201
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Lamoth F, Lewis RE, Walsh TJ, Kontoyiannis DP. Navigating the uncertainties of COVID-19 associated aspergillosis (CAPA): A comparison with influenza associated aspergillosis (IAPA). J Infect Dis 2021; 224:1631-1640. [PMID: 33770176 PMCID: PMC8083649 DOI: 10.1093/infdis/jiab163] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/23/2021] [Indexed: 12/15/2022] Open
Abstract
Invasive pulmonary aspergillosis (IPA) is increasingly recognized as a life-threatening superinfection of severe respiratory viral infections, such as influenza. The pandemic of Coronavirus Disease 2019 (COVID-19) due to emerging SARS-CoV-2 rose concern about the eventuality of IPA complicating COVID-19 in intensive care unit mechanically-ventilated patients. While the association between severe influenza and IPA has been demonstrated, it remains unclear whether SARS-CoV-2 infection represents a specific risk factor for IPA. A variable incidence of such complication has been previously reported, which can be partly attributed to differences in diagnostic strategy and IPA definitions, and possibly local environmental/epidemiological factors. In this article, we discuss the similarities and differences between influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA). Compared to IAPA, the majority of CAPA cases have been classified as putative rather than proven/probable IPA, in the absence of positive serum galactomannan or histopathologic evidence of angio-invasion. Discrimination between Aspergillus airways colonization and CAPA is difficult. Distinct physiopathology and cytokine profiles of influenza and COVID-19 may explain these discrepancies. Whether CAPA represents a distinct entity is still debatable and many questions remain unanswered, such as its actual incidence, the predisposing role of corticosteroids or immunomodulatory drugs, and the indications for antifungal therapy.
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Affiliation(s)
- Frederic Lamoth
- Infectious Diseases Service and Institute of Microbiology, University Hospital of Lausanne and Lausanne University, Lausanne, Switzerland
| | - Russell E Lewis
- Clinic of Infectious Diseases, S'Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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202
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Proven Fatal Invasive Aspergillosis in a Patient with COVID-19 and Staphylococcus aureus Pneumonia. J Fungi (Basel) 2021; 7:jof7030230. [PMID: 33808931 PMCID: PMC8003593 DOI: 10.3390/jof7030230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/13/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
There is increasing attention for opportunistic pathogens such as Aspergillus fumigatus complicating SARS-CoV-2 infections in the critically ill. For invasive fungal disease, establishing a clear diagnosis can be challenging due to the invasiveness of diagnostic procedures required for a proven case. Here we present one of the first proven cases of COVID-19-associated pulmonary aspergillosis by positive culture of post-mortem lung biopsy.
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203
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Chong WH, Saha BK, Ananthakrishnan Ramani, Chopra A. State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia. Infection 2021; 49:591-605. [PMID: 33709380 PMCID: PMC7951131 DOI: 10.1007/s15010-021-01602-z] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/03/2021] [Indexed: 01/08/2023]
Abstract
Background The incidence of secondary pulmonary infections is not well described in hospitalized COVID-19 patients. Understanding the incidence of secondary pulmonary infections and the associated bacterial and fungal microorganisms identified can improve patient outcomes. Objective This narrative review aims to determine the incidence of secondary bacterial and fungal pulmonary infections in hospitalized COVID-19 patients, and describe the bacterial and fungal microorganisms identified. Method We perform a literature search and select articles with confirmed diagnoses of secondary bacterial and fungal pulmonary infections that occur 48 h after admission, using respiratory tract cultures in hospitalized adult COVID-19 patients. We exclude articles involving co-infections defined as infections diagnosed at the time of admission by non-SARS-CoV-2 viruses, bacteria, and fungal microorganisms. Results The incidence of secondary pulmonary infections is low at 16% (4.8–42.8%) for bacterial infections and lower for fungal infections at 6.3% (0.9–33.3%) in hospitalized COVID-19 patients. Secondary pulmonary infections are predominantly seen in critically ill hospitalized COVID-19 patients. The most common bacterial microorganisms identified in the respiratory tract cultures are Pseudomonas aeruginosa, Klebsiella species, Staphylococcus aureus, Escherichia coli, and Stenotrophomonas maltophilia. Aspergillus fumigatus is the most common microorganism identified to cause secondary fungal pulmonary infections. Other rare opportunistic infection reported such as PJP is mostly confined to small case series and case reports. The overall time to diagnose secondary bacterial and fungal pulmonary infections is 10 days (2–21 days) from initial hospitalization and 9 days (4–18 days) after ICU admission. The use of antibiotics is high at 60–100% involving the studies included in our review. Conclusion The widespread use of empirical antibiotics during the current pandemic may contribute to the development of multidrug-resistant microorganisms, and antimicrobial stewardship programs are required for minimizing and de-escalating antibiotics. Due to the variation in definition across most studies, a large, well-designed study is required to determine the incidence, risk factors, and outcomes of secondary pulmonary infections in hospitalized COVID-19 patients.
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Affiliation(s)
- Woon H Chong
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, USA.
| | - Biplab K Saha
- Department of Pulmonary and Critical Care, Ozarks Medical Center, West Plains, MO, USA
| | | | - Amit Chopra
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, USA
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204
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Jabeen K, Farooqi J, Irfan M, Ali SA, Denning DW. Diagnostic dilemma in COVID-19-associated pulmonary aspergillosis. THE LANCET. INFECTIOUS DISEASES 2021; 21:767. [PMID: 33662326 PMCID: PMC8126797 DOI: 10.1016/s1473-3099(21)00066-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - David W Denning
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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205
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Benedetti MF, Alava KH, Sagardia J, Cadena RC, Laplume D, Capece P, Posse G, Nusblat AD, Cuestas ML. COVID-19 associated pulmonary aspergillosis in ICU patients: Report of five cases from Argentina. Med Mycol Case Rep 2021; 31:24-28. [PMID: 33312852 PMCID: PMC7719954 DOI: 10.1016/j.mmcr.2020.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 01/07/2023] Open
Abstract
Invasive pulmonary aspergillosis is a complication in critically ill patients with acute respiratory distress syndrome, especially those with severe coronavirus disease-associated pneumonia. In this study, five cases of presumed invasive pulmonary aspergillosis in one immunocompromised and four immunocompetent patients with COVID-19 in Buenos Aires are described. In all cases, the underlying conditions, clinical presentation, fungal diagnostic tests used and their results, features of the chest scan images, antifungals used and clinical outcomes are detailed.
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Affiliation(s)
| | - Katherine Hermida Alava
- Universidad de Buenos Aires. CONICET. Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM). Buenos Aires, Argentina
| | - Judith Sagardia
- Servicio de Infectología. Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Roberto Corella Cadena
- Servicio de Infectología. Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Diego Laplume
- Servicio de Infectología. Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Paula Capece
- Laboratorio de Micología. Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Gladys Posse
- Laboratorio de Micología. Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Alejandro David Nusblat
- Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Nanobiotecnología (NANOBIOTEC), Buenos Aires, Argentina
| | - María Luján Cuestas
- Universidad de Buenos Aires. CONICET. Instituto de Investigaciones en Microbiología y Parasitología Médica (IMPaM). Buenos Aires, Argentina
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206
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Banerjee S, Denning DW, Chakrabarti A. One Health aspects & priority roadmap for fungal diseases : A mini-review. Indian J Med Res 2021; 153:311-319. [PMID: 33906993 PMCID: PMC8204821 DOI: 10.4103/ijmr.ijmr_768_21] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Indexed: 11/29/2022] Open
Abstract
Fungal diseases have not been taken seriously in public health agendas as well as research priorities, despite of globally causing an estimated two million deaths every year, and the emergence of many troublesome fungal pathogens like Candida auris, azole resistant Aspergillus fumigatus, terbinafine and azole resistant dermatophytes, and zoonotic sporotrichosis in humans. Fungi are also responsible for huge losses of agricultural products and stored crops as well as recent massive and unexpected mortality in animals caused by white-nose syndrome in the bats and Chytridiomycosis in amphibians. This review aims to underscore the need for collaborative, multisectoral, and trans-disciplinary approach to include the One Health approach as an essential component of surveillance, prevention, and control of globally emerging fungal diseases. Rigorous evidence based surveillance of the environment as well as strengthening rapid and quality diagnosis of fungal diseases can save millions of lives and reduce significant morbidity.
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Affiliation(s)
- Sayantan Banerjee
- Department of Infectious Diseases, Beleghata Infectious Diseases & BG Hospitals, Beleghata, Kolkata, West Bengal, India
| | - David W. Denning
- Manchester Fungal Infection Group, Faculty of Biology, Medicine and Health, The University of Manchester, United Kingdom
- Global Action Fund for Fungal Infections, Geneva, Switzerland
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
- Center of Advanced Research in Medical Mycology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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207
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Moser D, Biere K, Han B, Hoerl M, Schelling G, Choukér A, Woehrle T. COVID-19 Impairs Immune Response to Candida albicans. Front Immunol 2021; 12:640644. [PMID: 33717195 PMCID: PMC7953065 DOI: 10.3389/fimmu.2021.640644] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/20/2021] [Indexed: 12/11/2022] Open
Abstract
Infection with SARS-CoV-2 can lead to Coronavirus disease-2019 (COVID-19) and result in severe acute respiratory distress syndrome (ARDS). Recent reports indicate an increased rate of fungal coinfections during COVID-19. With incomplete understanding of the pathogenesis and without any causative therapy available, secondary infections may be detrimental to the prognosis. We monitored 11 COVID-19 patients with ARDS for their immune phenotype, plasma cytokines, and clinical parameters on the day of ICU admission and on day 4 and day 7 of their ICU stay. Whole blood stimulation assays with lipopolysaccharide (LPS), heat-killed Listeria monocytogenes (HKLM), Aspergillus fumigatus, and Candida albicans were used to mimic secondary infections, and changes in immune phenotype and cytokine release were assessed. COVID-19 patients displayed an immune phenotype characterized by increased HLA-DR+CD38+ and PD-1+ CD4+ and CD8+ T cells, and elevated CD8+CD244+ lymphocytes, compared to healthy controls. Monocyte activation markers and cytokines IL-6, IL-8, TNF, IL-10, and sIL2Rα were elevated, corresponding to monocyte activation syndrome, while IL-1β levels were low. LPS, HKLM and Aspergillus fumigatus antigen stimulation provoked an immune response that did not differ between COVID-19 patients and healthy controls, while COVID-19 patients showed an attenuated monocyte CD80 upregulation and abrogated release of IL-6, TNF, IL-1α, and IL-1β toward Candida albicans. This study adds further detail to the characterization of the immune response in critically ill COVID-19 patients and hints at an increased susceptibility for Candida albicans infection.
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Affiliation(s)
| | | | | | | | | | - Alexander Choukér
- Department of Anesthesiology, LMU Hospital, Ludwig-Maximilians-University, Munich, Germany
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208
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Trovato L, Calvo M, Migliorisi G, Astuto M, Oliveri F, Oliveri S. Fatal VAP-related pulmonary aspergillosis by Aspergillus niger in a positive COVID-19 patient. Respir Med Case Rep 2021; 32:101367. [PMID: 33619451 PMCID: PMC7890353 DOI: 10.1016/j.rmcr.2021.101367] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 12/16/2022] Open
Abstract
Invasive pulmonary aspergillosis, known as a complication in patients with severe respiratory syndromes, recently showed a correlation with COVID-19 pneumonia, and the clinical characteristics of COVID-19 associated pulmonary aspergillosis (CAPA) have been described. Unfortunately, infections by the Aspergillus genus are often diagnosed in post-mortem time, because of diagnostic delays and a rapid worsening of respiratory conditions. Literature data document, in fact, only few cases of COVID-19 Aspergillus niger coinfection. The aim of this study was to describe a case of a VAP-related probable pulmonary aspergillosis by Aspergillus niger in a COVID-19 patient. Despite the definition of fungal etiology and the rapid administration of antifungal therapy, the patient died while on ventilator support because of severe respiratory impairment.
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Affiliation(s)
- Laura Trovato
- U.O.C. Laboratory Analysis Unit, A.O.U. "Policlinico-Vittorio Emanuele", Via S. Sofia 78, Catania, 95123, Italy.,Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 97, Catania, 95123, Italy
| | - Maddalena Calvo
- U.O.C. Laboratory Analysis Unit, A.O.U. "Policlinico-Vittorio Emanuele", Via S. Sofia 78, Catania, 95123, Italy
| | - Giuseppe Migliorisi
- U.O.C. Laboratory Analysis Unit, A.O.U. "Policlinico-Vittorio Emanuele", Via S. Sofia 78, Catania, 95123, Italy
| | - Marinella Astuto
- Department of Anesthesia and Intensive Care, A.O.U. "Policlinico -Vittorio Emanuele", Via S. Sofia 78, Catania, 95123, Italy
| | - Francesco Oliveri
- Department of Anesthesia and Intensive Care, A.O.U. "Policlinico -Vittorio Emanuele", Via S. Sofia 78, Catania, 95123, Italy
| | - Salvatore Oliveri
- U.O.C. Laboratory Analysis Unit, A.O.U. "Policlinico-Vittorio Emanuele", Via S. Sofia 78, Catania, 95123, Italy.,Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 97, Catania, 95123, Italy
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209
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Abstract
Invasive mold infections caused by molds other than Aspergillus spp. or Mucorales are emerging. The reported prevalences of infection due to these rare fungal pathogens vary among geographic regions, driven by differences in climatic conditions, susceptible hosts, and diagnostic capabilities. These rare molds—Fusarium, Lomentospora, and Scedosporium species and others—are difficult to detect and often show intrinsic antifungal resistance. Now, international societies of medical mycology and microbiology have joined forces and created the “Global guideline for the diagnosis and management of rare mould infections: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology and the American Society for Microbiology” (published in Lancet Infect Dis, https://doi.org/10.1016/S1473-3099(20)30784-2), with the goal of improving the diagnosis, treatment, prevention, and survival of persons with rare mold infections. The guideline provides cutting-edge guidance for the correct utilization and application of established and new diagnostic and therapeutic options.
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210
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Meijer EFJ, Dofferhoff ASM, Hoiting O, Meis JF. COVID-19-associated pulmonary aspergillosis: a prospective single-center dual case series. Mycoses 2021; 64:457-464. [PMID: 33569857 PMCID: PMC7986084 DOI: 10.1111/myc.13254] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/15/2022]
Abstract
Background COVID‐19–associated pulmonary aspergillosis (CAPA) has emerged as an invasive fungal disease, often affecting previously immunocompetent, mechanically ventilated, intensive care unit (ICU) patients. Incidence rates of 3.8%–33.3% have been reported depending on the geographic area, with high (47%) mortality. Objectives Here, we describe a single‐centre prospective case series with CAPA cases from both the first (March‐May, n = 5/33) and second (mid‐September through mid‐December, n = 8/33) COVID‐19 wave at a 500‐bed teaching hospital in the Netherlands. Patients/Methods In the first COVID‐19 wave, a total of 265 SARS‐CoV‐2 PCR‐positive patients were admitted to our hospital of whom 33 needed intubation and mechanical ventilation. In the second wave, 508 SARS‐CoV‐2 PCR‐positive patients were admitted of whom 33 needed mechanical ventilation. Data were prospectively collected. Results We found a significant decrease in COVID‐19 patients needing mechanical ventilation in the ICU in the second wave (p < .01). From these patients, however, a higher percentage were diagnosed with CAPA (24.2% vs 15.2%), although not significant (p = .36). All CAPA patients encountered in the second wave received dexamethasone. Mortality between both groups was similarly high (40%–50%). Moreover, we found environmental TR34/L98H azole‐resistant Aspergillus fumigatus isolates in two separate patients. Conclusions In this series, 19.7% (n = 13/66) of mechanically ventilated SARS‐CoV‐2 patients were diagnosed with CAPA. In addition, we found a significant reduction in COVID‐19 patients needing mechanical ventilation on the ICU in the second wave. Numbers are too small to determine whether there is a true difference in CAPA incidence in mechanically ventilated patients between the two waves, and whether it could be attributed to dexamethasone SARS‐CoV‐2 therapy.
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Affiliation(s)
- Eelco F J Meijer
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.,Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
| | - Anton S M Dofferhoff
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands.,Department of Internal Medicine, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
| | - Oscar Hoiting
- Department of Intensive Care Medicine, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands
| | - Jacques F Meis
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Center of Expertise in Mycology Radboudumc/CWZ, Nijmegen, The Netherlands.,Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), Nijmegen, The Netherlands.,Bioprocess Engineering and Biotechnology Graduate Program, Federal University of Paraná, Curitiba, Brazil
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211
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Roman-Montes CM, Martinez-Gamboa A, Diaz-Lomelí P, Cervantes-Sanchez A, Rangel-Cordero A, Sifuentes-Osornio J, Ponce-de-Leon A, Gonzalez-Lara MF. Accuracy of galactomannan testing on tracheal aspirates in COVID-19-associated pulmonary aspergillosis. Mycoses 2021; 64:364-371. [PMID: 33217784 PMCID: PMC7753336 DOI: 10.1111/myc.13216] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022]
Abstract
Objective Our aim was to evaluate the performance of two galactomannan (GM) assays (Platelia Aspergillus EIA, Bio‐Rad®, and Aspergillus GM LFA, IMMY®) in tracheal aspirate (TA) samples of consecutive critically ill patients with COVID‐19. Methods We included critically ill patients, performed GM‐EIA and GM‐Lateral Flow Assay (GM‐LFA) in TA and followed them until development of COVID‐19‐associated pulmonary aspergillosis (CAPA) or alternate diagnosis. CAPA was defined according to the modified AspICU criteria in patients with SARS‐CoV‐2 infection. We estimated sensitivity, specificity, positive and negative predictive values for GM‐EIA, GM‐LFA, the combination of both or either positive results for GM‐EIA and GM‐LFA. We explored accuracy using different breakpoints, through ROC analysis and Youden index to identify the optimal cut‐offs. We described antifungal treatment and 30‐day mortality. Results We identified 14/144 (9.7%) patients with CAPA, mean age was 50.35 (SD 11.9), the median time from admission to CAPA was 8 days; 28.5% received tocilizumab and 30‐day mortality was 57%. ROC analysis and Youden index identified 2.0 OD as the best cut‐off, resulting in sensitivity and specificity of 57.1% and 81.5% for GM‐EIA and 60% and 72.6% for GM‐LFA, respectively. Conclusions The diagnostic performance of GM in tracheal aspirates improved after using a cut‐off of 2 OD. Although bronchoalveolar lavage testing is the ideal test, centres with limited access to bronchoscopy may consider this approach to identify or rule out CAPA.
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Affiliation(s)
- Carla M Roman-Montes
- Clinical Microbiology Laboratory, Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Areli Martinez-Gamboa
- Clinical Microbiology Laboratory, Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paulette Diaz-Lomelí
- Clinical Microbiology Laboratory, Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Axel Cervantes-Sanchez
- Clinical Microbiology Laboratory, Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Andrea Rangel-Cordero
- Clinical Microbiology Laboratory, Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jose Sifuentes-Osornio
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo Ponce-de-Leon
- Clinical Microbiology Laboratory, Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Maria F Gonzalez-Lara
- Clinical Microbiology Laboratory, Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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212
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Garg D, Muthu V, Sehgal IS, Ramachandran R, Kaur H, Bhalla A, Puri GD, Chakrabarti A, Agarwal R. Coronavirus Disease (Covid-19) Associated Mucormycosis (CAM): Case Report and Systematic Review of Literature. Mycopathologia 2021; 186:289-298. [PMID: 33544266 PMCID: PMC7862973 DOI: 10.1007/s11046-021-00528-2] [Citation(s) in RCA: 308] [Impact Index Per Article: 102.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/15/2021] [Indexed: 12/16/2022]
Abstract
Severe coronavirus disease (COVID-19) is currently managed with systemic glucocorticoids. Opportunistic fungal infections are of concern in such patients. While COVID-19 associated pulmonary aspergillosis is increasingly recognized, mucormycosis is rare. We describe a case of probable pulmonary mucormycosis in a 55-year-old man with diabetes, end-stage kidney disease, and COVID-19. The index case was diagnosed with pulmonary mucormycosis 21 days following admission for severe COVID-19. He received 5 g of liposomal amphotericin B and was discharged after 54 days from the hospital. We also performed a systematic review of the literature and identified seven additional cases of COVID-19 associated mucormycosis (CAM). Of the eight cases included in our review, diabetes mellitus was the most common risk factor. Three subjects had no risk factor other than glucocorticoids for COVID-19. Mucormycosis usually developed 10–14 days after hospitalization. All except the index case died. In two subjects, CAM was diagnosed postmortem. Mucormycosis is an uncommon but serious infection that complicates the course of severe COVID-19. Subjects with diabetes mellitus and multiple risk factors may be at a higher risk for developing mucormycosis. Concurrent glucocorticoid therapy probably heightens the risk of mucormycosis. A high index of suspicion and aggressive management is required to improve outcomes.
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Affiliation(s)
- Deepak Garg
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India
| | - Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Harsimran Kaur
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Goverdhan D Puri
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India.
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213
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Salmanton-García J, Sprute R, Stemler J, Bartoletti M, Dupont D, Valerio M, Garcia-Vidal C, Falces-Romero I, Machado M, de la Villa S, Schroeder M, Hoyo I, Hanses F, Ferreira-Paim K, Giacobbe DR, Meis JF, Gangneux JP, Rodríguez-Guardado A, Antinori S, Sal E, Malaj X, Seidel D, Cornely OA, Koehler P. COVID-19-Associated Pulmonary Aspergillosis, March-August 2020. Emerg Infect Dis 2021; 27:1077-1086. [PMID: 33539721 PMCID: PMC8007287 DOI: 10.3201/eid2704.204895] [Citation(s) in RCA: 169] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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%.
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214
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Nargesi S, Bongomin F, Hedayati MT. The impact of COVID-19 pandemic on AIDS-related mycoses and fungal neglected tropical diseases: Why should we worry? PLoS Negl Trop Dis 2021; 15:e0009092. [PMID: 33561159 PMCID: PMC7872288 DOI: 10.1371/journal.pntd.0009092] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The World Health Organization (WHO) considers mycetoma, chromoblastomycosis, and paracoccidioidomycosis to be fungal neglected tropical diseases (FNTDs). Depending on climatic, cultural, and economic contexts, these diseases have a similar geographical distribution as many other diseases, particularly tuberculosis (TB) and malaria, but are often less targeted by the national and many international healthcare systems. Another subgroup of fungal infections, such as candidiasis, cryptococcosis, pneumocystosis, histoplasmosis, and to a lesser extent, aspergillosis, are known as AIDS-related mycoses. Although antiretroviral therapy (ART) has been able to decrease the mortality rate of these diseases, particularly cryptococcosis, the disproportionately low distribution of funds to their diagnosis and treatment remains an obstacle in saving and improving the lives of patients affected. A new wave of viral diseases dubbed the Coronavirus Disease 2019 (COVID-19) hit the world at the end of 2019. Due to progressive symptoms and high mortality rates of COVID-19 compared to fungal infections, particularly the FNTDs, funding is currently allocated predominantly for diagnostic and therapeutic research on COVID-19. As a result, advances in FNTDs and AIDS-related mycosis care are considerably reduced. This paper explores the association between COVID-19, FNTDs, and AIDS-related mycoses with a predictive perspective.
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Affiliation(s)
- Sanaz Nargesi
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
- Global Action Fund for Fungal Infections (GAFFI), Geneva, Switzerland
| | - Mohammad T. Hedayati
- Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Global Action Fund for Fungal Infections (GAFFI), Geneva, Switzerland
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215
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Machado M, Valerio M, Álvarez‐Uría A, Olmedo M, Veintimilla C, Padilla B, De la Villa S, Guinea J, Escribano P, Ruiz‐Serrano MJ, Reigadas E, Alonso R, Guerrero JE, Hortal J, Bouza E, Muñoz P. Invasive pulmonary aspergillosis in the COVID-19 era: An expected new entity. Mycoses 2021; 64:132-143. [PMID: 33210776 PMCID: PMC7753705 DOI: 10.1111/myc.13213] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Information on the recently COVID-19-associated pulmonary aspergillosis (CAPA) entity is scarce. We describe eight CAPA patients, compare them to colonised ICU patients with coronavirus disease 2019 (COVID-19), and review the published literature from Western countries. METHODS Prospective study (March to May, 2020) that included all COVID-19 patients admitted to a tertiary hospital. Modified AspICU and European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria were used. RESULTS COVID-19-associated pulmonary aspergillosis was diagnosed in eight patients (3.3% of 239 ICU patients), mostly affected non-immunocompromised patients (75%) with severe acute respiratory distress syndrome (ARDS) receiving corticosteroids. Diagnosis was established after a median of 15 days under mechanical ventilation. Bronchoalveolar lavage was performed in two patients with positive Aspergillus fumigatus cultures and galactomannan (GM) index. Serum GM was positive in 4/8 (50%). Thoracic CT scan findings fulfilled EORTC/MSG criteria in one case. Isavuconazole was used in 4/8 cases. CAPA-related mortality was 100% (8/8). Compared with colonised patients, CAPA subjects were administered tocilizumab more often (100% vs. 40%, p = .04), underwent longer courses of antibacterial therapy (13 vs. 5 days, p = .008), and had a higher all-cause mortality (100% vs. 40%, p = .04). We reviewed 96 similar cases from recent publications: 59 probable CAPA (also putative according modified AspICU), 56 putative cases and 13 colonisations according AspICU algorithm; according EORTC/MSG six proven and two probable. Overall, mortality in the reviewed series was 56.3%. CONCLUSIONS COVID-19-associated pulmonary aspergillosis must be considered a serious and potentially life-threatening complication in patients with severe COVID-19 receiving immunosuppressive treatment.
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Affiliation(s)
- Marina Machado
- Clinical Microbiology and Infectious Diseases DepartmentHospital General Universitario Gregorio MarañónMadridSpain
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
| | - Maricela Valerio
- Clinical Microbiology and Infectious Diseases DepartmentHospital General Universitario Gregorio MarañónMadridSpain
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
| | - Ana Álvarez‐Uría
- Clinical Microbiology and Infectious Diseases DepartmentHospital General Universitario Gregorio MarañónMadridSpain
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
- Medicine DepartmentSchool of MedicineUniversidad Complutense de MadridMadridSpain
| | - María Olmedo
- Clinical Microbiology and Infectious Diseases DepartmentHospital General Universitario Gregorio MarañónMadridSpain
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
| | - Cristina Veintimilla
- Clinical Microbiology and Infectious Diseases DepartmentHospital General Universitario Gregorio MarañónMadridSpain
| | - Belén Padilla
- Clinical Microbiology and Infectious Diseases DepartmentHospital General Universitario Gregorio MarañónMadridSpain
| | - Sofía De la Villa
- Clinical Microbiology and Infectious Diseases DepartmentHospital General Universitario Gregorio MarañónMadridSpain
| | - Jesús Guinea
- Clinical Microbiology and Infectious Diseases DepartmentHospital General Universitario Gregorio MarañónMadridSpain
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
- CIBER Enfermedades RespiratoriasCIBERES (CB06/06/0058)MadridSpain
| | - Pilar Escribano
- Clinical Microbiology and Infectious Diseases DepartmentHospital General Universitario Gregorio MarañónMadridSpain
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
| | - María Jesús Ruiz‐Serrano
- Clinical Microbiology and Infectious Diseases DepartmentHospital General Universitario Gregorio MarañónMadridSpain
| | - Elena Reigadas
- Clinical Microbiology and Infectious Diseases DepartmentHospital General Universitario Gregorio MarañónMadridSpain
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
| | - Roberto Alonso
- Clinical Microbiology and Infectious Diseases DepartmentHospital General Universitario Gregorio MarañónMadridSpain
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
- Medicine DepartmentSchool of MedicineUniversidad Complutense de MadridMadridSpain
| | - José Eugenio Guerrero
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
- Intensive Care UnitHospital General Universitario Gregorio MarañónMadridSpain
| | - Javier Hortal
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
- Anaesthesiology and Reanimation DepartmentHospital General Universitario Gregorio MarañónMadridSpain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases DepartmentHospital General Universitario Gregorio MarañónMadridSpain
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
- Medicine DepartmentSchool of MedicineUniversidad Complutense de MadridMadridSpain
- CIBER Enfermedades RespiratoriasCIBERES (CB06/06/0058)MadridSpain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases DepartmentHospital General Universitario Gregorio MarañónMadridSpain
- Instituto de Investigación Sanitaria Gregorio MarañónMadridSpain
- Medicine DepartmentSchool of MedicineUniversidad Complutense de MadridMadridSpain
- CIBER Enfermedades RespiratoriasCIBERES (CB06/06/0058)MadridSpain
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216
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Autopsy Proven Pulmonary Mucormycosis Due to Rhizopus microsporus in a Critically Ill COVID-19 Patient with Underlying Hematological Malignancy. J Fungi (Basel) 2021; 7:jof7020088. [PMID: 33513875 PMCID: PMC7912223 DOI: 10.3390/jof7020088] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/23/2020] [Accepted: 01/25/2021] [Indexed: 01/10/2023] Open
Abstract
Viral infections can cause acute respiratory distress syndrome (ARDS), consequently leading to susceptibility for secondary pulmonary infections. Over the past few weeks, a number of studies have reported on secondary pulmonary aspergillosis complicating severe COVID-19. We report the case of a 53-year old male patient with secondary acute myeloid leukemia (AML) who suffered from COVID-19 ARDS and was diagnosed postmortem with mucormycosis.
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217
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Chamilos G, Lionakis MS, Kontoyiannis DP. Are All Patients with Cancer at Heightened Risk for Severe Coronavirus Disease 2019 (COVID-19)? Clin Infect Dis 2021; 72:351-356. [PMID: 33501958 PMCID: PMC7454377 DOI: 10.1093/cid/ciaa1079] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022] Open
Abstract
Cancer patients are traditionally considered at high risk for complicated respiratory viral infections, due to their underlying immunosuppression. In line with this notion, early case series reported high mortality rates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with malignancy. However, subsequent large, prospective, epidemiological surveys indicate that the risk for severe coronavirus disease 2019 (COVID-19) may be largely attributed to the multiple confounders operating in this highly heterogeneous population of patients, rather than the cancer or its treatment per se. We critically discuss the conundrums of SARS-CoV-2 infection in cancer patients and underscore mechanistic insights on the outcome of COVID-19 as it relates to cancer therapy and the type and status of the underlying malignancy. Not all cancer patients are similarly at risk for a complicated COVID-19 course. A roadmap is needed for translational and clinical research on COVID-19 in this challenging group of patients.
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Affiliation(s)
- Georgios Chamilos
- Department of Clinical Microbiology and Microbial Pathogenesis, University of Crete, Crete, Greece
- Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology, Heraklion, Crete, Greece
| | - Michail S Lionakis
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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218
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Evert K, Dienemann T, Brochhausen C, Lunz D, Lubnow M, Ritzka M, Keil F, Trummer M, Scheiter A, Salzberger B, Reischl U, Boor P, Gessner A, Jantsch J, Calvisi DF, Evert M, Schmidt B, Simon M. Autopsy findings after long-term treatment of COVID-19 patients with microbiological correlation. Virchows Arch 2021; 479:97-108. [PMID: 33471172 PMCID: PMC7816067 DOI: 10.1007/s00428-020-03014-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/22/2020] [Accepted: 12/27/2020] [Indexed: 12/11/2022]
Abstract
Between April and June 2020, i.e., during the first wave of pandemic coronavirus disease 2019 (COVID-19), 55 patients underwent long-term treatment in the intensive care unit at the University Hospital of Regensburg. Most of them were transferred from smaller hospitals, often due to the need for an extracorporeal membrane oxygenation system. Autopsy was performed in 8/17 COVID-19-proven patients after long-term treatment (mean: 33.6 days). Autopsy revealed that the typical pathological changes occurring during the early stages of the disease (e.g., thrombosis, endothelitis, capillaritis) are less prevalent at this stage, while severe diffuse alveolar damage and especially coinfection with different fungal species were the most conspicuous finding. In addition, signs of macrophage activation syndrome was detected in 7 of 8 patients. Thus, fungal infections were a leading cause of death in our cohort of severely ill patients and may alter clinical management of patients, particularly in long-term periods of treatment.
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Affiliation(s)
- Katja Evert
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Thomas Dienemann
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Brochhausen
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Dirk Lunz
- Department of Medicine II, University Medical Centre, Regensburg, Germany
| | - Matthias Lubnow
- Department of Anesthesiology and Intensive Care, University Hospital Regensburg, Regensburg, Germany
| | - Markus Ritzka
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Felix Keil
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Matthias Trummer
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Alexander Scheiter
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Bernd Salzberger
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Udo Reischl
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Peter Boor
- Institute of Pathology, University Hospital Aachen, RWTH Aachen, Aachen, Germany
| | - André Gessner
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Jonathan Jantsch
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Diego F Calvisi
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Matthias Evert
- Institute of Pathology, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Barbara Schmidt
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
| | - Michaela Simon
- Institute of Clinical Microbiology and Hygiene, Regensburg University Hospital, Regensburg, Germany
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219
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Davies G, Singh O, Prattes J, Hoenigl M, Sheppard PW, Thornton CR. Aspergillus fumigatus and Its Allergenic Ribotoxin Asp f I: Old Enemies but New Opportunities for Urine-Based Detection of Invasive Pulmonary Aspergillosis Using Lateral-Flow Technology. J Fungi (Basel) 2020; 7:19. [PMID: 33396482 PMCID: PMC7823411 DOI: 10.3390/jof7010019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/17/2020] [Accepted: 12/30/2020] [Indexed: 12/21/2022] Open
Abstract
Invasive pulmonary aspergillosis (IPA) caused by Aspergillus fumigatus is a life-threatening lung disease of immunocompromised patients. Diagnosis currently relies on non-specific chest CT, culture of the fungus from invasive lung biopsy, and detection of the cell wall carbohydrate galactomannan (GM) in serum or in BAL fluids recovered during invasive bronchoscopy. Urine provides an ideal bodily fluid for the non-invasive detection of pathogen biomarkers, with current urine-based immunodiagnostics for IPA focused on GM. Surrogate protein biomarkers might serve to improve disease detection. Here, we report the development of a monoclonal antibody (mAb), PD7, which is specific to A. fumigatus and related species in the section Fumigati, and which binds to its 18 kDa ribotoxin Asp f I. Using PD7, we show that the protein is secreted during hyphal development, and so represents an ideal candidate for detecting invasive growth. We have developed a lateral-flow device (Afu-LFD®) incorporating the mAb which has a limit of detection of ~15 ng Asp f I/mL urine. Preliminary evidence of the test's diagnostic potential is demonstrated with urine from a patient with acute lymphoid leukaemia with probable IPA. The Afu-LFD® therefore provides a potential novel opportunity for non-invasive urine-based detection of IPA caused by A. fumigatus.
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Affiliation(s)
- Genna Davies
- ISCA Diagnostics Ltd., Hatherly Laboratories, Prince of Wales Road, Exeter EX4 4PS, UK;
- Biosciences and MRC Centre for Medical Mycology, Hatherly Laboratories, University of Exeter, Prince of Wales Road, Exeter EX4 4PS, UK;
| | - Oski Singh
- Biosciences and MRC Centre for Medical Mycology, Hatherly Laboratories, University of Exeter, Prince of Wales Road, Exeter EX4 4PS, UK;
| | - Juergen Prattes
- Department of Internal Medicine, Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, A-8036 Graz, Austria; (J.P.); (M.H.)
| | - Martin Hoenigl
- Department of Internal Medicine, Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, A-8036 Graz, Austria; (J.P.); (M.H.)
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA 92093, USA
| | - Paul W. Sheppard
- Vacye Associates, Lowerdown Cottage, Lowerdown, Bovey Tracey TQ13 9LF, UK;
| | - Christopher R. Thornton
- ISCA Diagnostics Ltd., Hatherly Laboratories, Prince of Wales Road, Exeter EX4 4PS, UK;
- Biosciences and MRC Centre for Medical Mycology, Hatherly Laboratories, University of Exeter, Prince of Wales Road, Exeter EX4 4PS, UK;
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220
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COVID-19-Associated Invasive Aspergillosis: Data from the UK National Mycology Reference Laboratory. J Clin Microbiol 2020; 59:JCM.02136-20. [PMID: 33087440 PMCID: PMC7771443 DOI: 10.1128/jcm.02136-20] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/17/2020] [Indexed: 12/21/2022] Open
Abstract
COVID-19-associated pulmonary aspergillosis (CAPA) was recently reported as a potential infective complication affecting critically ill patients with acute respiratory distress syndrome following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with incidence rates varying from 8 to 33% depending on the study. However, definitive diagnosis of CAPA is challenging. Standardized diagnostic algorithms and definitions are lacking, clinicians are reticent to perform aerosol-generating bronchoalveolar lavages for galactomannan testing and microscopic and cultural examination, and questions surround the diagnostic sensitivity of different serum biomarkers. COVID-19-associated pulmonary aspergillosis (CAPA) was recently reported as a potential infective complication affecting critically ill patients with acute respiratory distress syndrome following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with incidence rates varying from 8 to 33% depending on the study. However, definitive diagnosis of CAPA is challenging. Standardized diagnostic algorithms and definitions are lacking, clinicians are reticent to perform aerosol-generating bronchoalveolar lavages for galactomannan testing and microscopic and cultural examination, and questions surround the diagnostic sensitivity of different serum biomarkers. Between 11 March and 14 July 2020, the UK National Mycology Reference Laboratory received 1,267 serum and respiratory samples from 719 critically ill UK patients with COVID-19 and suspected pulmonary aspergillosis. The laboratory also received 46 isolates of Aspergillus fumigatus from COVID-19 patients (including three that exhibited environmental triazole resistance). Diagnostic tests performed included 1,000 (1-3)-β-d-glucan and 516 galactomannan tests on serum samples. The results of this extensive testing are presented here. For a subset of 61 patients, respiratory specimens (bronchoalveolar lavage specimens, tracheal aspirates, and sputum samples) in addition to serum samples were submitted and subjected to galactomannan testing, Aspergillus-specific PCR, and microscopy and culture. The incidence of probable/proven and possible CAPA in this subset of patients was approximately 5% and 15%, respectively. Overall, our results highlight the challenges in biomarker-driven diagnosis of CAPA, especially when only limited clinical samples are available for testing, and the importance of a multimodal diagnostic approach involving regular and repeat testing of both serum and respiratory samples.
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221
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Koehler P, Bassetti M, Chakrabarti A, Chen SCA, Colombo AL, Hoenigl M, Klimko N, Lass-Flörl C, Oladele RO, Vinh DC, Zhu LP, Böll B, Brüggemann R, Gangneux JP, Perfect JR, Patterson TF, Persigehl T, Meis JF, Ostrosky-Zeichner L, White PL, Verweij PE, Cornely OA. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. THE LANCET. INFECTIOUS DISEASES 2020; 21:e149-e162. [PMID: 33333012 PMCID: PMC7833078 DOI: 10.1016/s1473-3099(20)30847-1] [Citation(s) in RCA: 533] [Impact Index Per Article: 133.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 01/08/2023]
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.
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Affiliation(s)
- Philipp Koehler
- Faculty of Medicine, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany; Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), University Hospital Cologne, Cologne, Germany
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, Genoa, Italy; Policlinico San Martino Hospital, Genoa, Italy
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sharon C A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, NSW, Australia; Department of Infectious Diseases, Westmead Hospital, Sydney, NSW, Australia; School of Medicine, University of Sydney, Sydney, NSW, Australia
| | | | - Martin Hoenigl
- Clinical and Translational Fungal-Working Group and Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA; Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Nikolay Klimko
- Department of Clinical Mycology, Allergology and Immunology, North Western State Medical University, St Petersburg, Russia
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, ECMM, Medical University of Innsbruck, Innsbruck, Austria
| | - Rita O Oladele
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Donald C Vinh
- Division of Infectious Diseases, Department of Medicine, Department of Medical Microbiology, and Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, QC, Canada
| | - Li-Ping Zhu
- Department of Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Boris Böll
- Faculty of Medicine, University of Cologne, Cologne, Germany; Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), University Hospital Cologne, Cologne, Germany
| | - Roger Brüggemann
- Department of Pharmacy, ECMM, Center of Expertise in Mycology Radboudumc/CWZ, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands; Radboudumc Institute of Health Science, ECMM, Center of Expertise in Mycology Radboudumc/CWZ, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands
| | - Jean-Pierre Gangneux
- Université de Rennes, CHU de Rennes, EHESP, Institut de Recherche en Santé, Environnement et travail, Inserm UMR_S 1085, Rennes, France
| | - John R Perfect
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Thomas F Patterson
- University of Texas Health San Antonio, San Antonio, TX, USA; University Health, San Antonio, TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Thorsten Persigehl
- Faculty of Medicine, University of Cologne, Cologne, Germany; Department of Radiology, University Hospital Cologne, Cologne, Germany
| | - Jacques F Meis
- Department of Medical Microbiology, ECMM, Center of Expertise in Mycology Radboudumc/CWZ, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands; Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, Netherlands; Bioprocess Engineering and Biotechnology Graduate Program, Federal University of Paraná, Curitiba, Brazil
| | - Luis Ostrosky-Zeichner
- Division of Infectious Diseases, McGovern Medical School, University of Texas, Houston, TX, USA
| | - P Lewis White
- Mycology Reference Laboratory, Public Health Wales Microbiology Cardiff, Cardiff, UK
| | - Paul E Verweij
- Department of Medical Microbiology, ECMM, Center of Expertise in Mycology Radboudumc/CWZ, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands; Center for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Oliver A Cornely
- Faculty of Medicine, University of Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany; Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), University Hospital Cologne, Cologne, Germany; Clinical Trials Centre Cologne, ZKS Köln, Cologne, Germany; German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.
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222
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Dellière S, Dudoignon E, Fodil S, Voicu S, Collet M, Oillic PA, Salmona M, Dépret F, Ghelfenstein-Ferreira T, Plaud B, Chousterman B, Bretagne S, Azoulay E, Mebazaa A, Megarbane B, Alanio A. Risk factors associated with COVID-19-associated pulmonary aspergillosis in ICU patients: a French multicentric retrospective cohort. Clin Microbiol Infect 2020; 27:S1198-743X(20)30756-4. [PMID: 33316401 PMCID: PMC7733556 DOI: 10.1016/j.cmi.2020.12.005] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The main objective of this study was to determine the incidence of invasive pulmonary aspergillosis (IPA) in patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU), and to describe the patient characteristics associated with IPA occurrence and to evaluate its impact on prognosis. METHODS We conducted a retrospective cohort study including all successive COVID-19 patients, hospitalized in four ICUs, with secondary deterioration and one or more respiratory samples sent to the mycology department. We used a strengthened IPA testing strategy including seven mycological criteria. Patients were classified as probable IPA according to the European Organization for Research and Treatment of Cancer (EORTC)/Mycoses Study Group Education and Research Consortium (MSGERC) classification if immunocompromised, and according to the recent COVID-19-associated IPA classification otherwise. RESULTS Probable IPA was diagnosed in 21 out of the 366 COVID-19 patients (5.7%) admitted to the ICU and in the 108 patients (19.4%) who underwent respiratory sampling for deterioration. No significant differences were observed between patients with and without IPA regarding age, gender, medical history and severity on admission and during hospitalization. Treatment with azithromycin for ≥3 days was associated with the diagnosis of probable IPA (odds ratio 3.1, 95% confidence interval 1.1-8.5, p = 0.02). A trend was observed with high-dose dexamethasone and the occurrence of IPA. Overall mortality was higher in the IPA patients (15/21, 71.4% versus 32/87, 36.8%, p < 0.01). CONCLUSION IPA is a relatively frequent complication in severe COVID-19 patients and is responsible for increased mortality. Azithromycin, known to have immunomodulatory properties, may contribute to increase COVID-19 patient's susceptibility to IPA.
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Affiliation(s)
- Sarah Dellière
- Université de Paris, Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Molecular Mycology Unit, CNRS UMR2000, National Reference Centre for Invasive Mycoses and Antifungals (NRCMA), Institut Pasteur, Paris, France
| | - Emmanuel Dudoignon
- Université de Paris, FHU Promice, Département d'anesthésie-réanimation, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sofiane Fodil
- Université de Paris, Médecine Intensive Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sebastian Voicu
- Université de Paris, Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM UMRS-1144, Paris, France
| | - Magalie Collet
- Université de Paris, FHU Promice, Département d'anesthésie-réanimation, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Pierre-Antoine Oillic
- Université Paris-Saclay, Department of Anaesthesiology, Critical Care Medecine, Hôpital Universitaire Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin-Bicêtre, France
| | - Maud Salmona
- Université de Paris, INSERM U976, team INSIGHT, Laboratoire de Virologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - François Dépret
- Université de Paris, FHU Promice, Département d'anesthésie-réanimation, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; INI-CRCT Network, Nancy, France; INSERM U942, Paris, France
| | - Théo Ghelfenstein-Ferreira
- Université de Paris, Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Benoit Plaud
- Université de Paris, FHU Promice, Département d'anesthésie-réanimation, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Benjamin Chousterman
- Université de Paris, FHU Promice, Département d'anesthésie-réanimation, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Stéphane Bretagne
- Université de Paris, Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Molecular Mycology Unit, CNRS UMR2000, National Reference Centre for Invasive Mycoses and Antifungals (NRCMA), Institut Pasteur, Paris, France
| | - Elie Azoulay
- Université de Paris, Médecine Intensive Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alexandre Mebazaa
- Université de Paris, FHU Promice, Département d'anesthésie-réanimation, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; INI-CRCT Network, Nancy, France; INSERM U942, Paris, France
| | - Bruno Megarbane
- Université de Paris, Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM UMRS-1144, Paris, France
| | - Alexandre Alanio
- Université de Paris, Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Molecular Mycology Unit, CNRS UMR2000, National Reference Centre for Invasive Mycoses and Antifungals (NRCMA), Institut Pasteur, Paris, France.
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223
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Stevens DA. Advances against Aspergillosis and Mucormycosis. J Fungi (Basel) 2020; 6:E358. [PMID: 33322425 PMCID: PMC7770581 DOI: 10.3390/jof6040358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/04/2020] [Indexed: 11/17/2022] Open
Abstract
The 9th meeting of Advances Against Aspergillosis in beautiful Lugano, Switzerland clearly had the most drama of any of the previous meetings, exceeding even the 1st one, in San Francisco, when we, the Co-Organizers, weren't sure that although we had a great educational idea, and had put together a great list of speakers and topics, we might have few attendees, and go bankrupt! (The story of the birth efforts in initiating these meetings is described, for the historical record [...].
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Affiliation(s)
- David A. Stevens
- California Institute for Medical Research, San Jose, CA 95128, USA
- Division of Infectious Diseases and Geographic Medicine, Stanford University Medical School, Stanford, CA 94305, USA;
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224
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Arastehfar A, Gabaldón T, Garcia-Rubio R, Jenks JD, Hoenigl M, Salzer HJF, Ilkit M, Lass-Flörl C, Perlin DS. Drug-Resistant Fungi: An Emerging Challenge Threatening Our Limited Antifungal Armamentarium. Antibiotics (Basel) 2020; 9:antibiotics9120877. [PMID: 33302565 PMCID: PMC7764418 DOI: 10.3390/antibiotics9120877] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/02/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022] Open
Abstract
The high clinical mortality and economic burden posed by invasive fungal infections (IFIs), along with significant agricultural crop loss caused by various fungal species, has resulted in the widespread use of antifungal agents. Selective drug pressure, fungal attributes, and host- and drug-related factors have counteracted the efficacy of the limited systemic antifungal drugs and changed the epidemiological landscape of IFIs. Species belonging to Candida, Aspergillus, Cryptococcus, and Pneumocystis are among the fungal pathogens showing notable rates of antifungal resistance. Drug-resistant fungi from the environment are increasingly identified in clinical settings. Furthermore, we have a limited understanding of drug class-specific resistance mechanisms in emerging Candida species. The establishment of antifungal stewardship programs in both clinical and agricultural fields and the inclusion of species identification, antifungal susceptibility testing, and therapeutic drug monitoring practices in the clinic can minimize the emergence of drug-resistant fungi. New antifungal drugs featuring promising therapeutic profiles have great promise to treat drug-resistant fungi in the clinical setting. Mitigating antifungal tolerance, a prelude to the emergence of resistance, also requires the development of effective and fungal-specific adjuvants to be used in combination with systemic antifungals.
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Affiliation(s)
- Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA; (A.A.); (R.G.-R.)
| | - Toni Gabaldón
- Life Sciences Programme, Supercomputing Center (BSC-CNS), Jordi Girona, 08034 Barcelona, Spain;
- Mechanisms of Disease Programme, Institute for Research in Biomedicine (IRB), 08024 Barcelona, Spain
- Catalan Institution for Research and Advanced Studies. Pg. Lluís Companys 23, 08010 Barcelona, Spain
| | - Rocio Garcia-Rubio
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA; (A.A.); (R.G.-R.)
| | - Jeffrey D. Jenks
- Department of Medicine, University of California San Diego, San Diego, CA 92103, USA;
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA 92093, USA;
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| | - Martin Hoenigl
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA 92093, USA;
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA 92093, USA
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | | | - Macit Ilkit
- Division of Mycology, University of Çukurova, 01330 Adana, Turkey
- Correspondence: (M.I.); (D.S.P.); Tel.: +90-532-286-0099 (M.I.); +1-201-880-3100 (D.S.P.)
| | - Cornelia Lass-Flörl
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - David S. Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA; (A.A.); (R.G.-R.)
- Correspondence: (M.I.); (D.S.P.); Tel.: +90-532-286-0099 (M.I.); +1-201-880-3100 (D.S.P.)
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225
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Jenks JD, Miceli MH, Prattes J, Mercier T, Hoenigl M. The Aspergillus Lateral Flow Assay for the Diagnosis of Invasive Aspergillosis: an Update. CURRENT FUNGAL INFECTION REPORTS 2020; 14:378-383. [PMID: 33312332 PMCID: PMC7717101 DOI: 10.1007/s12281-020-00409-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
Abstract
Purpose of Review To review the data on the Aspergillus lateral flow assay for the diagnosis of invasive Aspergillosis. Recent Findings Aspergillus spp. cause a wide spectrum of disease with invasive aspergillosis (IA) as its most severe manifestation. Early and reliable diagnosis of disease is crucial to decrease associated morbidity and mortality, and enable prompt initiation of treatment for IA. Most recently, non-culture-based tests, such as Aspergillus galactomannan (GM), have been useful in early identification and treatment of patients with IA. However, cost, turnaround time, and variable performance indifferent populations at risk for IA remain significant drawbacks to the use of this test. Several diagnostic tests for IA have been developed, including the sōna Aspergillus GM Lateral flow assay (GM-LFA) rapid test. Summary The GM-LFA has shown excellent performance for the diagnosis of IA in patients with hematologic malignancy and may be a viable option for settings where ELISA GM testing is not feasible. Further evaluation of the GM-LFA in the non-hematology setting is ongoing, including in solid organ transplant recipients and patients in the intensive care unit.
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Affiliation(s)
- Jeffrey D. Jenks
- Division of General Internal Medicine, University of California San Diego, La Jolla, CA USA
- Division of Infectious Diseases and Global Health, University of California San Diego, La Jolla, CA USA
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA USA
| | - Marisa H. Miceli
- Division of Infectious Diseases, Department of Medicine, University of Michigan, Ann Arbor, MI USA
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Toine Mercier
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Health, University of California San Diego, La Jolla, CA USA
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA USA
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, 8036 Graz, Austria
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226
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Tavakoli M, Shokohi T, Lass Flörl C, Hedayati MT, Hoenigl M. Immunological response to COVID-19 and its role as a predisposing factor in invasive aspergillosis. Curr Med Mycol 2020; 6:75-79. [PMID: 34195465 PMCID: PMC8226042 DOI: 10.18502/cmm.6.4.5442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/22/2020] [Accepted: 11/07/2020] [Indexed: 12/31/2022] Open
Abstract
The world is involved with a pandemic coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2. The clinical manifestations of reported COVID-19-associated pulmonary impairments range from asymptomatic infections to a pneumonia-induced acute respiratory distress syndrome that requires mechanical ventilation. Fungal superinfections complicating the clinical course remain underexplored. Angiotensin-converting enzyme 2, the receptor for COVID-19 that is mainly expressed in airway epithelia and lung parenchyma, is considered an important regulator of innate immunity. With regard to the viral-cell interaction, imbalanced immune regulation between protective and altered responses caused by the exacerbation of inflammatory responses should be considered a major contributor to secondary pulmonary aspergillosis. In addition, the complex inherited factors, age-related changes, and lifestyle may also affect immune responses. The complication and persistence of invasive aspergillosis have been well described in patients with severe influenza or COVID-19. However, there is a scarcity of information about the immunological mechanisms predisposing patients with COVID-19 to fungal co-infections. Therefore, this study was conducted to investigate the aforementioned domain.
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Affiliation(s)
- Mahin Tavakoli
- Invasive Fungi Center, Communicable Diseases Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Parasitology and Mycology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Tahereh Shokohi
- Invasive Fungi Center, Communicable Diseases Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Cornelia Lass Flörl
- nstitute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Mohammad Taghi Hedayati
- Invasive Fungi Center, Communicable Diseases Research Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Health, University of California San Diego, La Jolla, California, USA
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
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227
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Costantini C, van de Veerdonk FL, Romani L. Covid-19-Associated Pulmonary Aspergillosis: The Other Side of the Coin. Vaccines (Basel) 2020; 8:vaccines8040713. [PMID: 33271780 PMCID: PMC7711593 DOI: 10.3390/vaccines8040713] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/19/2020] [Accepted: 11/27/2020] [Indexed: 01/08/2023] Open
Abstract
The immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a critical factor in the clinical presentation of COVID-19, which may range from asymptomatic to a fatal, multi-organ disease. A dysregulated immune response not only compromises the ability of the host to resolve the viral infection, but may also predispose the individual to secondary bacterial and fungal infections, a risk to which the current therapeutic immunomodulatory approaches significantly contribute. Among the secondary infections that may occur in COVID-19 patients, coronavirus-associated pulmonary aspergillosis (CAPA) is emerging as a potential cause of morbidity and mortality, although many aspects of the disease still remain unresolved. With this opinion, we present the current view of CAPA and discuss how the same mechanisms that underlie the dysregulated immune response in COVID-19 increase susceptibility to Aspergillus infection. Likewise, resorting to endogenous pathways of immunomodulation may not only restore immune homeostasis in COVID-19 patients, but also reduce the risk for aspergillosis. Therefore, CAPA represents the other side of the coin in COVID-19 and our advances in the understanding and treatment of the immune response in COVID-19 should represent the framework for the study of CAPA.
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Affiliation(s)
- Claudio Costantini
- Department of Experimental Medicine, University of Perugia, 06132 Perugia, Italy;
| | - Frank L. van de Veerdonk
- Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Luigina Romani
- Department of Experimental Medicine, University of Perugia, 06132 Perugia, Italy;
- Correspondence: ; Tel.: +39-075-5858234
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228
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Snarr BD, Drummond RA, Lionakis MS. It's all in your head: antifungal immunity in the brain. Curr Opin Microbiol 2020; 58:41-46. [PMID: 32828989 PMCID: PMC7438209 DOI: 10.1016/j.mib.2020.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/16/2022]
Abstract
As the incidence rate of invasive fungal infections has increased with the use of modern medical interventions, so too has the occurrence of fungi invading the brain. Fungi such as Candida albicans, Cryptococcus neoformans, and Aspergillus fumigatus often infect immunocompromised individuals, and can use several strategies to invade the central nervous system (CNS) by penetrating the blood-brain barrier. Once in the brain parenchyma the specialized resident immune cells need to effectively recognize the fungus and mount an appropriate immune response to clear the infection, without causing debilitating immune-mediated toxicity and neuronal damage. Here we review the current knowledge pertaining to the antifungal response of the CNS and highlight areas where future research is required.
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Affiliation(s)
- Brendan D Snarr
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy & Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca A Drummond
- Institute of Immunology & Immunotherapy, Institute of Microbiology & Infection, University of Birmingham, Birmingham, UK
| | - Michail S Lionakis
- Fungal Pathogenesis Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy & Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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229
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Verweij PE, Lucas JA, Arendrup MC, Bowyer P, Brinkmann AJ, Denning DW, Dyer PS, Fisher MC, Geenen PL, Gisi U, Hermann D, Hoogendijk A, Kiers E, Lagrou K, Melchers WJ, Rhodes J, Rietveld AG, Schoustra SE, Stenzel K, Zwaan BJ, Fraaije BA. The one health problem of azole resistance in Aspergillus fumigatus: current insights and future research agenda. FUNGAL BIOL REV 2020. [DOI: 10.1016/j.fbr.2020.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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230
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Trujillo H, Fernández-Ruiz M, Gutiérrez E, Sevillano Á, Caravaca-Fontán F, Morales E, López-Medrano F, Aguado JM, Praga M, Andrés A. Invasive pulmonary aspergillosis associated with COVID-19 in a kidney transplant recipient. Transpl Infect Dis 2020; 23:e13501. [PMID: 33185971 DOI: 10.1111/tid.13501] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/21/2020] [Accepted: 10/25/2020] [Indexed: 12/24/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might increase the risk of invasive pulmonary aspergillosis (IPA). Although several case reports and small series have been reported in the general population, scarce information is available regarding coronavirus disease 2019 (COVID-19)-associated IPA in the setting of solid organ transplantation. We describe a case of a kidney transplant recipient with severe COVID-19 that was subsequently diagnosed with probable IPA on the basis of the repeated isolation of Aspergillus fumigatus in sputum cultures, repeatedly increased serum (1 → 3)-β-d-glucan levels, and enlarging cavitary nodules in the CT scan. The evolution was favorable after initiation of isavuconazole and nebulized liposomal amphotericin B combination therapy and the withdrawal of immunosuppression.
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Affiliation(s)
- Hernando Trujillo
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain
| | - Mario Fernández-Ruiz
- Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain.,Unit of Infectious Diseases, University Hospital "12 de Octubre", Madrid, Spain
| | - Eduardo Gutiérrez
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain
| | - Ángel Sevillano
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain
| | - Fernando Caravaca-Fontán
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain.,Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Enrique Morales
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain
| | - Francisco López-Medrano
- Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain.,Unit of Infectious Diseases, University Hospital "12 de Octubre", Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
| | - José María Aguado
- Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain.,Unit of Infectious Diseases, University Hospital "12 de Octubre", Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
| | - Manuel Praga
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain.,Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
| | - Amado Andrés
- Department of Nephrology, University Hospital "12 de Octubre", Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
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231
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Lipopolysaccharide Binding Protein and Bactericidal/Permeability-Increasing Protein as Biomarkers for Invasive Pulmonary Aspergillosis. J Fungi (Basel) 2020; 6:jof6040304. [PMID: 33233831 PMCID: PMC7712449 DOI: 10.3390/jof6040304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022] Open
Abstract
Early diagnosis of invasive pulmonary aspergillosis (IPA) is crucial to prevent lethal disease in immunocompromized hosts. So far, lipopolysaccharide binding protein (LBP) and bactericidal/permeability-increasing protein (BPI) levels have not been evaluated as biomarkers for IPA. IL-8, previously introduced as a biomarker for IPA, was also included in this study. Bronchoalveolar lavage fluid (BALF) of IPA patients and control patients with non-infectious lung disease was collected according to clinical indications. Measurements in BALF displayed significantly higher levels of LBP (p < 0.0001), BPI (p = 0.0002) and IL-8 (p < 0.0001) in IPA compared to control patients. Receiver operating characteristic curve analysis revealed higher AUC for LBP (0.98, 95% CI 0.95–1.00) than BPI (0.84, 95% CI 0.70–0.97; p = 0.0301). Although not significantly different, AUC of IL-8 (0.93, 95% CI 0.85–1.00) also tended to be higher than AUC for BPI (p = 0.0624). When the subgroup of non-hematological patients was analyzed, test performance of LBP (AUC 0.99, 95% CI 0.97–1.00), BPI (AUC 0.97, 95% CI 0.91–1.00) and IL-8 (AUC 0.96, 95% CI: 0.90–1.00) converged. In conclusion, LBP and—to a lesser extend—BPI displayed high AUCs that were comparable to those of IL-8 for diagnosis of IPA in BALF. Further investigations are worthwhile, especially in non-hematological patients in whom sensitive biomarkers for IPA are lacking.
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232
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Talento AF, Hoenigl M. Fungal Infections Complicating COVID-19: With the Rain Comes the Spores. J Fungi (Basel) 2020; 6:jof6040279. [PMID: 33187364 PMCID: PMC7711594 DOI: 10.3390/jof6040279] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Alida Fe Talento
- Department of Microbiology, Children’s Health Ireland at Temple St., D01 YC67 Dublin, Ireland
- Correspondence: (A.F.T.); (M.H.)
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Health, University of California San Diego, San Diego, CA 92093, USA
- Clinical and Translational Fungal-Working Group, University of California San Diego, San Diego, CA 92093, USA
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, 8036 Graz, Austria
- Correspondence: (A.F.T.); (M.H.)
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233
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Bassetti M, Kollef MH, Timsit JF. Bacterial and fungal superinfections in critically ill patients with COVID-19. Intensive Care Med 2020; 46:2071-2074. [PMID: 32902729 PMCID: PMC7479998 DOI: 10.1007/s00134-020-06219-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/14/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Matteo Bassetti
- Clinica Malattie Infettive, Ospedale Policlinico San Martino-IRCCS, L.go R. Benzi 10, 16132, Genoa, Italy.
- Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Marin H Kollef
- Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Jean-Francois Timsit
- Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard University Hospital, Paris, France
- INSERM IAME, U1137, Team DesCID, Paris, France
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234
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Jenks JD, Prattes J, Buchheidt D, Hoenigl M. Reply to Mikulska, Furfaro, and Bassetti. Clin Infect Dis 2020; 73:e1784-e1785. [PMID: 33125456 DOI: 10.1093/cid/ciaa1670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Jeffrey D Jenks
- Division of General Internal Medicine, University of California San Diego, San Diego, CA, United States.,Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States.,Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA, United States
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States.,Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA, United States.,Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
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235
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Swilaiman SS, O’Gorman CM, Du W, Sugui JA, Del Buono J, Brock M, Kwon-Chung KJ, Szakacs G, Dyer PS. Global Sexual Fertility in the Opportunistic Pathogen Aspergillus fumigatus and Identification of New Supermater Strains. J Fungi (Basel) 2020; 6:E258. [PMID: 33143051 PMCID: PMC7712211 DOI: 10.3390/jof6040258] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022] Open
Abstract
A sexual cycle in Aspergillus fumigatus was first described in 2009 with isolates from Dublin, Ireland. However, the extent to which worldwide isolates can undergo sexual reproduction has remained unclear. In this study a global collection of 131 isolates was established with a near 1:1 ratio of mating types. All isolates were crossed to MAT1-1 or MAT1-2 Irish strains, and a subset of isolates from different continents were crossed together. Ninety seven percent of isolates were found to produce cleistothecia with at least one mating partner, showing that sexual fertility is not limited to the Irish population but is a characteristic of global A. fumigatus. However, large variation was seen in numbers of cleistothecia produced per cross, suggesting differences in the possibility for genetic exchange between strains in nature. The majority of crosses produced ascospores with >50% germination rates, but with wide variation evident. A high temperature heat shock was required to induce ascospore germination. Finally, a new set of highly fertile MAT1-1 and MAT1-2 supermater strains were identified and pyrimidine auxotrophs generated for community use. Results provide insights into the potential for the A. fumigatus sexual cycle to generate genetic variation and allow gene flow of medically important traits.
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Affiliation(s)
- Sameira S. Swilaiman
- School of Life Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK; (S.S.S.); (C.M.O.); (W.D.); (J.D.B.); (M.B.)
| | - Céline M. O’Gorman
- School of Life Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK; (S.S.S.); (C.M.O.); (W.D.); (J.D.B.); (M.B.)
| | - Wenyue Du
- School of Life Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK; (S.S.S.); (C.M.O.); (W.D.); (J.D.B.); (M.B.)
| | - Janyce A. Sugui
- Molecular Microbiology Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20825, USA; (J.A.S.); (K.J.K.-C.)
| | - Joanne Del Buono
- School of Life Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK; (S.S.S.); (C.M.O.); (W.D.); (J.D.B.); (M.B.)
| | - Matthias Brock
- School of Life Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK; (S.S.S.); (C.M.O.); (W.D.); (J.D.B.); (M.B.)
| | - Kyung J. Kwon-Chung
- Molecular Microbiology Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20825, USA; (J.A.S.); (K.J.K.-C.)
| | - George Szakacs
- Department of Applied Biotechnology and Food Science, Budapest University of Technology and Economics, Szent Gellert ter 4, 1111 Budapest, Hungary;
| | - Paul S. Dyer
- School of Life Sciences, University of Nottingham, University Park, Nottingham NG7 2RD, UK; (S.S.S.); (C.M.O.); (W.D.); (J.D.B.); (M.B.)
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236
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Diagnosis of Breakthrough Fungal Infections in the Clinical Mycology Laboratory: An ECMM Consensus Statement. J Fungi (Basel) 2020; 6:jof6040216. [PMID: 33050598 PMCID: PMC7712958 DOI: 10.3390/jof6040216] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Abstract
Breakthrough invasive fungal infections (bIFI) cause significant morbidity and mortality. Their diagnosis can be challenging due to reduced sensitivity to conventional culture techniques, serologic tests, and PCR-based assays in patients undergoing antifungal therapy, and their diagnosis can be delayed contributing to poor patient outcomes. In this review, we provide consensus recommendations on behalf of the European Confederation for Medical Mycology (ECMM) for the diagnosis of bIFI caused by invasive yeasts, molds, and endemic mycoses, to guide diagnostic efforts in patients receiving antifungals and support the design of future clinical trials in the field of clinical mycology. The cornerstone of lab-based diagnosis of breakthrough infections for yeast and endemic mycoses remain conventional culture, to accurately identify the causative pathogen and allow for antifungal susceptibility testing. The impact of non-culture-based methods are not well-studied for the definite diagnosis of breakthrough invasive yeast infections. Non-culture-based methods have an important role for the diagnosis of breakthrough invasive mold infections, in particular invasive aspergillosis, and a combination of testing involving conventional culture, antigen-based assays, and PCR-based assays should be considered. Multiple diagnostic modalities, including histopathology, culture, antibody, and/or antigen tests and occasionally PCR-based assays may be required to diagnose breakthrough endemic mycoses. A need exists for diagnostic tests that are effective, simple, cheap, and rapid to enable the diagnosis of bIFI in patients taking antifungals.
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237
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Arastehfar A, Carvalho A, Nguyen MH, Hedayati MT, Netea MG, Perlin DS, Hoenigl M. COVID-19-Associated Candidiasis (CAC): An Underestimated Complication in the Absence of Immunological Predispositions? J Fungi (Basel) 2020; 6:jof6040211. [PMID: 33050019 PMCID: PMC7712987 DOI: 10.3390/jof6040211] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 12/20/2022] Open
Abstract
The recent global pandemic of COVID-19 has predisposed a relatively high number of patients to acute respiratory distress syndrome (ARDS), which carries a risk of developing super-infections. Candida species are major constituents of the human mycobiome and the main cause of invasive fungal infections, with a high mortality rate. Invasive yeast infections (IYIs) are increasingly recognized as s complication of severe COVID-19. Despite the marked immune dysregulation in COVID-19, no prominent defects have been reported in immune cells that are critically required for immunity to Candida. This suggests that relevant clinical factors, including prolonged ICU stays, central venous catheters, and broad-spectrum antibiotic use, may be key factors causing COVID-19 patients to develop IYIs. Although data on the comparative performance of diagnostic tools are often lacking in COVID-19 patients, a combination of serological and molecular techniques may present a promising option for the identification of IYIs. Clinical awareness and screening are needed, as IYIs are difficult to diagnose, particularly in the setting of severe COVID-19. Echinocandins and azoles are the primary antifungal used to treat IYIs, yet the therapeutic failures exerted by multidrug-resistant Candida spp. such as C. auris and C. glabrata call for the development of new antifungal drugs with novel mechanisms of action.
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Affiliation(s)
- Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA;
- Correspondence: (A.A.); (A.C.); (M.H.); Tel./Fax: +1-201-880-3100 (A.A.); +351-253-604811 (A.C.); +1-619-543-5605 (M.H.)
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Guimarães/Braga, Portugal
- Correspondence: (A.A.); (A.C.); (M.H.); Tel./Fax: +1-201-880-3100 (A.A.); +351-253-604811 (A.C.); +1-619-543-5605 (M.H.)
| | - M. Hong Nguyen
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA;
| | - Mohammad Taghi Hedayati
- Invasive Fungi Research Center, Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari 4815733971, Iran;
| | - Mihai G. Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Centre, 6500HB Nijmegen, The Netherlands;
- Department of Genomics & Immunoregulation, Life and Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany
- Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - David S. Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA;
| | - Martin Hoenigl
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA 92093, USA
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, CA 92093, USA
- Correspondence: (A.A.); (A.C.); (M.H.); Tel./Fax: +1-201-880-3100 (A.A.); +351-253-604811 (A.C.); +1-619-543-5605 (M.H.)
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238
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Pan-Echinocandin-Resistant Candida glabrata Bloodstream Infection Complicating COVID-19: A Fatal Case Report. J Fungi (Basel) 2020; 6:jof6030163. [PMID: 32899996 PMCID: PMC7559523 DOI: 10.3390/jof6030163] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 02/07/2023] Open
Abstract
Coinfections with bacteria or fungi may be a frequent complication of COVID-19, but coinfections with Candida species in COVID-19 patients remain rare. We report the 53-day clinical course of a complicated type-2 diabetes patient diagnosed with COVID-19, who developed bloodstream infections initially due to methicillin-resistant Staphylococcus aureus, secondly due to multidrug-resistant Gram-negative bacteria, and lastly due to a possibly fatal Candida glabrata. The development of FKS-associated pan-echinocandin resistance in the C. glabrata isolated from the patient after 13 days of caspofungin treatment aggravated the situation. The patient died of septic shock shortly before the prospect of receiving potentially effective antifungal therapy. This case emphasizes the importance of early diagnosis and monitoring for antimicrobial drug-resistant coinfections to reduce their unfavorable outcomes in COVID-19 patients.
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239
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Jenks JD, Prattes J, Frank J, Spiess B, Mehta SR, Boch T, Buchheidt D, Hoenigl M. Performance of the Bronchoalveolar Lavage Fluid Aspergillus Galactomannan Lateral Flow Assay with Cube Reader for Diagnosis of Invasive Pulmonary Aspergillosis: a Multicenter Cohort Study. Clin Infect Dis 2020; 73:e1737-e1744. [PMID: 32866234 DOI: 10.1093/cid/ciaa1281] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/26/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Aspergillus Galactomannan Lateral Flow Assay (LFA) is a rapid test for the diagnosis of invasive aspergillosis (IA) that has been almost exclusively evaluated in patients with hematologic malignancies. An automated digital cube reader which allows for quantification of results has recently been added to the test kits. METHODS We performed a retrospective multicenter study on bronchoalveolar lavage fluid (BALF) samples obtained from 296 patients with various underlying diseases (65% without underlying hematological malignancy) who had BALF galactomannan (GM) ordered between 2013 and 2019 at the University of California San Diego, the Medical University of Graz, Austria, and the Mannheim University Hospital, Germany. RESULTS Cases were classified as proven (n=2), probable (n=56), putative (n=30), possible (n=45), and no IA (n=162). The LFA showed an area under the curve (AUC) of 0.865 (95% CI 0.815-0.916) for differentiating proven/probable or putative IA versus no IA, with a sensitivity of 74% and a specificity of 83% at an optical density index cut-off of 1.5. After exclusion of GM as mycological criterion for case classification, diagnostic performance of the LFA was highly similar to GM testing (AUC 0.892 versus 0.893, respectively). LFA performance was consistent across different patient cohorts and centers. CONCLUSION In this multicenter study the LFA assay from BALF demonstrated good diagnostic performance for IA that was consistent across patient cohorts and locations. The LFA may serve a role as a rapid test that may replace conventional GM testing in settings where GM results are not rapidly available.
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Affiliation(s)
- Jeffrey D Jenks
- Division of General Internal Medicine, University of California San Diego, San Diego, CA, United States.,Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States.,Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA, United States
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Johanna Frank
- Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Birgit Spiess
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Sanjay R Mehta
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States.,Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA, United States
| | - Tobias Boch
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States.,Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA, United States.,Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
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240
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White PL, Dhillon R, Cordey A, Hughes H, Faggian F, Soni S, Pandey M, Whitaker H, May A, Morgan M, Wise MP, Healy B, Blyth I, Price JS, Vale L, Posso R, Kronda J, Blackwood A, Rafferty H, Moffitt A, Tsitsopoulou A, Gaur S, Holmes T, Backx M. A national strategy to diagnose COVID-19 associated invasive fungal disease in the ICU. Clin Infect Dis 2020; 73:e1634-e1644. [PMID: 32860682 PMCID: PMC7499527 DOI: 10.1093/cid/ciaa1298] [Citation(s) in RCA: 284] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/28/2020] [Indexed: 11/24/2022] Open
Abstract
Background Fungal co-infection is a recognised complication of respiratory virus infections, increasing morbidity and mortality, but can be readily treated if diagnosed early. An increasing number of small studies describing aspergillosis in COVID-19 patients with severe respiratory distress are being reported, but comprehensive data is lacking. The aim of this study was to determine the incidence, risk factors and impact of invasive fungal disease in adult COVID-19 patients with severe respiratory distress. Methods An evaluation of a national, multi-centre, prospective cohort evaluation of an enhanced testing strategy to diagnose invasive fungal disease in COVID-19 intensive care patients. Results were used to generate a mechanism to define aspergillosis in future COVID-19 patients. Results One-hundred and thirty-five adults (median age: 57, M/F: 2·2/1) were screened. The incidence was 26.7% (14.1% aspergillosis, 12·6% yeast infections). The overall mortality rate was 38%; 53% and 31% in patients with and without fungal disease, respectively (P: 0.0387). The mortality rate was reduced by the use of antifungal therapy (Mortality: 38·5% in patients receiving therapy versus 90% in patients not receiving therapy (P: 0.008). The use of corticosteroids (P: 0.007) and history of chronic respiratory disease (P: 0.05) increased the likelihood of aspergillosis. Conclusions Fungal disease occurs frequently in critically ill, mechanically ventilated COVID-19 patients. The survival benefit observed in patients receiving antifungal therapy implies that the proposed diagnostic and defining criteria are appropriate. Screening using a strategic diagnostic approach and antifungal prophylaxis of patients with risk factors will likely enhance the management of COVID-19 patients.
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Affiliation(s)
- P Lewis White
- Public Health Wales Microbiology Cardiff, UHW, Cardiff, UK
| | - Rishi Dhillon
- Public Health Wales Microbiology Cardiff, UHW, Cardiff, UK
| | - Alan Cordey
- Public Health Wales Microbiology Cardiff, UHW, Cardiff, UK
| | - Harriet Hughes
- Public Health Wales Microbiology Cardiff, UHW, Cardiff, UK
| | | | - Shuchita Soni
- Public Health Wales Microbiology Cardiff, UHW, Cardiff, UK
| | - Manish Pandey
- Intensive Care Medicine, UHW, Heath Park, Cardiff, UK
| | | | - Alex May
- Public Health Wales Microbiology Cardiff, UHW, Cardiff, UK
| | - Matt Morgan
- Intensive Care Medicine, UHW, Heath Park, Cardiff, UK
| | | | - Brendan Healy
- Public Health Wales Microbiology Swansea, Singleton Hospital, Swansea, UK
| | - Ian Blyth
- Public Health Wales Microbiology Swansea, Singleton Hospital, Swansea, UK
| | | | - Lorna Vale
- Public Health Wales Microbiology Cardiff, UHW, Cardiff, UK
| | - Raquel Posso
- Public Health Wales Microbiology Cardiff, UHW, Cardiff, UK
| | - Joanna Kronda
- Public Health Wales Microbiology Cardiff, UHW, Cardiff, UK
| | - Adam Blackwood
- Public Health Wales Microbiology Cardiff, UHW, Cardiff, UK
| | | | - Amy Moffitt
- Public Health Wales Microbiology Cardiff, UHW, Cardiff, UK
| | | | - Soma Gaur
- Aneurin Bevan Microbiology Department, Royal Gwent Hospital, Newport, Gwent, UK
| | - Tom Holmes
- Intensive Care Medicine, UHW, Heath Park, Cardiff, UK
| | - Matthijs Backx
- Public Health Wales Microbiology Cardiff, UHW, Cardiff, UK
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241
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Is the COVID-19 Pandemic a Good Time to Include Aspergillus Molecular Detection to Categorize Aspergillosis in ICU Patients? A Monocentric Experience. J Fungi (Basel) 2020; 6:jof6030105. [PMID: 32664423 PMCID: PMC7558333 DOI: 10.3390/jof6030105] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 12/18/2022] Open
Abstract
(1) Background: The diagnosis of invasive aspergillosis (IA) in an intensive care unit (ICU) remains a challenge and the COVID-19 epidemic makes it even harder. Here, we evaluated Aspergillus PCR input to help classifying IA in SARS-CoV-2-infected patients. (2) Methods: 45 COVID-19 patients were prospectively monitored twice weekly for Aspergillus markers and anti-Aspergillus serology. We evaluated the concordance between (I) Aspergillus PCR and culture in respiratory samples, and (II) blood PCR and serum galactomannan. Patients were classified as putative/proven/colonized using AspICU algorithm and two other methods. (3) Results: The concordance of techniques applied on respiratory and blood samples was moderate (kappa = 0.58 and kappa = 0.63, respectively), with a higher sensitivity of PCR. According to AspICU, 9/45 patients were classified as putative IA. When incorporating PCR results, 15 were putative IA because they met all criteria, probably with a lack of specificity in the context of COVID-19. Using a modified AspICU algorithm, eight patients were classified as colonized and seven as putative IA. (4) Conclusion: An appreciation of the fungal burden using PCR and Aspergillus serology was added to propose a modified AspICU algorithm. This proof of concept seemed relevant, as it was in agreement with the outcome of patients, but will need validation in larger cohorts.
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242
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Silva LN, de Mello TP, de Souza Ramos L, Branquinha MH, Roudbary M, Dos Santos ALS. Fungal Infections in COVID-19-Positive Patients: A Lack of Optimal Treatment Options. Curr Top Med Chem 2020; 20:1951-1957. [PMID: 33040728 DOI: 10.2174/156802662022200917110102] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Laura Nunes Silva
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes Centro de Ciencias da Saude (CCS), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Thaís Pereira de Mello
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes Centro de Ciencias da Saude (CCS), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Lívia de Souza Ramos
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes Centro de Ciencias da Saude (CCS), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Marta Helena Branquinha
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes Centro de Ciencias da Saude (CCS), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Maryam Roudbary
- Iran University of Medical Sciences, School of Medicine, Department of Medical Mycology and Parasitology, Tehran, Iran
| | - André Luis Souza Dos Santos
- Laboratorio de Estudos Avancados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Goes Centro de Ciencias da Saude (CCS), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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