COVID-19-associated pulmonary aspergillosis: an underdiagnosed or overtreated infection?
Curr Opin Crit Care
; 28(5): 470-479, 2022 10 01.
Article
in English
| MEDLINE | ID: covidwho-1992400
ABSTRACT
PURPOSE OF REVIEW Coronavirus disease (COVID-19)-associated pulmonary aspergillosis (CAPA) may concern up to one third of intensive care unit (ICU) patients. The purpose of this review is to discuss the diagnostic criteria, the pathogenesis, the risk factors, the incidence, the impact on outcome, and the diagnostic and therapeutic management of CAPA in critically ill patients. RECENT FINDINGS:
The incidence of CAPA ranges 3--28% of critically ill patients, depending on the definition used, study design, and systematic or triggered screening. COVID-19 is associated with direct damage of the respiratory epithelium, immune dysregulation, and common use of immunosuppressive drugs which might promote Aspergillus respiratory tract colonization and invasion. Positive Aspergillus tests among COVID-19 critically patients might reflect colonization rather than invasive disease. CAPA usually appears during the second week after starting invasive mechanical ventilation and is independently associated with ICU mortality.SUMMARY:
Further studies are needed to validate CAPA case definitions, to determine the accurate incidence of CAPA in comparison to adequate controls, and its evolution during the pandemic. A pro-active diagnostic strategy, based on risk stratification, clinical assessment, and bronchoalveolar lavage could be recommended to provide early antifungal treatment in patients with high probability of CAPA and clinical deterioration.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pulmonary Aspergillosis
/
COVID-19
Type of study:
Diagnostic study
/
Observational study
/
Prognostic study
/
Systematic review/Meta Analysis
Topics:
Long Covid
Limits:
Humans
Language:
English
Journal:
Curr Opin Crit Care
Journal subject:
Critical Care
Year:
2022
Document Type:
Article
Affiliation country:
MCC.0000000000000977
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