; 64(9): 1062-1072, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1358623

ABSTRACT

OBJECTIVES: To describe the first outbreak of Candida auris in Brazil, including epidemiological, clinical and microbiological data. METHODS: After the first Candida auris-colonised patient was diagnosed in a COVID-19 ICU at a hospital in Salvador, Brazil, a multidisciplinary team conducted a local C. auris prevalence investigation. Screening cultures for C. auris were collected from patients, healthcare workers and inanimate surfaces. Risk factors for C. auris colonisation were evaluated, and the fungemia episodes that occurred after the investigation were also analysed and described. Antifungal susceptibility of the C. auris isolates was determined, and they were genotyped with microsatellite analysis. RESULTS: Among body swabs collected from 47 patients, eight (n = 8/47, 17%) samples from the axillae were positive for C. auris. Among samples collected from inanimate surfaces, digital thermometers had the highest rate of positive cultures (n = 8/47, 17%). Antifungal susceptibility testing showed MICs of 0.5 to 1 mg/L for AMB, 0.03 to 0.06 mg/L for voriconazole, 2 to 4 mg/L for fluconazole and 0.03 to 0.06 mg/L for anidulafungin. Microsatellite analysis revealed that all C. auris isolates belong to the South Asian clade (Clade I) and had different genotypes. In multivariate analysis, having a colonised digital thermometer was the only independent risk factor associated with C. auris colonisation. Three episodes of C. auris fungemia occurred after the investigation, with 30-day attributable mortality of 33.3%. CONCLUSIONS: Emergence of C. auris in Salvador, Brazil, may be related to local C. auris clade I closely related genotypes. Contaminated axillary monitoring thermometers may facilitate the dissemination of C. auris reinforcing the concept that these reusable devices should be carefully cleaned with an effective disinfectant or replaced by other temperature monitoring methods.


Subject(s)
Antifungal Agents/therapeutic use , Candida/drug effects , Candidiasis/diagnosis , Candidiasis/drug therapy , Candidiasis/epidemiology , Disease Transmission, Infectious , Thermometers/microbiology , Adult , Aged , Aged, 80 and over , Anidulafungin/therapeutic use , Brazil/epidemiology , COVID-19/complications , COVID-19/microbiology , Critical Care , Disease Outbreaks , Female , Fluconazole/therapeutic use , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Prevalence , SARS-CoV-2 , Voriconazole/therapeutic use
9.
Am J Case Rep ; 22: e932544, 2021 Aug 10.
Article in English | MEDLINE | ID: covidwho-1350539

ABSTRACT

BACKGROUND Fusarium spp. is a rare cause of opportunistic life-threatening fungal infections. It has a remarkably high resistance profile with few effective antifungal agents, mostly limited to voriconazole and liposomal amphotericin B. Drug-induced liver injury (DILI) by 1 of these 2 antifungal agents further complicates the management of these infections. CASE REPORT A 38-year-old woman with short bowel syndrome presented to the hospital with concerns of abdominal pain and loose stools. An abdominal CT was negative for inflammatory or ischemic bowel disease, and there was no evidence of liver disease. She tested positive for SARS-CoV-2 and required transfer to the ICU due to hypotension requiring fluid resuscitation and vasopressors. On day 43 of her admission, the patient developed a low-grade fever, for which she underwent central-line and peripheral-blood cultures that were positive for Fusarium dimerum. The central line was removed and i.v. voriconazole started. After 3 days of treatment, the patient's liver enzymes rose abruptly. Voriconazole was discontinued and replaced with liposomal amphotericin B, and the liver enzymes improved significantly. The patient completed 14 days of therapy and was discharged from the hospital. CONCLUSIONS This is a case of F. dimerum infection followed by DILI from voriconazole treatment. Her infection was resolved after switching to liposomal amphotericin B, with improvement in liver enzymes on day 1 after discontinuing voriconazole. This observation demonstrates that altering antifungal classes may be an appropriate strategy when confronted with DILI.


Subject(s)
COVID-19 , Chemical and Drug Induced Liver Injury , Fusarium , Sepsis , Adult , Amphotericin B/adverse effects , Antifungal Agents/adverse effects , Chemical and Drug Induced Liver Injury/etiology , Female , Humans , SARS-CoV-2 , Sepsis/drug therapy , Voriconazole/adverse effects
10.
Chest ; 160(1): e39-e44, 2021 07.
Article in English | MEDLINE | ID: covidwho-1291398

ABSTRACT

CASE PRESENTATION: A 65-year-old man presented with shortness of breath, gradually worsening for the previous 2 weeks, associated with dry cough, sore throat, and diarrhea. He denied fever, chills, chest pain, abdominal pain, nausea, or vomiting. He did not have any sick contacts or travel history outside of Michigan. His medical history included hypertension, diabetes mellitus, chronic kidney disease, morbid obesity, paroxysmal atrial fibrillation, and tobacco use. He was taking amiodarone, carvedilol, furosemide, pregabalin, and insulin. The patient appeared to be in mild respiratory distress. He was afebrile and had saturation at 93% on 3 L of oxygen, heart rate of 105 beats/min, BP of 145/99 mm Hg, and respiratory rate of 18 breaths/min. On auscultation, there were crackles on bilateral lung bases and chronic bilateral leg swelling with hyperpigmented changes. His WBC count was 6.0 K/cumm (3.5 to 10.6 K/cumm) with absolute lymphocyte count 0.7 K/cumm (1.0 to 3.8 K/cumm); serum creatinine was 2.81 mg/dL (0.7 to 1.3 mg/dL). He had elevated inflammatory markers (serum ferritin, C-reactive protein, lactate dehydrogenase, D-dimer, and creatinine phosphokinase). Chest radiography showed bilateral pulmonary opacities that were suggestive of multifocal pneumonia (Fig 1). Nasopharyngeal swab for SARS-CoV-2 was positive. Therapy was started with ceftriaxone, doxycycline, hydroxychloroquine, and methylprednisolone 1 mg/kg IV for 3 days. By day 3 of hospitalization, he required endotracheal intubation, vasopressor support, and continuous renal replacement. Blood cultures were negative; respiratory cultures revealed only normal oral flora, so antibiotic therapy was discontinued. On day 10, WBC count increased to 28 K/cumm, and chest radiography showed persistent bilateral opacities with left lower lobe consolidation. Repeat respiratory cultures grew Pseudomonas aeruginosa (Table 1). Antibiotic therapy with IV meropenem was started. His condition steadily improved; eventually by day 20, he was off vasopressors and was extubated. However, on day 23, he experienced significant hemoptysis that required reintubation and vasopressor support.


Subject(s)
Aspergillus niger/isolation & purification , COVID-19 , Hemoptysis , Invasive Pulmonary Aspergillosis , Pseudomonas aeruginosa/isolation & purification , SARS-CoV-2/isolation & purification , Superinfection , Voriconazole/administration & dosage , Aged , Antifungal Agents/administration & dosage , COVID-19/complications , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/therapy , Clinical Deterioration , Critical Illness/therapy , Critical Pathways , Diagnosis, Differential , Hemoptysis/diagnosis , Hemoptysis/etiology , Hemoptysis/therapy , Humans , Invasive Pulmonary Aspergillosis/complications , Invasive Pulmonary Aspergillosis/diagnosis , Invasive Pulmonary Aspergillosis/physiopathology , Lung/diagnostic imaging , Lung/physiopathology , Male , Radiography, Thoracic/methods , Respiration, Artificial/methods , Superinfection/diagnosis , Superinfection/microbiology , Superinfection/physiopathology , Superinfection/therapy , Tomography, X-Ray Computed/methods , Treatment Outcome
13.
Monaldi Arch Chest Dis ; 91(2)2021 Apr 06.
Article in English | MEDLINE | ID: covidwho-1183944

ABSTRACT

Dear Editor, A 55-year-female, house wife, non-smoker, morbidly obese (BMI>35) with no other co-morbidities or pre-existing lung disease presented to the emergency room with complaints of highgrade fever, cough with minimal sputum, progressive breathlessness, streaky haemoptysis, and anorexia for the past 5 days. She was admitted in intensive care unit (ICU) for severe COVID-19 pneumonia three months back and had successfully recovered after 24 days of hospitalization....


Subject(s)
COVID-19/complications , Invasive Pulmonary Aspergillosis/complications , Antifungal Agents/therapeutic use , COVID-19/therapy , Coinfection , Critical Care , Female , Humans , Invasive Pulmonary Aspergillosis/diagnosis , Invasive Pulmonary Aspergillosis/drug therapy , Middle Aged , Obesity, Morbid/complications , SARS-CoV-2 , Treatment Outcome , Voriconazole/therapeutic use
14.
Indian J Ophthalmol ; 69(4): 987-989, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1138817

ABSTRACT

A 42-year-old male patient presented with profound impairment of vision in both eyes, just as he was recovering from COVID-19. A known diabetic and hypertensive, he suffered from COVID-19 pneumonia further complicated by ARDS, septicaemia and acute kidney injury. His vision on presentation was finger counting close to face bilaterally with multiple, yellowish lesions at the posterior pole. Based on the clinical findings and previous blood culture report, it was diagnosed as candida retinitis and treated with oral and intravitreal anti-fungals. The lesions were regressing at follow-up. This is a post COVID-19 presumed candida retinitis case report.


Subject(s)
COVID-19/diagnosis , Candidiasis/diagnosis , Eye Infections, Fungal/diagnosis , Opportunistic Infections/diagnosis , Retinitis/diagnosis , SARS-CoV-2 , Administration, Oral , Adult , Antifungal Agents/therapeutic use , Candidiasis/drug therapy , Candidiasis/microbiology , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/microbiology , Fluconazole/therapeutic use , Humans , Intravitreal Injections , Male , Opportunistic Infections/drug therapy , Opportunistic Infections/microbiology , Retinitis/drug therapy , Retinitis/microbiology , Tomography, Optical Coherence , Visual Acuity/physiology , Voriconazole/therapeutic use
15.
J Mycol Med ; 31(2): 101124, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1096172

ABSTRACT

Aspergillus infection is a well-known complication of severe influenza and severe acute respiratory syndrome coronavirus (SARS-CoV), and these infections have been related with significant morbidity and mortality even when appropriately diagnosed and treated. Recent studies have indicated that SARS-CoV-2 might increase the risk of invasive pulmonary aspergillosis (IPA). Here, we report the first case of Aspergillus ochraceus in a SARS-CoV-2 positive immunocompetent patient, which is complicated by pulmonary and brain infections. Proven IPA is supported by the positive Galactomannan test, culture-positive, and histopathological evidence. The patient did not respond to voriconazole, and liposomal amphotericin B was added to his anti-fungal regimen. Further studies are needed to evaluate the prevalence of IPA in immunocompetent patients infected with SARS-CoV-2. Consequently, testing for the incidence of Aspergillus species in lower respiratory secretions and Galactomannan test of COVID-19 patients with appropriate therapy and targeted anti-fungal therapy based on the primary clinical suspicion of IPA are highly recommended.


Subject(s)
Aspergillosis/complications , Aspergillus ochraceus/isolation & purification , COVID-19/complications , Invasive Fungal Infections/complications , SARS-CoV-2/isolation & purification , Adult , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Aspergillosis/diagnostic imaging , Aspergillosis/drug therapy , Biomarkers , Brain Abscess/diagnostic imaging , Brain Abscess/etiology , Brain Abscess/microbiology , Bronchoalveolar Lavage Fluid/microbiology , COVID-19/diagnostic imaging , COVID-19 Nucleic Acid Testing , Fatal Outcome , Galactose/analogs & derivatives , Humans , Immunocompetence , Invasive Fungal Infections/diagnostic imaging , Invasive Fungal Infections/drug therapy , Invasive Fungal Infections/microbiology , Lung Diseases, Fungal/complications , Lung Diseases, Fungal/diagnostic imaging , Lung Diseases, Fungal/microbiology , Male , Mannans/blood , Voriconazole/therapeutic use
16.
Emerg Infect Dis ; 27(4): 1077-1086, 2021.
Article in English | MEDLINE | ID: covidwho-1067634

ABSTRACT

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Because of the severe immunomodulation and lymphocyte depletion caused by this virus and the subsequent administration of drugs directed at the immune system, we anticipated that patients might experience fungal superinfection. We collected data from 186 patients who had coronavirus disease-associated pulmonary aspergillosis (CAPA) worldwide during March-August 2020. Overall, 182 patients were admitted to the intensive care unit (ICU), including 180 with acute respiratory distress syndrome and 175 who received mechanical ventilation. CAPA was diagnosed a median of 10 days after coronavirus disease diagnosis. Aspergillus fumigatus was identified in 80.3% of patient cultures, 4 of which were azole-resistant. Most (52.7%) patients received voriconazole. In total, 52.2% of patients died; of the deaths, 33.0% were attributed to CAPA. We found that the cumulative incidence of CAPA in the ICU ranged from 1.0% to 39.1%.


Subject(s)
Aspergillus fumigatus/isolation & purification , COVID-19 , Intensive Care Units/statistics & numerical data , Pulmonary Aspergillosis , Voriconazole/therapeutic use , Aged , Antifungal Agents/therapeutic use , COVID-19/complications , COVID-19/immunology , COVID-19/mortality , COVID-19/therapy , Female , Humans , Immunologic Factors/administration & dosage , Immunologic Factors/adverse effects , Incidence , International Cooperation , Male , Outcome and Process Assessment, Health Care , Pulmonary Aspergillosis/diagnosis , Pulmonary Aspergillosis/drug therapy , Pulmonary Aspergillosis/mortality , Registries , Respiration, Artificial/methods , Risk Factors , SARS-CoV-2/isolation & purification
17.
Lancet Infect Dis ; 21(6): e149-e162, 2021 06.
Article in English | MEDLINE | ID: covidwho-974782

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 causes direct damage to the airway epithelium, enabling aspergillus invasion. Reports of COVID-19-associated pulmonary aspergillosis have raised concerns about it worsening the disease course of COVID-19 and increasing mortality. Additionally, the first cases of COVID-19-associated pulmonary aspergillosis caused by azole-resistant aspergillus have been reported. This article constitutes a consensus statement on defining and managing COVID-19-associated pulmonary aspergillosis, prepared by experts and endorsed by medical mycology societies. COVID-19-associated pulmonary aspergillosis is proposed to be defined as possible, probable, or proven on the basis of sample validity and thus diagnostic certainty. Recommended first-line therapy is either voriconazole or isavuconazole. If azole resistance is a concern, then liposomal amphotericin B is the drug of choice. Our aim is to provide definitions for clinical research and up-to-date recommendations for clinical management of the diagnosis and treatment of COVID-19-associated pulmonary aspergillosis.


Subject(s)
Antifungal Agents/therapeutic use , COVID-19/complications , Coinfection/drug therapy , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/drug therapy , Amphotericin B , Azoles/pharmacology , Humans , Nitriles , Pyridines , SARS-CoV-2 , Triazoles , Voriconazole/therapeutic use
18.
Diagn Microbiol Infect Dis ; 99(4): 115272, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-938872

ABSTRACT

Tocilizumab, an interleukin-6 receptor antagonist, has been used to treat critically ill patients with coronavirus disease-2019. We present the case of a previously immunocompetent man with coronavirus disease-2019 who developed invasive pulmonary aspergillosis after treatment with tocilizumab, illustrating the importance of considering opportunistic infections when providing immune modulating therapy.


Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Antiviral Agents/adverse effects , COVID-19/drug therapy , Invasive Pulmonary Aspergillosis/diagnosis , Aged , Antibodies, Monoclonal, Humanized/therapeutic use , Antiviral Agents/therapeutic use , Aspergillus/isolation & purification , Humans , Immunomodulation , Invasive Pulmonary Aspergillosis/drug therapy , Male , Micafungin/therapeutic use , Opportunistic Infections/chemically induced , Receptors, Interleukin-6/antagonists & inhibitors , SARS-CoV-2/drug effects , Voriconazole/therapeutic use
20.
Mycoses ; 63(6): 528-534, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-547397

ABSTRACT

OBJECTIVES: Patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications like invasive aspergillosis. Our study evaluates coronavirus disease 19 (COVID-19) associated invasive aspergillosis at a single centre in Cologne, Germany. METHODS: A retrospective chart review of all patients with COVID-19 associated ARDS admitted to the medical or surgical intensive care unit at the University Hospital of Cologne, Cologne, Germany. RESULTS: COVID-19 associated invasive pulmonary aspergillosis was found in five of 19 consecutive critically ill patients with moderate to severe ARDS. CONCLUSION: Clinicians caring for patients with ARDS due to COVID-19 should consider invasive pulmonary aspergillosis and subject respiratory samples to comprehensive analysis to detect co-infection.


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Pulmonary Aspergillosis/complications , Respiratory Distress Syndrome/complications , Aged , Antifungal Agents/therapeutic use , Bronchoalveolar Lavage Fluid/chemistry , Bronchoalveolar Lavage Fluid/virology , COVID-19 , Coronavirus Infections/diagnostic imaging , Female , Galactose/analogs & derivatives , Germany , Hemorrhage/etiology , Hospitals, Teaching , Humans , Intensive Care Units , Lung Diseases/etiology , Male , Mannans/analysis , Metapneumovirus/isolation & purification , Middle Aged , Nitriles/therapeutic use , Pandemics , Paramyxoviridae Infections/etiology , Pneumonia, Viral/diagnostic imaging , Pulmonary Aspergillosis/diagnostic imaging , Pyridines/therapeutic use , Respiratory Distress Syndrome/diagnostic imaging , Retrospective Studies , Thorax/diagnostic imaging , Tomography, X-Ray Computed , Triazoles/therapeutic use , Voriconazole/therapeutic use
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