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COVID-19-associated aspergillosis in a Brazilian referral centre: Diagnosis, risk factors and outcomes.
de Almeida, João N; Doi, André Mario; Watanabe, Maria Julia L; Maluf, Maira Maraghello; Calderon, Cecília Leon; Silva, Moacyr; Pasternak, Jacyr; Koga, Paula Célia M; Santiago, Kelly Aline S; Aranha, Luis Fernando C; Szarf, Gilberto; da Silva Teles, Gustavo B; Filippi, Renée Zon; Paes, Vitor Ribeiro; Baeta, Marina; Hamerschlak, Nelson; Mangueira, Cristovão Luis P; Martino, Marines Dalla Valle.
  • de Almeida JN; Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Doi AM; Special Laboratory of Mycology, Federal University of São Paulo, São Paulo, Brazil.
  • Watanabe MJL; Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Maluf MM; Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Calderon CL; Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Silva M; Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Pasternak J; Infection Control Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Koga PCM; Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Santiago KAS; Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Aranha LFC; Clinical Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Szarf G; Clinical Department, Infectious Diseases Team, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • da Silva Teles GB; Department of Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil.
  • Filippi RZ; Radiology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Paes VR; Radiology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Baeta M; Pathology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Hamerschlak N; Pathology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Mangueira CLP; Oncohematology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
  • Martino MDV; Oncohematology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Mycoses ; 65(4): 449-457, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1691476
ABSTRACT

BACKGROUND:

COVID-19 patients on mechanical ventilation are at risk to develop invasive aspergillosis. To provide additional data regarding this intriguing entity, we conducted a retrospective study describing risk factors, radiology and prognosis of this emerging entity in a Brazilian referral centre.

METHODS:

This retrospective study included intubated (≥18 years) patients with COVID-19 admitted from April 2020 until July 2021 that had bronchoscopy to investigate pulmonary co-infections. COVID-19-associated aspergillosis (CAPA) was defined according to the 2020 European Confederation of Medical Mycology/International Society of Human and Animal Mycosis consensus criteria. The performance of tracheal aspirate (TA) cultures to diagnose CAPA were described, as well as the radiological findings, risk factors and outcomes.

RESULTS:

Fourteen patients (14/87, 16%) had probable CAPA (0.9 cases per 100 ICU admissions). The sensitivity, specificity, positive predictive value and negative predictive value of TA for the diagnosis of CAPA were 85.7%, 73.1%, 46.2% and 95% respectively. Most of the radiological findings of CAPA were classified as typical of invasive pulmonary aspergillosis (64.3%). The overall mortality rate of probable CAPA was 71.4%. Age was the only independent risk factor for CAPA [p = .03; odds ratio (OR) 1.072]. CAPA patients under renal replacement therapy (RRT) may have a higher risk for a fatal outcome (p = .053, hazard ratio 8.047).

CONCLUSIONS:

CAPA was a prevalent co-infection in our cohort of patients under mechanical ventilation. Older patients had a higher risk to develop CAPA, and a poor prognosis may be associated with RRT.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Invasive Pulmonary Aspergillosis / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Animals / Humans Country/Region as subject: South America / Brazil Language: English Journal: Mycoses Journal subject: Microbiology Year: 2022 Document Type: Article Affiliation country: Myc.13433

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Invasive Pulmonary Aspergillosis / COVID-19 Type of study: Cohort study / Diagnostic study / Observational study / Prognostic study Limits: Animals / Humans Country/Region as subject: South America / Brazil Language: English Journal: Mycoses Journal subject: Microbiology Year: 2022 Document Type: Article Affiliation country: Myc.13433