Fungal pneumonia in COVID-19 patients: Risk factors and early prediction

Objective To determine the risk factors for developing secondary fungal pneumonia in moderate to severe coronavirus disease 2019 (COVID-19) cases. Using predictors of fungal infection helps to guide the diagnosis and treatment in these cases and save their lives. Patients and methods A total of 257 patients with moderate to severe COVID-19 pneumonia were examined in this retrospective study at Al Qassimi Hospital of EHS. An assessment of clinical, laboratory, and radiologic findings was performed upon admission. The data were collected and analyzed. Results Overall, 32% of critically ill COVID cases had fungal infection;47% of them were candida, whereas aspergillosis and yeast were positive in 26.5% each. At the time of hospitalization, computed tomography chest findings had a strong correlation with fungal culture results in COVID-19 cases. Fungal infection in COVID-19 cases correlated strongly with metabolic acidosis, high erythrocyte sedimentation rate, high blood sugar, need for mechanical ventilation at admission, vasopressor use, renal replacement, long duration of steroid treatment, long stay in ICU, and long duration on mechanical ventilation. The longer the duration of PCR positivity, the higher the incidence of positive sputum fungal culture result. Conclusion COVID-19-infected patients with other risk factors for fungal infections should always be considered to have fungal infections if pathogenic organisms are isolated from respiratory secretions or other microbiological or immunological markers appear positive. Computed tomography chest finding in COVID-19 cases is an important predictor for fungal infection.Copyright © 2023 The Egyptian Journal of Chest Diseases and Tuberculosis.

POSSIBILE CAPA: A CASE REPORT

TYPE: Case Report TOPIC: Critical Care INTRODUCTION: COVID-19 infection may moderately or severely compromise the patient´s immunity. CASE PRESENTATION: A case of CAPA in a 38 years female whose COVID PCR was positive. She did not have host factors and clinically responded to 6 weeks voriconazole. She was presented with fever, tachypnea, tachycardia, pleuritic Chest pain and High oxygen requirement.she developed ARDS and mechanically ventilated. CRP, procalcitonin. Blood culture, sputum bacterial, fungal cultures, and autoimmune markers were negative. Mycoplasma antibodies and Quantiferon test were also negative. HRCT chest showed the halo sign (Figure 1). Voriconazole IV was initiated. CT PE excluded pulmonary embolism.Diagnosis of CAPA was challenging because of absence of host factor, negative fungal culture, nonavailability of galactomanan test.Despite that she was managed as a possible CAPA with good response to voriconazole. The diagnosis depended on refractory fever, refractory hypoxia after a period of adequate antibiotics, negative procalcitonin, halo sign in HRCT, negative bacterial cultures, positive serum aspergillus antibodies and positive (1–3)-β-D-glucan. Prone positioning and (APRV) led to improved oxygenation. Intravenous 3 days pulse dose methylprednisolone started on the day of progressive HRCT chest.After (SPT) the patient was extubated. Voriconazole tab continued for 3 more weeks and prednisone tab 10 mg tab for 10 days. HRCT chest after 2 weeks showed improvment DISCUSSION: Patients may be moderately immunocompromised after COVID-19 infection hence, susceptible to CAPA. Early detection of radiologic finding in HRCT may warrant early initiation of antifungal if CAPA is clinically suspected. CONCLUSIONS: Serum Aspergillus IgG may be of clinical value indiagnosing IPA DISCLOSURE: Nothing to declare. KEYWORD: COVID, HYPOXIA, CAPA, IPA, HALO SIGN, SOLITARY LUNG CONSOLIDATION