RESUMEN
BACKGROUND: An increasing number of reports have described the COVID-19-associated pulmonary aspergillosis (CAPA) as being a further contributing factor to mortality. Based on a recent consensus statement supported by international medical mycology societies, it has been proposed to define CAPA as possible, probable, or proven on the basis of sample validity and thus diagnostic certainty. Considering current challenges associated with proven diagnoses, there is pressing need to study the epidemiology of proven CAPA. METHODS: We report the incidence of histologically diagnosed CAPA in a series of 45 consecutive COVID-19 laboratory-confirmed autopsies, performed at Padova University Hospital during the first and second wave of the pandemic. Clinical data, laboratory data and radiological features were also collected for each case. RESULTS: Proven CAPA was detected in 9 (20%) cases, mainly in the second wave of the pandemic (7/17 vs. 2/28 of the first wave). The population of CAPA patients consisted of seven males and two females, with a median age of 74 years. Seven patients were admitted to the intensive care unit. All patients had at least two comorbidities, and concomitant lung diseases were detected in three cases. CONCLUSION: We found a high frequency of proven CAPA among patients with severe COVID-19 thus confirming at least in part the alarming epidemiological data of this important complication recently reported as probable CAPA.
Asunto(s)
COVID-19/epidemiología , Aspergilosis Pulmonar Invasiva/epidemiología , Insuficiencia Respiratoria/mortalidad , Anciano , Anciano de 80 o más Años , Aspergillus , COVID-19/mortalidad , COVID-19/patología , Comorbilidad , Femenino , Humanos , Unidades de Cuidados Intensivos , Aspergilosis Pulmonar Invasiva/mortalidad , Aspergilosis Pulmonar Invasiva/patología , Masculino , Persona de Mediana Edad , Insuficiencia Respiratoria/microbiología , Insuficiencia Respiratoria/patología , SARS-CoV-2RESUMEN
The occurrence of invasive pulmonary aspergillosis (IPA) in critically ill patients with viral pneumonitis has increasingly been reported in recent years. Influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) are the two most common forms of this fungal infection. These diseases cause high mortality in patients, most of whom were previously immunocompetent. The pathogenesis of IAPA and CAPA is still not fully understood, but involves viral, fungal and host factors. In this article, we discuss several aspects regarding IAPA and CAPA, including their possible pathogenesis, the use of immunotherapy, and future challenges.
Asunto(s)
COVID-19/complicaciones , Gripe Humana/complicaciones , Aspergilosis Pulmonar Invasiva/etiología , Neumonía Viral/complicaciones , COVID-19/inmunología , Enfermedad Crítica , Humanos , Inmunoterapia , Gripe Humana/inmunología , Aspergilosis Pulmonar Invasiva/inmunología , Aspergilosis Pulmonar Invasiva/patología , Aspergilosis Pulmonar Invasiva/terapia , Neumonía Viral/inmunologíaRESUMEN
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.