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Imoto W, Ihara Y, Imai T, Kawai R, Yamada K, Kaneko Y, Shintani A, Kakeya H. Incidence and risk factors for coronavirus disease 2019-associated pulmonary aspergillosis using administrative claims data. Mycoses 2024; 67:e13773. [PMID: 39090076 DOI: 10.1111/myc.13773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/26/2024] [Accepted: 07/19/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is one of the noticeable complications of COVID-19 and its incidence varies widely. In Japan, research on the incidence, risk factors and mortality associated with CAPA is limited. OBJECTIVES This study aimed to explore the incidence and potential risk factors for CAPA in patients with severe or critical COVID-19 and evaluate the relationship between CAPA and mortality of patients with severe or critical COVID-19. METHODS We investigated the incidence of CAPA in patients with severe and critical COVID-19 using administrative claims data from acute care hospitals in Japan. We employed multivariable regression models to explore potential risk factors for CAPA and their contribution to mortality in patients with severe and critical COVID-19. RESULTS The incidence of CAPA was 0.4%-2.7% in 33,136 patients with severe to critical COVID-19. Age, male sex, chronic lung disease, steroids, immunosuppressants, intensive care unit admission, blood transfusion and dialysis were potential risk factors for CAPA in patients with severe to critical COVID-19. CAPA was an independent factor associated with mortality. CONCLUSIONS CAPA is a serious complication in patients with severe and critical COVID-19 and may increase mortality.
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Affiliation(s)
- Waki Imoto
- Department of Infection Control Science, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Department of Infectious Disease Medicine, Osaka Metropolitan University Hospital, Osaka, Japan
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, Osaka, Japan
- Research Center for Infectious Disease Sciences (RCIDS), Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Osaka International Research for Infectious Diseases (OIRCID), Osaka Metropolitan University, Osaka, Japan
| | - Yasutaka Ihara
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Data Intelligence Department, Global DX, Daiichi Sankyo Co., Ltd, Tokyo, Japan
| | - Takumi Imai
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ryota Kawai
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Koichi Yamada
- Department of Infection Control Science, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Department of Infectious Disease Medicine, Osaka Metropolitan University Hospital, Osaka, Japan
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, Osaka, Japan
- Research Center for Infectious Disease Sciences (RCIDS), Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Osaka International Research for Infectious Diseases (OIRCID), Osaka Metropolitan University, Osaka, Japan
| | - Yukihiro Kaneko
- Research Center for Infectious Disease Sciences (RCIDS), Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Osaka International Research for Infectious Diseases (OIRCID), Osaka Metropolitan University, Osaka, Japan
- Department of Bacteriology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Kakeya
- Department of Infection Control Science, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
- Department of Infectious Disease Medicine, Osaka Metropolitan University Hospital, Osaka, Japan
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, Osaka, Japan
- Research Center for Infectious Disease Sciences (RCIDS), Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Osaka International Research for Infectious Diseases (OIRCID), Osaka Metropolitan University, Osaka, Japan
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2
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Hatmaker EA, Barber AE, Drott MT, Sauters TJC, Alastruey-Izquierdo A, Garcia-Hermoso D, Kurzai O, Rokas A. Pathogenicity is associated with population structure in a fungal pathogen of humans. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.05.602241. [PMID: 39026826 PMCID: PMC11257439 DOI: 10.1101/2024.07.05.602241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Aspergillus flavus is a clinically and agriculturally important saprotrophic fungus responsible for severe human infections and extensive crop losses. We analyzed genomic data from 250 (95 clinical and 155 environmental) A. flavus isolates from 9 countries, including 70 newly sequenced clinical isolates, to examine population and pan-genome structure and their relationship to pathogenicity. We identified five A. flavus populations, including a new population, D, corresponding to distinct clades in the genome-wide phylogeny. Strikingly, > 75% of clinical isolates were from population D. Accessory genes, including genes within biosynthetic gene clusters, were significantly more common in some populations but rare in others. Population D was enriched for genes associated with zinc ion binding, lipid metabolism, and certain types of hydrolase activity. In contrast to the major human pathogen Aspergillus fumigatus, A. flavus pathogenicity in humans is strongly associated with population structure, making it a great system for investigating how population-specific genes contribute to pathogenicity.
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Affiliation(s)
- E. Anne Hatmaker
- Department of Biological Sciences, Vanderbilt University, Nashville, TN, USA
- Evolutionary Studies Initiative, Vanderbilt University, Nashville, TN, USA
| | - Amelia E. Barber
- Institute for Microbiology, Friedrich Schiller University, Jena, Germany
| | - Milton T. Drott
- Cereal Disease Laboratory, Agricultural Research Service, USDA, Saint Paul, MN, USA
| | - Thomas J. C. Sauters
- Department of Biological Sciences, Vanderbilt University, Nashville, TN, USA
- Evolutionary Studies Initiative, Vanderbilt University, Nashville, TN, USA
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
- Center for Biomedical Research in Network in Infectious Diseases (CIBERINFEC), Carlos III Heath Institute, Madrid, Spain
| | - Dea Garcia-Hermoso
- Institut Pasteur, Université Paris Cité, National Reference Center for Invasive Mycoses and Antifungals, Translational Mycology Research Group, Mycology Department, Paris, France
| | - Oliver Kurzai
- National Reference Center for Invasive Fungal Infections NRZMyk, Leibniz Institute for Natural Product Research and Infection Biology – Hans-Knoell-Institute, Jena, Germany
- Institute for Hygiene and Microbiology, University of Würzburg. Würzburg, Germany
| | - Antonis Rokas
- Department of Biological Sciences, Vanderbilt University, Nashville, TN, USA
- Evolutionary Studies Initiative, Vanderbilt University, Nashville, TN, USA
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3
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Ye F, Cai S, Cao B, Cheng L, Fan H, Huang Y, Jiang S, Lai G, Li Y, Shi Y, She D, Su X, Tang K, Wang H, Wang L, Xu B, Xu J, Zhang J, Zhang J, Zhang T, Zhang W, Zhang Y, Zhou H, Hu J, Huang X, Jiang E, Liu Q, Wang J, Wu D, Zhang X, Kang Y, Qiu H, Gu B, Sun B, Xu Y, Cao C, Li R, Pan W, Zhuo C, Zhu L, Huang H, Tong R, Zhang J, Jiang M, Qu J. Consensus for antifungal stewardship in China (2024 edition). J Thorac Dis 2024; 16:4016-4029. [PMID: 38983176 PMCID: PMC11228704 DOI: 10.21037/jtd-24-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/17/2024] [Indexed: 07/11/2024]
Abstract
Background Invasive fungal disease (IFD) has become a serious threat to human health in China and around the world, with high mortality and morbidity. Currently, the misdiagnosis rate of IFD is extremely high, compounded with the low quality of prescription antifungals and the high incidence of adverse events associated with IFD treatment, resulting in lengthy hospitalization, low clinical response, and high disease burden, which have become serious challenges in clinical practice. Antifungal stewardship (AFS) can not only significantly increase the early diagnosis rate of IFD, reduce inappropriate utilization of antifungal drugs, improve patient prognosis, but can also improve therapeutic safety and reduce healthcare expenses. Thus, it is urgent to identify key AFS metrics suitable for China's current situation. Methods Based on metrics recommended by international AFS consensuses, combined with the current situation of China and the clinical experience of authoritative experts in various fields, several metrics were selected, and experts in the fields of respiratory diseases, hematology, intensive care units (ICUs), dermatology, infectious diseases, microbiology laboratory and pharmacy were invited to assess AFS metrics by the Delphi method. Consensus was considered to be reached with an agreement level of ≥80% for the metric. Results Consensus was reached for 24 metrics, including right patient metrics (n=4), right time metrics (n=3), and right use metrics (n=17). Right use metrics were further subdivided into drug choice (n=8), drug dosage (n=4), drug de-escalation (n=1), drug duration (n=2), and drug consumption (n=2) metrics. Forty-six authoritative experts assessed and reviewed the above metrics, and a consensus was reached with a final agreement level of ≥80% for 22 metrics. Conclusions This consensus is the first to propose a set of AFS metrics suitable for China, which helps to establish AFS standards in China and is also the first AFS consensus in Asia, and may improve the standard of clinical diagnosis and treatment of IFD, and guide hospitals to implement AFS, ultimately promoting the rational use of antifungal drugs and improving patient prognosis.
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Affiliation(s)
- Feng Ye
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, Guangzhou National Laboratory, Guangzhou Medical University, Guangzhou, China
| | - Shaoxi Cai
- Department of Pulmonary Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Linling Cheng
- The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Department of Pulmonary and Critical Care Medicine, Guangzhou Institute of Respiratory Health, Guangzhou National Laboratory, Guangzhou Medical University, Guangzhou, China
| | - Hong Fan
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Huang
- Department of Pulmonary and Critical Care Medicine, Shanghai Changhai Hospital, Navy Medical University, Shanghai, China
| | - Shanping Jiang
- Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Guoxiang Lai
- Department of Pulmonary and Critical Care Medicine, The Second Affiliated Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yuping Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Shi
- Department of Pulmonary and Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Danyang She
- Department of Pulmonary and Critical Care Medicine, the First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xin Su
- Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Kejing Tang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hongmin Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lingwei Wang
- Department of Pulmonary and Critical Care Medicine, Shenzhen People’s Hospital, Shenzhen, China
| | - Bin Xu
- Jiangxi Health Committee Key (JHCK) Laboratory of Tumor Metastasis, Jiangxi Cancer Hospital, Nanchang, China
| | - Jinfu Xu
- Department of Pulmonary and Critical Care Medicine, Tongji University Affiliated Shanghai Pulmonary Hospital, Shanghai, China
| | - Jing Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianquan Zhang
- Department of Pulmonary and Critical Care Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Tiantuo Zhang
- Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Zhang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yunhui Zhang
- Department of Pulmonary and Critical Care Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Hua Zhou
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianda Hu
- Department of Hematology, The Second Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiaojun Huang
- Department of Hematology, Peking University People’s Hospital, Beijing, China
| | - Erlie Jiang
- Department of Hematology, Institute of Hematology and Blood Disease Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China
| | - Qifa Liu
- Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jingbo Wang
- Department of Hematology, Aerospace Center Hospital, Beijing, China
| | - Depei Wu
- Department of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xi Zhang
- Department of Hematology, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, West China Tianfu Hospital, Chengdu, China
| | - Haibo Qiu
- Department of Critical Care Medicine, Zhongda Hospital Southeast University, Nanjing, China
| | - Bing Gu
- Department of Laboratory Medicine, Guangdong Provincial People’s Hospital, Guangzhou, China
| | - Baoqing Sun
- Department of Clinical Laboratory, National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingchun Xu
- Department of Laboratory Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Cunwei Cao
- Department of Dermatology and Venerology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ruoyu Li
- Department of Dermatology and Venereology, Peking University First Hospital, National Clinical Research Centre for Skin and Immune Diseases, Beijing, China
| | - Weihua Pan
- Department of Dermatology, Shanghai Changzheng Hospital, Shanghai, China
| | - Chao Zhuo
- Department of Infectious Disease, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Liping Zhu
- Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai, China
| | - Haihui Huang
- Department of Infectious Disease, Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Rongsheng Tong
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu, China
| | - Jing Zhang
- Department of Pharmacy, Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China
| | - Mei Jiang
- Department of Biostatistics, National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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4
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Chun JY, Jeong SJ, Kim S, Choi S, Lee JH, Chung HS, Park S, Lee H, Kim HY, Hwangbo B, Choi YJ. Performance of the galactomannan test for the diagnosis of invasive pulmonary aspergillosis using non-invasive proximal airway samples. J Infect 2024; 88:106159. [PMID: 38641139 DOI: 10.1016/j.jinf.2024.106159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE To diagnose invasive pulmonary aspergillosis (IPA), galactomannan (GM) detection in serum or bronchoalveolar lavage fluid (BALF) is widely used. However, the utility of proximal airway GM test (from induced sputum or tracheal aspirate) has not been well elucidated. METHODS In this retrospective cohort study, we evaluated the diagnostic performance of proximal airway GM in diagnosis of IPA including COVID-19 associated pulmonary aspergillosis (CAPA). Between January 2022 and January 2023, patients who had been tested for GM with clinical suspicion or for surveillance from any specimen (serum, induced sputum, tracheal aspirate, and BALF) were screened. IPA was diagnosed using EORTC/MSGERC criteria, and CAPA was diagnosed following the 2020 ECMM/ISHAM consensus criteria. RESULTS Of 624 patients with GM results, 70 met the criteria for proven/probable IPA and 427 had no IPA. The others included possible IPA and chronic form of aspergillosis. The sensitivities and specificities of serum, proximal airway, and BALF GM for proven/probable IPA versus no IPA were 78.9% and 70.6%, 93.1% and 78.7%, and 78.6% and 91.0%, respectively. Areas under the receiver operating characteristic curve (AUCs) were 0.742 for serum GM, 0.935 for proximal airway GM, and 0.849 for BALF GM (serum GM vs proximal airway GM, p = 0.014; proximal airway GM vs BALF GM, p = 0.334; serum GM vs BALF GM, p = 0.286). CONCLUSION This study demonstrates that the performance of GM test from non-invasive proximal airway samples is comparable or even better than those from serum and distal airway sample (BALF).
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Affiliation(s)
- June Young Chun
- Division of Infectious Disease, Department of Internal Medicine, National Cancer Center, Goyang, South Korea.
| | - Sahng-Joon Jeong
- Department of Internal Medicine, National Cancer Center, Goyang, South Korea
| | - Sinae Kim
- Biostatics Collaboration Team, Research Core Center, National Cancer Center, Goyang, South Korea
| | - Soyoung Choi
- Department of Agricultural Biotechnology, Seoul National University, Seoul, South Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; College of Medicine, Seoul National University, Seoul, South Korea
| | - Hyun Sung Chung
- Division of Pulmonology, Department of Internal Medicine, National Cancer Center, Goyang, South Korea
| | - Seungman Park
- Department of Laboratory Medicine, National Cancer Center, Goyang, South Korea
| | - Hyewon Lee
- Division of Hemato-oncology, Department of Internal Medicine, National Cancer Center, Goyang, South Korea
| | - Hyae Young Kim
- Department of Radiology, National Cancer Center, Goyang, South Korea
| | - Bin Hwangbo
- Division of Pulmonology, Department of Internal Medicine, National Cancer Center, Goyang, South Korea
| | - Young Ju Choi
- Division of Infectious Disease, Department of Internal Medicine, National Cancer Center, Goyang, South Korea
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Auxier B, Zhang J, Marquez FR, Senden K, van den Heuvel J, Aanen DK, Snelders E, Debets AJM. The Narrow Footprint of Ancient Balancing Selection Revealed by Heterokaryon Incompatibility Genes in Aspergillus fumigatus. Mol Biol Evol 2024; 41:msae079. [PMID: 38652808 PMCID: PMC11138114 DOI: 10.1093/molbev/msae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
In fungi, fusion between individuals leads to localized cell death, a phenomenon termed heterokaryon incompatibility. Generally, the genes responsible for this incompatibility are observed to be under balancing selection resulting from negative frequency-dependent selection. Here, we assess this phenomenon in Aspergillus fumigatus, a human pathogenic fungus with a very low level of linkage disequilibrium as well as an extremely high crossover rate. Using complementation of auxotrophic mutations as an assay for hyphal compatibility, we screened sexual progeny for compatibility to identify genes involved in this process, called het genes. In total, 5/148 (3.4%) offspring were compatible with a parent and 166/2,142 (7.7%) sibling pairs were compatible, consistent with several segregating incompatibility loci. Genetic mapping identified five loci, four of which could be fine mapped to individual genes, of which we tested three through heterologous expression, confirming their causal relationship. Consistent with long-term balancing selection, trans-species polymorphisms were apparent across several sister species, as well as equal allele frequencies within A. fumigatus. Surprisingly, a sliding window genome-wide population-level analysis of an independent dataset did not show increased Tajima's D near these loci, in contrast to what is often found surrounding loci under balancing selection. Using available de novo assemblies, we show that these balanced polymorphisms are restricted to several hundred base pairs flanking the coding sequence. In addition to identifying the first het genes in an Aspergillus species, this work highlights the interaction of long-term balancing selection with rapid linkage disequilibrium decay.
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Affiliation(s)
- Ben Auxier
- Laboratory of Genetics, Wageningen University & Research, Wageningen, the Netherlands
| | - Jianhua Zhang
- Laboratory of Genetics, Wageningen University & Research, Wageningen, the Netherlands
| | | | - Kira Senden
- Laboratory of Genetics, Wageningen University & Research, Wageningen, the Netherlands
| | - Joost van den Heuvel
- Laboratory of Genetics, Wageningen University & Research, Wageningen, the Netherlands
| | - Duur K Aanen
- Laboratory of Genetics, Wageningen University & Research, Wageningen, the Netherlands
| | - Eveline Snelders
- Laboratory of Genetics, Wageningen University & Research, Wageningen, the Netherlands
| | - Alfons J M Debets
- Laboratory of Genetics, Wageningen University & Research, Wageningen, the Netherlands
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Zhao J, Zhuo X, Pu D, Fan G, Lu B, Cao B. Comparison of influenza- and COVID-19-associated pulmonary aspergillosis in China. Eur J Clin Microbiol Infect Dis 2024; 43:683-692. [PMID: 38326545 DOI: 10.1007/s10096-024-04772-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/31/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE We conducted a monocentric retrospective study using the latest definitions to compare the demographic, clinical, and biological characteristics of influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA). METHODS The study retrospectively enrolled 180 patients, including 70 influenza/IPA patients (with positive influenza A/B and Aspergillus) and 110 COVID-19/IPA patients (with positive SARS-CoV-2 and Aspergillus). Among them, 42 (60%) and 30 (27.3%) patients fulfilled the definitions of IAPA and CAPA, respectively. RESULTS The CAPA patients had significantly higher in-hospital mortality (13/31, 41.9%) than IAPA patients (8/42, 19%) with a P-value of 0.033. Kaplan-Meier survival curve also showed significantly higher 30-day mortality for CAPA patients (P = 0.025). Additionally, the CAPA patients were older, though insignificantly, than IAPA patients (70 (60-80) vs. 62 (52-72), P = 0.075). A lower percentage of chronic pulmonary disease (12.9 vs. 40.5%, P = 0.01) but higher corticosteroids use 7 days before and after ICU admission (22.6% vs. 0%, P = 0.002) were found in CAPA patients. Notably, there were no significant differences in the percentage of ICU admission or ICU mortality between the two groups. In addition, the time from observation to Aspergillus diagnosis was significantly longer in CAPA patients than in IAPA patients (7 (2-13) vs. 0 (0-4.5), P = 0.048). CONCLUSION Patients infected with SARS-CoV-2 and Aspergillus during the concentrated outbreak of COVID-19 in China had generally higher in-hospital mortality but a lower percentage of chronic pulmonary disease than those infected with influenza and Aspergillus. For influenza-infected patients who require hospitalization, close attention should be paid to the risk of invasive aspergillosis upfront.
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Affiliation(s)
- Jiankang Zhao
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xianxia Zhuo
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Danni Pu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Guohui Fan
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Binghuai Lu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
| | - Bin Cao
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
- Department of Respiratory Medicine, Capital Medical University, Beijing, China.
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
- Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China.
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7
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Başkol Elik D, Kaya Ş, Alkan S, Demirdal T, Sener A, Kaya S, Güzel Tunçcan Ö, Kayaaslan B, Güner R, Eser F, Kahraman H, Birengel S, Sarıcaoğlu EM, Eroğlu E, Çölkesen F, Öztürk E, Berk Cam H, Mermutluoğlu Ç, Özer Balin Ş, Sincan G, Altın N, Sili U, Suntur BM, Arslan Gülen T, Deveci B, Saba R, İncecik Ş, Eser Karlıdağ G, Hakko E, Akdağ D, Erdem HA, Sipahi H, Çicek C, Taşbakan MS, Taşbakan M, Pullukçu H, Yamazhan T, Arda B, Ulusoy S, Sipahi OR. The clinical features, treatment and prognosis of neutropenic fever and Coronavirus disease 2019 results of the multicentre teos study. Sci Rep 2024; 14:5218. [PMID: 38433274 PMCID: PMC10909849 DOI: 10.1038/s41598-024-55886-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 02/28/2024] [Indexed: 03/05/2024] Open
Abstract
This multicentre (22 centres in Turkey) retrospective cohort study aimed to assess the clinical outcomes of patients with neutropenic fever and SARS-CoV-2 positivity. Study period was 15 March 2020-15 August 2021. A total of 170 cases (58 female, aged 59 ± 15.5 years) that fulfilled the inclusion criteria were included in the study. One-month mortality rate (OMM) was 44.8%. The logistic regression analysis showed the following significant variables for the mentioned dependent variables: (i) achieving PCR negativity: receiving a maximum of 5 days of favipiravir (p = 0.005, OR 5.166, 95% CI 1.639-16.280); (ii) need for ICU: receiving glycopeptide therapy at any time during the COVID-19/FEN episode (p = 0.001, OR 6.566, 95% CI 2.137-20.172), the need for mechanical ventilation (p < 0.001, OR 62.042, 95% CI 9.528-404.011); (iii) need for mechanical ventilation: failure to recover from neutropenia (p < 0.001, OR 17.869, 95% CI 3.592-88.907), receiving tocilizumab therapy (p = 0.028, OR 32.227, 95% CI 1.469-707.053), septic shock (p = 0.001, OR 15.4 96% CI 3.164-75.897), and the need for ICU (p < 0.001, OR 91.818, 95% CI 15.360-548.873), (iv) OMM: [mechanical ventilation (p = 0.001, OR 19.041, 95% CI 3.229-112.286) and septic shock (p = 0.010, OR 5.589,95% CI 1.509-20.700)]. Although it includes a relatively limited number of patients, our findings suggest that COVID-19 and FEN are associated with significant mortality and morbidity.
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Affiliation(s)
- Dilşah Başkol Elik
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey.
- Infectious Disease and Clinical Microbiology, Turgutlu State Hospital, Manisa, Turkey.
| | - Şafak Kaya
- Department of Infectious Diseases, Gazi Yaşargil Training and Research Hospital, University of Health Sciences, Diyarbakir, Turkey
| | - Sevil Alkan
- Department of Infectious Disease, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Tuna Demirdal
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Alper Sener
- Department of Infectious Disease, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
| | - Selçuk Kaya
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Özlem Güzel Tunçcan
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Rahmet Güner
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazit University, Ankara, Turkey
| | - Hasip Kahraman
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Serhat Birengel
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Elif Mukime Sarıcaoğlu
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Esma Eroğlu
- Department of Infectious Disease and Clinical Microbiology, Konya Meram State Hospital, Konya, Turkey
| | - Fatma Çölkesen
- Department of Infectious Disease and Clinical Microbiology, Konya Meram State Hospital, Konya, Turkey
| | - Erman Öztürk
- Department of Hematology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Hande Berk Cam
- Department of Infectious Disease and Clinical Microbiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Çiğdem Mermutluoğlu
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Şafak Özer Balin
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Gülden Sincan
- Department of Hematology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Nilgün Altın
- Department of Infectious Disease and Clinical Microbiology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Uluhan Sili
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Bedia Mutay Suntur
- Infectious Diseases, Adana City Training and Research Hospital, Adana, Turkey
| | - Tuğba Arslan Gülen
- Infectious Diseases, Adana City Training and Research Hospital, Adana, Turkey
| | - Burak Deveci
- Department of Hematology and Stem Cell Transplant Unit, Medstar Antalya Hospital, Antalya, Turkey
| | - Rabin Saba
- Department of Hematology and Stem Cell Transplant Unit, Medstar Antalya Hospital, Antalya, Turkey
| | - Şaban İncecik
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Van Yüzüncü Yıl University, Van, Turkey
| | - Gülden Eser Karlıdağ
- Department of Infectious Disease and Clinical Microbiology, Elazığ Fethi Sekin City Hospital, University of Health Sciences, Elazig, Turkey
| | - Elif Hakko
- Department of Infectious Disease and Clinical Microbiology, Anadolu Medical Center, Istanbul, Turkey
| | - Damla Akdağ
- Department of Infectious Diseases and Clinical Microbiology, Basaksehir Cam Sakura City Hospital, Istanbul, Turkey
| | - Hüseyin Aytaç Erdem
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Hilal Sipahi
- Bornova Directorate of Health, Bornova, Izmir, Turkey
| | - Candan Çicek
- Department of Medical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Mehmet Sezai Taşbakan
- Department of Chest Diseases, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Meltem Taşbakan
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Hüsnü Pullukçu
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Tansu Yamazhan
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Bilgin Arda
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Sercan Ulusoy
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
| | - Oguz Resat Sipahi
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ege University, Bornova, Izmir, Turkey
- Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Muharraq, Bahrain
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8
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Huang C, Chang S, Ma R, Shang Y, Li Y, Wang Y, Feng M, Guo W. COVID-19 in pulmonary critically ill patients: metagenomic identification of fungi and characterization of pathogenic microorganisms. Front Cell Infect Microbiol 2024; 13:1220012. [PMID: 38444540 PMCID: PMC10912313 DOI: 10.3389/fcimb.2023.1220012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 12/31/2023] [Indexed: 03/07/2024] Open
Abstract
Background Fungal co-infection is prevalent in critically ill patients with COVID-19. The conventional approach applied to fungal identification has relatively low sensitivity and is time-consuming. The metagenomic next-generation sequencing (mNGS) technology can simultaneously detect a variety of microorganisms, and is increasingly being used for the rapid detection and diagnosis of pathogens. Methods In this single-center retrospective study, we described the clinical presentation and outcomes of COVID-19 and mNGS positive for fungi in pulmonary critically ill patients during the outbreak of Omicron infection from December 2022 to January 2023. Results Among 43 COVID-19 patients with acute respiratory distress syndrome (ARDS) on a single intensive care unit (ICU), 10 were reported to be fungal positive using the mNGS test. The number of pathogenic microorganisms detected by mNGS was significantly higher than that via traditional methods, especially in the detection of fungi and viruses. Aspergillus infection was dominant, and most of these patients also had concurrent bacterial or viral infections. Probable or possible COVID-19-associated pulmonary aspergillosis (CAPA) was diagnosed in all 10 patients, and the prognosis was poor. Conclusion Patients with COVID-19 may be at increased risk of developing fungal infections as well as concurrent bacterial or viral infections, and mNGS can be a powerful tool in identifying these infections. Clinicians should be aware of the increased risk of fungal infections in COVID-19 patients, particularly those who have underlying immunocompromising conditions, and should monitor for early signs of infection.
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Affiliation(s)
- Changjun Huang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Siyuan Chang
- Department of Surgical Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui Ma
- Department of Surgical Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yishu Shang
- Department of Surgical Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuexia Li
- Department of Surgical Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yun Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Min Feng
- Department of Surgical Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenzhi Guo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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9
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Ghassan M, Wissam S. Severe pulmonary aspergillosis post viral illness in immunocompetent patients: A case series. Respir Med Case Rep 2024; 48:101991. [PMID: 38380072 PMCID: PMC10876679 DOI: 10.1016/j.rmcr.2024.101991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/12/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
Invasive pulmonary aspergillosis (IPA) is a life-threatening disease commonly affecting the lungs of immunosuppressed patients. Recently, Aspergillosis was diagnosed in immunocompetent patients with viral pneumonia due to influenza virus and coronavirus-19 infections. A series of four immunocompetent patients from different hospitals in Lebanon diagnosed with pulmonary aspergillosis post viral infection is reported. Aspergillosis is an important differential diagnosis in patients with viral infections and worsening infiltrates on chest x-ray, in addition to bacterial and mycobacterial infections with which they share common features. Fungal infections should be suspected early, and treatment should be considered knowing that these infections entail worse outcomes.
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Affiliation(s)
- Moujaes Ghassan
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Balamand, Lebanon
| | - Sleiman Wissam
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Balamand, Mount Lebanon Hospital – University Medical Center, Hazmieh, Lebanon
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Ain W Zain Medical Village University Hospital, Ain W Zain, Lebanon
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10
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Schippers JR, Verweij PE, Heunks LMA, van Dijk K. Absence of COVID-19 associated mucormycosis in a tertiary intensive care unit in the Netherlands. Sci Rep 2023; 13:22134. [PMID: 38092785 PMCID: PMC10719264 DOI: 10.1038/s41598-023-47231-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023] Open
Abstract
Mucormycosis is a severe complication in critically ill COVID-19 patients. Throughout the pandemic, a notable prevalence of mucormycosis has been observed in the Indian population, whereas lower occurrences have been reported in Europe. However, limited data exist regarding its prevalence in Europe, which is potentially underestimated due to the low sensitivity of bronchoalveolar lavage (BAL) cultures. We aimed to evaluate the prevalence of mucormycosis in a high-risk critically ill COVID-19 population in the Netherlands, and to evaluate the potential benefit of adding Mucor PCR to BAL as part of routine follow-up. In this study, we included 1035 critically ill COVID-19 patients admitted to either one of the two ICUs at AmsterdamUMC between March 2020 and May 2022; of these, 374 had undergone at least one bronchoscopy. Following the AmsterdamUMC protocols, bronchoscopies were conducted weekly until clinical improvement was achieved. We cultured BAL fluid for fungi and used PCR and galactomannan testing to detect Aspergillus spp. Additionally, we retrospectively performed qPCR targeting Mucorales DNA in the BAL of 89 deceased patients. All cultures were negative for Mucorales, whereas 42 (11%) cultures were positive for Aspergillus. Furthermore, qPCR targeting Mucorales was negative in all 89 deceased patients. This study showed that pulmonary mucormycosis was not present in critically ill COVID-19 patients in two tertiary care ICUs. These results indicate routine Mucorales qPCR screening is not clinically necessary in a high-standard-of-care tertiary ICU in a low-endemic area.
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Affiliation(s)
- J R Schippers
- Department of Pulmonary Medicine, AmsterdamUMC, VUmc, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - P E Verweij
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L M A Heunks
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K van Dijk
- Department of Medical Microbiology and Infection Control, AmsterdamUMC, VUMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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11
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Teboul A, Faury H, Sakr C, Ducellier D, Cizeau F, Monpierre L, Botterel F, Decousser JW. Long-term microbiological safety of the use of stacker cranes for storage and distribution of surgical and medical devices in operating theatres and intensive care units. J Hosp Infect 2023; 142:138-139. [PMID: 37634604 DOI: 10.1016/j.jhin.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/05/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Affiliation(s)
- A Teboul
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - H Faury
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - C Sakr
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France; UR DYNAMYC 7380, Faculté de Santé, Univ Paris-Est Créteil (UPEC), Enva, USC ANSES, Créteil, France
| | - D Ducellier
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - F Cizeau
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - L Monpierre
- UR DYNAMYC 7380, Faculté de Santé, Univ Paris-Est Créteil (UPEC), Enva, USC ANSES, Créteil, France; Parasitology and Mycology Unit, Microbiology Department, University Hospital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - F Botterel
- UR DYNAMYC 7380, Faculté de Santé, Univ Paris-Est Créteil (UPEC), Enva, USC ANSES, Créteil, France; Parasitology and Mycology Unit, Microbiology Department, University Hospital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - J-W Decousser
- Infection Control Team, Microbiology Department, University Hospital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France; UR DYNAMYC 7380, Faculté de Santé, Univ Paris-Est Créteil (UPEC), Enva, USC ANSES, Créteil, France.
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12
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Ozturk A, Bozok T, Erdogan M, Ibrahim BMS, Bozok TS. COVID-19-associated pulmonary aspergillosis (CAPA): identification of Aspergillus species and determination of antifungal susceptibility profiles. Folia Microbiol (Praha) 2023; 68:951-959. [PMID: 37294497 PMCID: PMC10250855 DOI: 10.1007/s12223-023-01069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
Among the co-infectious agents in COVID-19 patients, Aspergillus species cause invasive pulmonary aspergillosis (IPA). IPA is difficult to diagnose and is associated with high morbidity and mortality. This study is aimed at identifying Aspergillus spp. from sputum and tracheal aspirate (TA) samples of COVID-19 patients and at determining their antifungal susceptibility profiles. A total of 50 patients with COVID-19 hospitalized in their intensive care units (ICU) were included in the study. Identification of Aspergillus isolates was performed by phenotypic and molecular methods. ECMM/ISHAM consensus criteria were used for IPA case definitions. The antifungal susceptibility profiles of isolates were determined by the microdilution method. Aspergillus spp. was detected in 35 (70%) of the clinical samples. Among the Aspergillus spp., 20 (57.1%) A. fumigatus, six (17.1%) A. flavus, four (11.4%) A. niger, three (8.6%) A. terreus, and two (5.7%) A. welwitschiae were identified. In general, Aspergillus isolates were susceptible to the tested antifungal agents. In the study, nine patients were diagnosed with possible IPA, 11 patients were diagnosed with probable IPA, and 15 patients were diagnosed with Aspergillus colonization according to the used algorithms. Serum galactomannan antigen positivity was found in 11 of the patients diagnosed with IPA. Our results provide data on the incidence of IPA, identification of Aspergillus spp., and its susceptibility profiles in critically ill COVID-19 patients. Prospective studies are needed for a faster diagnosis or antifungal prophylaxis to manage the poor prognosis of IPA and reduce the risk of mortality.
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Affiliation(s)
- Ali Ozturk
- Department of Medical Microbiology, Faculty of Medicine, Nigde Omer Halisdemir University, Nigde, Turkey
| | - Taylan Bozok
- Department of Medical Microbiology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Merve Erdogan
- Department of Medical Microbiology, Faculty of Medicine, Sanko University, Gaziantep, Turkey
| | - Bashar MS. Ibrahim
- Department of Pharmaceutical Microbiology, Suleyman Demirel University, Isparta, Turkey
| | - Tugce Simsek Bozok
- Department of Infectious Diseases and Clinical Microbiology, Mersin University Hospital, Mersin, Turkey
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13
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Zhou X, Wu X, Chen Z, Cui X, Cai Y, Liu Y, Weng B, Zhan Q, Huang L. Risk factors and the value of microbiological examinations of COVID-19 associated pulmonary aspergillosis in critically ill patients in intensive care unit: the appropriate microbiological examinations are crucial for the timely diagnosis of CAPA. Front Cell Infect Microbiol 2023; 13:1287496. [PMID: 38076456 PMCID: PMC10703051 DOI: 10.3389/fcimb.2023.1287496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction During the Omicron pandemic in China, a significant proportion of patients with Coronavirus Disease 2019 (COVID-19) associated pulmonary aspergillosis (CAPA) necessitated admission to intensive care unit (ICU) and experienced a high mortality. To explore the clinical risk factors and the application/indication of microbiological examinations of CAPA in ICU for timely diagnosis are very important. Methods This prospective study included patients with COVID-19 admitted to ICU between December 1, 2022, and February 28, 2023. The clinical data of influenza-associated pulmonary aspergillosis (IAPA) patients from the past five consecutive influenza seasons (November 1, 2017, to March 31, 2022) were collected for comparison. The types of specimens and methods used for microbiological examinations were also recorded to explore the efficacy in early diagnosis. Results Among 123 COVID-19 patients, 36 (29.3%) were diagnosed with probable CAPA. CAPA patients were more immunosuppressed, in more serious condition, required more advanced respiratory support and had more other organ comorbidities. Solid organ transplantation, APACHEII score ≥20 points, 5 points ≤SOFA score <10 points were independent risk factors for CAPA. Qualified lower respiratory tract specimens were obtained from all patients, and 84/123 (68.3%) patients underwent bronchoscopy to obtain bronchoalveolar lavage fluid (BALF) specimens. All patients' lower respiratory tract specimens underwent fungal smear and culture; 79/123 (64.2%) and 69/123 (56.1%) patients underwent BALF galactomannan (GM) and serum GM detection, respectively; metagenomic next-generation sequencing (mNGS) of the BALF was performed in 62/123 (50.4%) patients. BALF GM had the highest diagnostic sensitivity (84.9%), the area under the curve of the mNGS were the highest (0.812). Conclusion The incidence of CAPA was extremely high in patients admitted to the ICU. CAPA diagnosis mainly depends on microbiological evidence owing to non-specific clinical manifestations, routine laboratory examinations, and CT findings. The bronchoscopy should be performed and the BALF should be obtained as soon as possible. BALF GM are the most suitable microbiological examinations for the diagnosis of CAPA. Due to the timely and accuracy result of mNGS, it could assist in early diagnosis and might be an option in critically ill CAPA patients.
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Affiliation(s)
- Xiaoyi Zhou
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xiaojing Wu
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ziying Chen
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoyang Cui
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ying Cai
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Youfang Liu
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Bejing University of Chinese Medicine, Beijing, China
| | - Bingbing Weng
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Bejing University of Chinese Medicine, Beijing, China
| | - Qingyuan Zhan
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Bejing University of Chinese Medicine, Beijing, China
| | - Linna Huang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
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14
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Bartczak KT, Miłkowska-Dymanowska J, Pietrusińska M, Kumor-Kisielewska A, Stańczyk A, Majewski S, Piotrowski WJ, Lipiński C, Wawrocki S, Białas AJ. Is Pulmonary Involvement a Distinct Phenotype of Post-COVID-19? Biomedicines 2023; 11:2694. [PMID: 37893068 PMCID: PMC10604471 DOI: 10.3390/biomedicines11102694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: COVID-19 infection often provokes symptoms lasting many months: most commonly fatigue, dyspnea, myalgia and mental distress symptoms. In this study, we searched for clinical features of post-COVID-19 condition (PCC) and differences between patients with and without pulmonary involvement. (2) Methods: A total of 282 patients with a mean age of 57 years (SD +/- 12 years) underwent assessment up to 12 weeks after COVID-19 recovery. The course of acute disease, past medical history and clinical symptoms were gathered; pulmonary function tests were performed; radiographic studies were assessed and follow-up examinations were conducted. Patients with and without detectable pulmonary lesions were divided into separate groups. (3) Results: Patients within the pulmonary group were more often older (59 vs. 51 y.o.; p < 0.001) males (p = 0.002) that underwent COVID-19-related hospitalization (p < 0.001) and were either ex- or active smokers with the median of 20 pack-years. We also managed to find correlations with hypertension (p = 0.01), liver failure (p = 0.03), clinical symptoms such as dyspnea (p < 0.001), myalgia (p = 0.04), headache (p = 0.009), sleeplessness (p = 0.046), pulmonary function tests (such as FVC, TLCO, RV and TLC; p < 0.001) and several basic laboratory tests (D-dimer, cardiac troponin, WBC, creatinine and others). (4) Conclusions: Our results indicate that initial pulmonary involvement alters the PCC, and it can be used to individualize clinical approaches.
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Affiliation(s)
- Krystian T. Bartczak
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland; (J.M.-D.); (A.K.-K.); (S.M.); (W.J.P.); (A.J.B.)
| | - Joanna Miłkowska-Dymanowska
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland; (J.M.-D.); (A.K.-K.); (S.M.); (W.J.P.); (A.J.B.)
| | - Małgorzata Pietrusińska
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland; (J.M.-D.); (A.K.-K.); (S.M.); (W.J.P.); (A.J.B.)
| | - Anna Kumor-Kisielewska
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland; (J.M.-D.); (A.K.-K.); (S.M.); (W.J.P.); (A.J.B.)
| | - Adam Stańczyk
- Department of Clinical Pharmacology, Medical University of Lodz, 90-153 Lodz, Poland;
| | - Sebastian Majewski
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland; (J.M.-D.); (A.K.-K.); (S.M.); (W.J.P.); (A.J.B.)
| | - Wojciech J. Piotrowski
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland; (J.M.-D.); (A.K.-K.); (S.M.); (W.J.P.); (A.J.B.)
| | - Cezary Lipiński
- The Center for Innovation and Technology Transfer, Medical University of Lodz, 92-215 Lodz, Poland (S.W.)
| | - Sebastian Wawrocki
- The Center for Innovation and Technology Transfer, Medical University of Lodz, 92-215 Lodz, Poland (S.W.)
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, 7265 Davos, Switzerland
| | - Adam J. Białas
- Department of Pneumology, Medical University of Lodz, 90-153 Lodz, Poland; (J.M.-D.); (A.K.-K.); (S.M.); (W.J.P.); (A.J.B.)
- Department of Pulmonary Rehabilitation, Center for Lung Diseases and Rehabilitation, Blessed Rafal Chylinski Memorial Hospital for Lung Diseases, 91-520 Lodz, Poland
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15
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Tokamani M, Figgou E, Papamichail L, Sakka E, Toros A, Bouchorikou A, Giannakakis A, Matthaiou EI, Sandaltzopoulos R. A Multiplex PCR Melting-Curve-Analysis-Based Detection Method for the Discrimination of Five Aspergillus Species. J Fungi (Basel) 2023; 9:842. [PMID: 37623613 PMCID: PMC10455196 DOI: 10.3390/jof9080842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
Aspergillus mold is a ubiquitously found, airborne pathogen that can cause a variety of diseases from mild to life-threatening in severity. Limitations in diagnostic methods combined with anti-fungal resistance render Aspergillus a global emerging pathogen. In industry, Aspergilli produce toxins, such as aflatoxins, which can cause food spoilage and pose public health risk issues. Here, we report a multiplex qPCR method for the detection and identification of the five most common pathogenic Aspergillus species, Aspergillus fumigatus, Aspergillus flavus, Aspergillus niger, Aspergillus terreus, and Aspergillus nidulans. Our approach exploits species-specific nucleotide polymorphisms within their ITS genomic regions. This novel assay combines multiplex single-color real time qPCR and melting curve analysis and provides a straight-forward, rapid, and cost-effective detection method that can identify five Aspergillus species simultaneously in a single reaction using only six unlabeled primers. Due to their unique fragment lengths, the resulting amplicons are directly linked to certain Aspergillus species like fingerprints, following either electrophoresis or melting curve analysis. Our method is characterized by high analytical sensitivity and specificity, so it may serve as a useful and inexpensive tool for Aspergillus diagnostic applications both in health care and the food industry.
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Affiliation(s)
- Maria Tokamani
- Department of Molecular Biology and Genetics, Faculty of Health Sciences, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (M.T.); (E.F.); (L.P.); (E.S.); (A.T.); (A.B.); (A.G.)
| | - Eleftheria Figgou
- Department of Molecular Biology and Genetics, Faculty of Health Sciences, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (M.T.); (E.F.); (L.P.); (E.S.); (A.T.); (A.B.); (A.G.)
| | - Lito Papamichail
- Department of Molecular Biology and Genetics, Faculty of Health Sciences, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (M.T.); (E.F.); (L.P.); (E.S.); (A.T.); (A.B.); (A.G.)
| | - Eleni Sakka
- Department of Molecular Biology and Genetics, Faculty of Health Sciences, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (M.T.); (E.F.); (L.P.); (E.S.); (A.T.); (A.B.); (A.G.)
| | - Athanasios Toros
- Department of Molecular Biology and Genetics, Faculty of Health Sciences, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (M.T.); (E.F.); (L.P.); (E.S.); (A.T.); (A.B.); (A.G.)
| | - Anastasia Bouchorikou
- Department of Molecular Biology and Genetics, Faculty of Health Sciences, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (M.T.); (E.F.); (L.P.); (E.S.); (A.T.); (A.B.); (A.G.)
| | - Antonis Giannakakis
- Department of Molecular Biology and Genetics, Faculty of Health Sciences, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (M.T.); (E.F.); (L.P.); (E.S.); (A.T.); (A.B.); (A.G.)
| | - Efthymia Iliana Matthaiou
- Department of Medicine, Division of Pulmonary Allergy and Critical Care Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA;
| | - Raphael Sandaltzopoulos
- Department of Molecular Biology and Genetics, Faculty of Health Sciences, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (M.T.); (E.F.); (L.P.); (E.S.); (A.T.); (A.B.); (A.G.)
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16
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Colosi IA, Crișan M, Țoc DA, Colosi HA, Georgiu C, Sabou M, Costache C. First Reported Case of a Clinically Nonresponsive-to-Itraconazole Alternaria alternata Isolated from a Skin Infection of a Nonimmunocompromised Patient from Romania. J Fungi (Basel) 2023; 9:839. [PMID: 37623610 PMCID: PMC10455085 DOI: 10.3390/jof9080839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/12/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Alternaria alternata is a melanic fungus capable of causing a wide variety of infections, some of which have lethal potential. It is a ubiquitous fungus and a well-known plant pathogen. Cutaneous infections with Alternaria alternata most often occur in the extremities of patients who perform conventional agriculture, thus being exposed to occupational hazards leading to the disruption of the skin barrier. METHODS This paper presents the first case report from Romania of an itraconazole nonresponsive cutaneous alternariosis in a patient without any type of immunosuppression. RESULTS After an initial misdiagnosis regarding the etiology of the patient's skin infection, two successive punch biopsies, followed by mycologic examination, lead to the final diagnosis of cutaneous alternariosis. Treatment guided by antifungal susceptibility testing has been instituted, leading to the gradual healing of the patient's skin ulcerations. CONCLUSIONS The ability of Alternaria alternata to infect immunocompetent human hosts and to develop resistance to antifungal drugs highlight the importance of correctly diagnosing the etiology of skin ulcerations and instituting appropriate treatment guided by antifungal susceptibility testing whenever the suspicion of a fungal skin infection is plausible.
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Affiliation(s)
- Ioana Alina Colosi
- Microbiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Maria Crișan
- Histology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Cluj County Emergency Hospital, 400000 Cluj-Napoca, Romania
| | - Dan Alexandru Țoc
- Microbiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Horațiu Alexandru Colosi
- Division of Medical Informatics and Biostatistics, Department of Medical Education, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Carmen Georgiu
- Cluj County Emergency Hospital, 400000 Cluj-Napoca, Romania
- Pathological Anatomy Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Marcela Sabou
- Institut de Parasitologie et de Pathologie Tropicale, UR7292 Dynamique des Interactions Hôte Pathogène, Fédération de Médecine Translationnelle, Université de Strasbourg, F-6700 Strasbourg, France
- Laboratoire de Parasitologie et Mycologie Médicale, Les Hôpitaux Universitaires de Strasbourg, F-6700 Strasbourg, France
| | - Carmen Costache
- Microbiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Cluj County Emergency Hospital, 400000 Cluj-Napoca, Romania
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17
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Ouranos K, Tsakiri K, Massa E, Dourliou V, Mouratidou C, Soundoulounaki S, Mouloudi E. COVID-19-associated pulmonary aspergillosis in patients with severe SARS-CoV-2 infection: A single-center observational study from Greece. Ann Thorac Med 2023; 18:116-123. [PMID: 37663880 PMCID: PMC10473063 DOI: 10.4103/atm.atm_14_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION COVID-19-associated pulmonary aspergillosis (CAPA) is a serious complication affecting patients with severe SARS-CoV-2 infection, and is associated with increased mortality. OBJECTIVE The objective of this study was to investigate potential risk factors, and to estimate the incidence and mortality in patients diagnosed with CAPA. METHODS A single-center retrospective observational study was conducted on patients admitted to the intensive care unit (ICU) with severe COVID-19 from October 2020 to May 2022. Patients with deterioration of their clinical status were evaluated with serum galactomannan (GM) for probable CAPA. Baseline demographic patient characteristics, vaccination status, and time period during which each patient was infected with SARS-CoV-2 were obtained, and risk stratification according to underlying comorbidities was performed in an effort to assess various risk factors for CAPA. The incidence of CAPA in the entire cohort was measured, and mortality rates in the CAPA and non-CAPA groups were calculated and compared. RESULTS Of 488 patients admitted to the ICU, 95 (19.4%) had deterioration of their clinical status, which prompted testing with serum GM. Positive serum testing was observed in 39/95 patients, with an overall CAPA incidence in the entire study cohort reaching 7.9% (39/488). The mortality rate was 75% (42/56) in the non-CAPA group that was tested for serum GM, and 87.2% (34/39) in the CAPA group (P = 0.041). Multivariable Cox regression hazard models were tested for 28- and 90-day survival from ICU admission. An invasive pulmonary aspergillosis (IPA) risk-stratified cox regression model corrected for the SARS-CoV-2 variant of the patient identified the diagnosis of probable CAPA and elevated procalcitonin (PCT) levels measured at least 10 days after ICU admission, as significantly associated with death in the IPA-risk subgroup only, with hazard ratio (HR): 3.687 (95% confidence interval [CI], 1.030-13.199, P = 0.045) for the diagnosis of probable CAPA, and HR: 1.022 (95% CI, 1.003-1.042, P = 0.026) for every 1 ng/mL rise in PCT. CONCLUSIONS Patients in the IPA-risk subgroup that were diagnosed with CAPA had a lower 90-day survival when compared to patients in the same group without a CAPA diagnosis.
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Affiliation(s)
- Konstantinos Ouranos
- Department of Medicine, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kalliopi Tsakiri
- Department of Adult Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - Eleni Massa
- Department of Adult Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - Vassiliki Dourliou
- Department of Adult Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - Christina Mouratidou
- Department of Adult Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - Stella Soundoulounaki
- Department of Adult Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
| | - Eleni Mouloudi
- Department of Adult Intensive Care Unit, Hippokratio General Hospital, Thessaloniki, Greece
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18
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Beltrame A, Stevens DA, Haiduven D. Mortality in ICU Patients with COVID-19-Associated Pulmonary Aspergillosis. J Fungi (Basel) 2023; 9:689. [PMID: 37367625 DOI: 10.3390/jof9060689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
A review of 38 studies involving 1437 COVID-19 patients admitted to intensive care units (ICUs) with pulmonary aspergillosis (CAPA) was conducted to investigate whether mortality has improved since the pandemic's onset. The study found that the median ICU mortality was 56.8%, ranging from 30% to 91.8%. These rates were higher for patients admitted during 2020-2021 (61.4%) compared to 2020 (52.3%), and prospective studies found higher ICU mortality (64.7%) than retrospective ones (56.4%). The studies were conducted in various countries and used different criteria to define CAPA. The percentage of patients who received antifungal therapy varied across studies. These results indicate that the mortality rate among CAPA patients is a growing concern, mainly since there has been an overall reduction in mortality among COVID-19 patients. Urgent action is needed to improve prevention and management strategies for CAPA, and additional research is needed to identify optimal treatment strategies to reduce mortality rates among these patients. This study serves as a call to action for healthcare professionals and policymakers to prioritize CAPA, a serious and potentially life-threatening complication of COVID-19.
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Affiliation(s)
- Anna Beltrame
- College of Public Health, University of South Florida, Tampa, FL 33622, USA
| | - 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
| | - Donna Haiduven
- College of Public Health, University of South Florida, Tampa, FL 33622, USA
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19
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Hlaing KM, Monday LM, Nucci M, Nouér SA, Revankar SG. Invasive Fungal Infections Associated with COVID-19. J Fungi (Basel) 2023; 9:667. [PMID: 37367603 DOI: 10.3390/jof9060667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
The COVID-19 pandemic caused >6 million deaths worldwide, often from respiratory failure. Complications frequently occurred in hospitalized patients, particularly in the intensive care unit. Among these, fungal infections were a cause of high morbidity and mortality. Invasive aspergillosis, candidiasis and mucormycosis were the most serious of these infections. Risk factors included alterations in immune defense mechanisms by COVID-19 itself, as well as immunosuppression due to various therapies utilized in severely ill patients. Diagnosis was often challenging due to lack of sensitivity of current testing. Outcomes were generally poor, due to significant co-morbidities and delayed diagnosis, with mortality rates >50% in some studies. High index of clinical suspicion is needed to facilitate early diagnosis and initiation of appropriate antifungal therapy.
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Affiliation(s)
- Kyaw M Hlaing
- Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Lea M Monday
- Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Marcio Nucci
- University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
| | - Simone A Nouér
- University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
| | - Sanjay G Revankar
- Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI 48201, USA
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20
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Roman-Montes CM, Bojorges-Aguilar S, Corral-Herrera EA, Rangel-Cordero A, Díaz-Lomelí P, Cervantes-Sanchez A, Martinez-Guerra BA, Rajme-López S, Tamez-Torres KM, Martínez-Gamboa RA, González-Lara MF, Ponce-de-Leon A, Sifuentes-Osornio J. Fungal Infections in the ICU during the COVID-19 Pandemic in Mexico. J Fungi (Basel) 2023; 9:jof9050583. [PMID: 37233294 DOI: 10.3390/jof9050583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Background: Invasive Fungal Infections (IFI) are emergent complications of COVID-19. In this study, we aim to describe the prevalence, related factors, and outcomes of IFI in critical COVID-19 patients. Methods: We conducted a nested case-control study of all COVID-19 patients in the intensive care unit (ICU) who developed any IFI and matched age and sex controls for comparison (1:1) to evaluate IFI-related factors. Descriptive and comparative analyses were made, and the risk factors for IFI were compared versus controls. Results: We found an overall IFI prevalence of 9.3% in COVID-19 patients in the ICU, 5.6% in COVID-19-associated pulmonary aspergillosis (CAPA), and 2.5% in invasive candidiasis (IC). IFI patients had higher SOFA scores, increased frequency of vasopressor use, myocardial injury, and more empirical antibiotic use. CAPA was classified as possible in 68% and 32% as probable by ECMM/ISHAM consensus criteria, and 57.5% of mortality was found. Candidemia was more frequent for C. parapsilosis Fluconazole resistant outbreak early in the pandemic, with a mortality of 28%. Factors related to IFI in multivariable analysis were SOFA score > 2 (aOR 5.1, 95% CI 1.5-16.8, p = 0.007) and empiric antibiotics for COVID-19 (aOR 30, 95% CI 10.2-87.6, p = <0.01). Conclusions: We found a 9.3% prevalence of IFIs in critically ill patients with COVID-19 in a single center in Mexico; factors related to IFI were associated with higher SOFA scores and empiric antibiotic use for COVID-19. CAPA is the most frequent type of IFI. We did not find a mortality difference.
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Affiliation(s)
- Carla M Roman-Montes
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Saul Bojorges-Aguilar
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Ever Arturo Corral-Herrera
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Andrea Rangel-Cordero
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Paulette Díaz-Lomelí
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Axel Cervantes-Sanchez
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Bernardo A Martinez-Guerra
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Sandra Rajme-López
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Karla María Tamez-Torres
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Rosa Areli Martínez-Gamboa
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Maria Fernanda González-Lara
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - Alfredo Ponce-de-Leon
- Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
| | - José Sifuentes-Osornio
- General Direction, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City 14080, Mexico
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Pereira de Sa N, Jayanetti K, Rendina D, Clement T, Soares Brauer V, Mota Fernandes C, Ojima I, Airola MV, Del Poeta M. Targeting Sterylglucosidase A to Treat Aspergillus fumigatus Infections. mBio 2023; 14:e0033923. [PMID: 36877042 PMCID: PMC10128061 DOI: 10.1128/mbio.00339-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/07/2023] Open
Abstract
Invasive fungal infections are a leading cause of death in immunocompromised patients. Current therapies have several limitations, and innovative antifungal agents are critically needed. Previously, we identified the fungus-specific enzyme sterylglucosidase as essential for pathogenesis and virulence of Cryptococcus neoformans and Aspergillus fumigatus (Af) in murine models of mycoses. Here, we developed Af sterylglucosidase A (SglA) as a therapeutic target. We identified two selective inhibitors of SglA with distinct chemical scaffolds that bind in the active site of SglA. Both inhibitors induce sterylglucoside accumulation and delay filamentation in Af and increase survival in a murine model of pulmonary aspergillosis. Structure-activity relationship (SAR) studies identified a more potent derivative that enhances both in vitro phenotypes and in vivo survival. These findings support sterylglucosidase inhibition as a promising antifungal approach with broad-spectrum potential. IMPORTANCE Invasive fungal infections are a leading cause of death in immunocompromised patients. Aspergillus fumigatus is a fungus ubiquitously found in the environment that, upon inhalation, causes both acute and chronic illnesses in at-risk individuals. A. fumigatus is recognized as one of the critical fungal pathogens for which a substantive treatment breakthrough is urgently needed. Here, we studied a fungus-specific enzyme, sterylglucosidase A (SglA), as a therapeutic target. We identified selective inhibitors of SglA that induce accumulation of sterylglucosides and delay filamentation in A. fumigatus and increase survival in a murine model of pulmonary aspergillosis. We determined the structure of SglA, predicted the binding poses of these inhibitors through docking analysis, and identified a more efficacious derivative with a limited SAR study. These results open several exciting avenues for the research and development of a new class of antifungal agents targeting sterylglucosidases.
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Affiliation(s)
- Nivea Pereira de Sa
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Kalani Jayanetti
- Department of Chemistry, Stony Brook University, Stony Brook, New York, USA
| | - Dominick Rendina
- Department of Chemistry, Stony Brook University, Stony Brook, New York, USA
| | - Timothy Clement
- Department of Chemistry, Stony Brook University, Stony Brook, New York, USA
| | - Veronica Soares Brauer
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Caroline Mota Fernandes
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
| | - Iwao Ojima
- Department of Chemistry, Stony Brook University, Stony Brook, New York, USA
- Institute of Chemical Biology and Drug Discovery, Stony Brook, New York, USA
| | - Michael V. Airola
- Institute of Chemical Biology and Drug Discovery, Stony Brook, New York, USA
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, New York, USA
| | - Maurizio Del Poeta
- Department of Microbiology and Immunology, Stony Brook University, Stony Brook, New York, USA
- Institute of Chemical Biology and Drug Discovery, Stony Brook, New York, USA
- Division of Infectious Diseases, School of Medicine, Stony Brook University, Stony Brook, New York, USA
- Veterans Administration Medical Center, Northport, New York, USA
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22
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Dunne K, Reece E, McClean S, Doyle S, Rogers TR, Murphy P, Renwick J. Aspergillus fumigatus Supernatants Disrupt Bronchial Epithelial Monolayers: Potential Role for Enhanced Invasion in Cystic Fibrosis. J Fungi (Basel) 2023; 9:jof9040490. [PMID: 37108944 PMCID: PMC10141846 DOI: 10.3390/jof9040490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/14/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Aspergillus fumigatus is the most commonly isolated fungus in chronic lung diseases, with a prevalence of up to 60% in cystic fibrosis patients. Despite this, the impact of A. fumigatus colonisation on lung epithelia has not been thoroughly explored. We investigated the influence of A. fumigatus supernatants and the secondary metabolite, gliotoxin, on human bronchial epithelial cells (HBE) and CF bronchial epithelial (CFBE) cells. CFBE (F508del CFBE41o-) and HBE (16HBE14o-) trans-epithelial electrical resistance (TEER) was measured following exposure to A. fumigatus reference and clinical isolates, a gliotoxin-deficient mutant (ΔgliG) and pure gliotoxin. The impact on tight junction (TJ) proteins, zonula occludens-1 (ZO-1) and junctional adhesion molecule-A (JAM-A) were determined by western blot analysis and confocal microscopy. A. fumigatus conidia and supernatants caused significant disruption to CFBE and HBE TJs within 24 h. Supernatants from later cultures (72 h) caused the greatest disruption while ΔgliG mutant supernatants caused no disruption to TJ integrity. The ZO-1 and JAM-A distribution in epithelial monolayers were altered by A. fumigatus supernatants but not by ΔgliG supernatants, suggesting that gliotoxin is involved in this process. The fact that ΔgliG conidia were still capable of disrupting epithelial monolayers indicates that direct cell-cell contact also plays a role, independently of gliotoxin production. Gliotoxin is capable of disrupting TJ integrity which has the potential to contribute to airway damage, and enhance microbial invasion and sensitisation in CF.
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Affiliation(s)
- Katie Dunne
- Discipline of Clinical Microbiology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Emma Reece
- Discipline of Clinical Microbiology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Siobhán McClean
- School of Biomolecular and Biomedical Science, University College Dublin, Belfield, D04 V1W8 Dublin, Ireland
| | - Sean Doyle
- Department of Biology, Maynooth University, Maynooth, W23 F2K8 Kildare, Ireland
| | - Thomas R Rogers
- Discipline of Clinical Microbiology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Philip Murphy
- Discipline of Clinical Microbiology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Julie Renwick
- Discipline of Clinical Microbiology, School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland
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23
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Kundu P, Gupta N, Sood N. The Fragile Patient: Considerations in the Management of Invasive Mould Infections (IMIs) in India. Cureus 2023; 15:e38085. [PMID: 37252469 PMCID: PMC10209389 DOI: 10.7759/cureus.38085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Invasive mould infections (IMIs), which are mostly caused by Aspergillus spp. and Mucormycetes, are opportunistic infections that impose a substantial threat to patients who are considered to be 'fragile'. There is no fixed definition for fragile patients; however, patients with cancer or acquired immunodeficiency syndrome (AIDS), patients who have undergone organ transplants, and patients being treated in the intensive care units (ICUs) were considered fragile. Management of IMIs in fragile patients is challenging, owing to their compromised immune status. The diagnostic challenges associated with IMIs due to insufficient sensitivity and specificity of the current diagnostic tests lead to delayed treatment. A widening demographic of at-risk patients and a broadening spectrum of pathogenic fungi have added to the challenges to ascertain a definite diagnosis. A recent surge of mucormycosis associated with SARS-CoV-2 infections and the resultant steroid usage has been reported. Liposomal amphotericin B (L-AmB) is the mainstay for treating mucormycosis while voriconazole has displaced amphotericin B as the mainstay for treating Aspergillus infection due to its better response, improved survival, and fewer severe side effects. The selection of antifungal treatment has to be subjected to more scrutiny in fragile patients owing to their comorbidities, organ impairment, and multiple ongoing treatment modalities. Isavuconazole has been documented to have a better safety profile, stable pharmacokinetics, fewer drug-drug interactions, and a broad spectrum of coverage. Isavuconazole has thus found its place in the recommendations and can be considered a suitable option for treating fragile patients with IMIs. In this review, the authors have critically appraised the challenges in ascertaining an accurate diagnosis and current management considerations and suggested an evidence-based approach to managing IMIs in fragile patients.
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Affiliation(s)
| | - Neha Gupta
- Internal Medicine, Fortis Memorial Research Institute, Gurugram, IND
- Internal Medicine, Medanta - The Medicity, Gurugram, IND
| | - Nitin Sood
- Hematology and Oncology/Stem Cell Transplant, Cancer Institute, Medanta - The Medicity, Gurugram, IND
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24
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Tehrani S, Fekri S, Demirci H, Nourizadeh AM, Kashefizadeh A, Shahrbaf MA, Keyvanfar A, Maghsoudi Nejad F. Coincidence of Candida Endophthalmitis, and Aspergillus and Pneumocystis jirovecii Pneumonia in a COVID-19 Patient: Case Report. Ocul Immunol Inflamm 2023:1-4. [PMID: 36952481 DOI: 10.1080/09273948.2023.2188224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is associated with immune system dysfunction and makes patients vulnerable to opportunistic infections. This report presents a patient with a history of COVID-19, suffering from opportunistic infections. CASE DESCRIPTION We reported a 64-year-old man complaining of progressive visual loss in his left eye, who had previously been hospitalized for three weeks due to COVID-19. In the ophthalmologic assessment, large foci of dense subretinal and intraretinal infiltrations involving the macula were observed (compatible with endogenous fungal endophthalmitis). Real-time PCR result of intraocular fluid was positive for Candida spp. During subsequent hospitalization, the patient also suffered from fever and productive coughs (manifestations of pneumonia caused by Aspergillus fumigatus and Pneumocystis jirovecii). In response to antibiotic therapy, the fever and coughs subsided, and the ocular examination revealed a dramatic decrease in the size of retinal infiltrations. CONCLUSIONS In patients with severe COVID-19, long-term ICU admission and immunosuppressive drugs lead to immune system dysfunction and make the patient more susceptible to opportunistic infections. Consequently, fungal pathogens such as Aspergillus, Pneumocystis jirovecii, and Candida spp. may cause infection in different body organs. Thus, clinicians should be alert and have clinical suspicion to diagnose accurately and manage patients accordingly.
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Affiliation(s)
- Shabnam Tehrani
- Department of Infectious Disease, Labbafinejad Clinical Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahba Fekri
- Department of Ophthalmology, Labbafinejad Clinical Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hakan Demirci
- Department of Ophthalmology and Visual Science, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Alireza Kashefizadeh
- Department of Internal Medicine, Labbafinejad Clinical Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amirreza Keyvanfar
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Maghsoudi Nejad
- Department of Infectious Disease, Labbafinejad Clinical Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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25
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Kitayama T, Tone K, Makimura K, Takagi M, Kuwano K. COVID-19-Associated Pulmonary Aspergillosis Complicated by Severe Coronavirus Disease: Is Detection of Aspergillus in Airway Specimens Before Disease Onset an Indicator of Antifungal Prophylaxis? Cureus 2023; 15:e36212. [PMID: 37069870 PMCID: PMC10105287 DOI: 10.7759/cureus.36212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
A 55-year-old man was admitted for coronavirus disease 2019 (COVID-19)-related respiratory failure. He was treated with corticosteroids and tocilizumab in the intensive care unit. Aspergillus fumigatus (A. fumigatus) was isolated from his sputum on admission. However, no radiological findings suggesting pulmonary aspergillosis were seen on chest computed tomography (CT). Since the fungus had merely colonized in airways, antifungal drugs were not administered immediately. On day 19 of hospitalization, a high (1→3)-β-D-glucan (BDG) level was noted. A CT scan on day 22 revealed consolidations with a cavity in the right lung. A. fumigatus was isolated from his sputum again. Thus, we diagnosed the patient with COVID-19-associated pulmonary aspergillosis (CAPA) and started voriconazole. After the treatment, BDG levels and radiological findings were noted to improve. In this case, tocilizumab probably had a critical role in developing the disease. Although antifungal prophylaxis therapy for CAPA is not well established, this case shows that detecting Aspergillus in airway specimens before the disease onset possibly implies a high risk of developing CAPA and is an indicator of antifungal prophylaxis.
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26
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Erami M, Aboutalebian S, Hezaveh SJH, Ghazvini RD, Momen-Heravi M, Jafari Y, Ahsaniarani AH, Basirpour B, Matini AH, Mirhendi H. Microbial and clinical epidemiology of invasive fungal rhinosinusitis in hospitalized COVID-19 patients, the divergent causative agents. Med Mycol 2023; 61:myad020. [PMID: 36906282 DOI: 10.1093/mmy/myad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/19/2023] [Accepted: 03/10/2023] [Indexed: 03/13/2023] Open
Abstract
Since COVID-19 spread worldwide, invasive fungal rhinosinusitis (IFRS) has emerged in immunocompromised patients as a new clinical challenge. In this study, clinical specimens of 89 COVID-19 patients who presented clinical and radiological evidence suggestive of IFRS were examined by direct microscopy, histopathology, and culture, and the isolated colonies were identified through DNA sequence analysis. Fungal elements were microscopically observed in 84.27% of the patients. Males (53.9%) and patients over 40 (95.5%) were more commonly affected than others. Headache (94.4%) and retro-orbital pain (87.6%) were the most common symptoms, followed by ptosis/proptosis/eyelid swelling (52.8%), and 74 patients underwent surgery and debridement. The most common predisposing factors were steroid therapy (n = 83, 93.3%), diabetes mellitus (n = 63, 70.8%), and hypertension (n = 42, 47.2%). The culture was positive for 60.67% of the confirmed cases, and Mucorales were the most prevalent (48.14%) causative fungal agents. Different species of Aspergillus (29.63%) and Fusarium (3.7%) and a mix of two filamentous fungi (16.67%) were other causative agents. For 21 patients, no growth was seen in culture despite a positive result on microscopic examinations. In PCR-sequencing of 53 isolates, divergent fungal taxons, including 8 genera and 17 species, were identified as followed: Rhizopus oryzae (n = 22), Aspergillus flavus (n = 10), A. fumigatus (n = 4), A. niger (n = 3), R. microsporus (n = 2), Mucor circinelloides, Lichtheimia ramosa, Apophysomyces variabilis, A. tubingensis, A. alliaceus, A. nidulans, A. calidoustus, Fusarium fujikuroi/proliferatum, F. oxysporum, F. solani, Lomentospora prolificans, and Candida albicans (each n = 1). In conclusion, a diverse set of species involved in COVID-19-associated IFRS was observed in this study. Our data encourage specialist physicians to consider the possibility of involving various species in IFRS in immunocompromised and COVID-19 patients. In light of utilizing molecular identification approaches, the current knowledge of microbial epidemiology of invasive fungal infections, especially IFRS, may change dramatically.
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Affiliation(s)
- Mahzad Erami
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Infectious Disease, School of Medicine, infectious diseases research center, Kashan University of Medical Sciences, Kashan, Iran
| | - Shima Aboutalebian
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Jamal Hashemi Hezaveh
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Roshanak Daie Ghazvini
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansooreh Momen-Heravi
- Department of Infectious Disease, School of Medicine, infectious diseases research center, Kashan University of Medical Sciences, Kashan, Iran
| | - Yazdan Jafari
- Department of Internal Medicine, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Amir Hossein Ahsaniarani
- Department of Otorhinolaryngology, School of Medicine, Matini Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Bahare Basirpour
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Hassan Matini
- Department of Pathology and Histology, School of Medicine, Shahid Beheshti Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Mycology Reference Laboratory, Research Core Facilities Laboratory, Isfahan University of Medical Sciences, Isfahan, Iran
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27
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Managing the Next Wave of Influenza and/or SARS-CoV-2 in the ICU—Practical Recommendations from an Expert Group for CAPA/IAPA Patients. J Fungi (Basel) 2023; 9:jof9030312. [PMID: 36983480 PMCID: PMC10058160 DOI: 10.3390/jof9030312] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/22/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
The aim of this study was to establish practical recommendations for the diagnosis and treatment of influenza-associated invasive aspergillosis (IAPA) based on the available evidence and experience acquired in the management of patients with COVID-19-associated pulmonary aspergillosis (CAPA). The CAPA/IAPA expert group defined 14 areas in which recommendations would be made. To search for evidence, the PICO strategy was used for both CAPA and IAPA in PubMed, using MeSH terms in combination with free text. Based on the results, each expert developed recommendations for two to three areas that they presented to the rest of the group in various meetings in order to reach consensus. As results, the practical recommendations for the management of CAPA/IAPA patients have been grouped into 12 sections. These recommendations are presented for both entities in the following situations: when to suspect fungal infection; what diagnostic methods are useful to diagnose these two entities; what treatment is recommended; what to do in case of resistance; drug interactions or determination of antifungal levels; how to monitor treatment effectiveness; what action to take in the event of treatment failure; the implications of concomitant corticosteroid administration; indications for the combined use of antifungals; when to withdraw treatment; what to do in case of positive cultures for Aspergillus spp. in a patient with severe viral pneumonia or Aspergillus colonization; and how to position antifungal prophylaxis in these patients. Available evidence to support the practical management of CAPA/IAPA patients is very scarce. Accumulated experience acquired in the management of CAPA patients can be very useful for the management of IAPA patients. The expert group presents eminently practical recommendations for the management of CAPA/IAPA patients.
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28
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Shah M, Reveles K, Moote R, Hand E, Kellogg Iii D, Attridge RL, Maselli DJ, Gutierrez GC. Risk of Coronavirus Disease 2019-Associated Pulmonary Aspergillosis Based on Corticosteroid Duration in Intensive Care Patients. Open Forum Infect Dis 2023; 10:ofad062. [PMID: 36879627 PMCID: PMC9984984 DOI: 10.1093/ofid/ofad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Indexed: 03/07/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a potential complication in critically ill COVID-19 patients. Corticosteroids are standard of care for hospitalized COVID-19 patients but carry an increased risk of secondary infections including CAPA. The objective of this study was to evaluate if duration of corticosteroid therapy ≤10 days versus >10 days affects the risk of developing CAPA. Methods This was a retrospective cohort study of adult patients with severe COVID-19 pneumonia requiring mechanical ventilation who received at least 3 days of corticosteroid treatment. Incidence of CAPA and secondary outcomes were compared using appropriate bivariable analyses. Steroid duration was evaluated as an independent predictor in a logistic regression model. Results A total of 278 patients were included (n = 169 for ≤10 days' steroid duration; n = 109 for >10 days). CAPA developed in 20 of 278 (7.2%) patients. Patients treated with >10 days of corticosteroid therapy had significantly higher incidence of CAPA (11.9% vs 4.1%; P = .0156), and steroid duration >10 days was independently associated with CAPA (odds ratio, 3.17 [95% confidence interval, 1.02-9.83]). Secondary outcomes including inpatient mortality (77.1% vs 43.2%; P < .0001), mechanical ventilation-free days at 28 days (0 vs 1.5; P < .0001), and secondary infections (44.9% vs 28.4% P = .0220) were worse in the >10 days cohort. Conclusions Corticosteroid treatment >10 days in critically ill COVID-19 patients is associated with an increased risk of CAPA. Patients may require corticosteroids for reasons beyond COVID-19 and clinicians should be cognizant of risk of CAPA with prolonged courses.
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Affiliation(s)
- Meera Shah
- Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, Texas, USA.,Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.,Pharmacotherapy Education and Research Center, UT Health San Antonio, San Antonio, Texas, USA
| | - Kelly Reveles
- Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.,Pharmacotherapy Education and Research Center, UT Health San Antonio, San Antonio, Texas, USA
| | - Rebecca Moote
- Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, Texas, USA.,Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.,Pharmacotherapy Education and Research Center, UT Health San Antonio, San Antonio, Texas, USA
| | - Elizabeth Hand
- Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, Texas, USA.,Pharmacotherapy Education and Research Center, UT Health San Antonio, San Antonio, Texas, USA
| | - Dean Kellogg Iii
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, Joe R. and Terry Lozano Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Rebecca L Attridge
- Feik School of Pharmacy, University of the Incarnate Word, San Antonio, Texas, USA.,The Craneware Group, Deerfield Beach, Florida, USA
| | - Diego J Maselli
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, Joe R. and Terry Lozano Long School of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - G Christina Gutierrez
- Department of Pharmacotherapy and Pharmacy Services, University Health, San Antonio, Texas, USA.,Division of Pharmacotherapy, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.,Pharmacotherapy Education and Research Center, UT Health San Antonio, San Antonio, Texas, USA
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29
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Current and Future Pathways in Aspergillus Diagnosis. Antibiotics (Basel) 2023; 12:antibiotics12020385. [PMID: 36830296 PMCID: PMC9952630 DOI: 10.3390/antibiotics12020385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/10/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023] Open
Abstract
Aspergillus fumigatus has been designated by the World Health Organization as a critical priority fungal pathogen. Some commercially available diagnostics for many forms of aspergillosis rely on fungal metabolites. These encompass intracellular molecules, cell wall components, and extracellular secretomes. This review summarizes the shortcomings of antibody tests compared to tests of fungal products in body fluids and highlights the application of β-d-glucan, galactomannan, and pentraxin 3 in bronchoalveolar lavage fluids. We also discuss the detection of nucleic acids and next-generation sequencing, along with newer studies on Aspergillus metallophores.
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30
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Ogawa M, Niki M, Imoto W, Dobashi A, Imai M, Takayama N, Mitani K, Kakuno S, Shibata W, Yamada K, Kakeya H. Characterization of Aspergillus spp. isolated from patients with coronavirus disease 2019. J Infect Chemother 2023; 29:580-585. [PMID: 36758677 PMCID: PMC9904853 DOI: 10.1016/j.jiac.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/11/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Invasive pulmonary aspergillosis (IPA) is an important complication of coronavirus disease 2019 (COVID-19), and while there are case reports and epidemiological studies, few studies have isolated Aspergillus strains from patients. Therefore, we analyzed the strains, sensitivities, and genetic homology of Aspergillus spp. Isolated from patients with COVID-19. METHODS We investigated the Aspergillus strains detected from patients with COVID-19 hospitalized in Osaka Metropolitan University Hospital from December 2020 to June 2021. A molecular epidemiological analysis of Aspergillus fumigatus was performed using drug susceptibility tests and TRESPERG typing, and data on patient characteristics were collected from electronic medical records. RESULTS Twelve strains of Aspergillus were detected in 11 of the 122 patients (9%) with COVID-19. A. fumigatus was the most common species detected, followed by one strain each of Aspergillus aureolus, Aspergillus nidulans, Aspergillus niger, and Aspergillus terreus. A. aureolus was resistant to voriconazole, and no resistance was found in other strains. All A. fumigatus strains were genetically distinct strains. Six of the 11 patients that harbored Aspergillus received antifungal drug treatment and tested positive for β-D-glucan and/or Aspergillus galactomannan antigen. The results indicated that Aspergillus infections were acquired from outside the hospital and not from nosocomial infections. CONCLUSION Strict surveillance of Aspergillus spp. is beneficial in patients at high-risk for IPA. When Aspergillus is detected, it is important to monitor the onset of IPA carefully and identify the strain, perform drug sensitivity tests, and facilitate early administration of therapeutic agents to patients with IPA.
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Affiliation(s)
- Masashi Ogawa
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan.
| | - Makoto Niki
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan.
| | - Waki Imoto
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan; Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan; Department of Infectious Disease Medicine, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan.
| | - Akane Dobashi
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan.
| | - Minami Imai
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan.
| | - Naomi Takayama
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan.
| | - Kei Mitani
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan.
| | - Shigeki Kakuno
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan; Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan; Department of Infectious Disease Medicine, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan.
| | - Wataru Shibata
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan; Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan; Department of Infectious Disease Medicine, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan.
| | - Koichi Yamada
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan; Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan; Department of Infectious Disease Medicine, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan.
| | - Hiroshi Kakeya
- Department of Infection Control and Prevention, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan; Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan; Department of Infectious Disease Medicine, Osaka Metropolitan University Hospital, 1-5-7 Asahi-machi, Abeno-ku, Osaka, 545-8586, Japan; Research Center for Infectious Disease Sciences, Osaka Metropolitan University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
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31
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Aspergillosis ball graft as complication of Covid-19 infection: Case report. Radiol Case Rep 2023; 18:610-612. [PMCID: PMC9710145 DOI: 10.1016/j.radcr.2022.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 12/03/2022] Open
Abstract
Invasive pulmonary aspergillosis is a severe presentation of aspergillosis fungal infection, with a high mortality rate. Many Covid-19-associated pulmonary aspergillosis cases have been described in the literature giving rise to a major dilemma for physicians: discriminate a simple colonization from an invasive infection. In this paper, we will describe the case of a 40-year-old immunocompetent man with no medical history was admitted to the intensive care unit for Covid-19 infection with lung damage initially estimated at 50%-75%. Two weeks later, patient condition got worse, with a thoracic CT showing a newly developed, well limited lung cavitation indicative of an aspergillosis fungus ball.
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32
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Amstutz P, Bahr NC, Snyder K, Shoemaker DM. Pneumocystis jirovecii Infections Among COVID-19 Patients: A Case Series and Literature Review. Open Forum Infect Dis 2023; 10:ofad043. [PMID: 36817747 PMCID: PMC9933943 DOI: 10.1093/ofid/ofad043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/24/2023] [Indexed: 01/30/2023] Open
Abstract
Background Pneumocystis jirovecii pneumonia (PCP) is a serious, emerging complication of coronavirus disease 2019 (COVID-19). Methods We performed a systematic review of published cases. We describe 6 new cases of PCP/COVID-19 coinfection. Among our cases (n = 6) and those in the literature (n = 69) with available data, the median age (interquartile range [IQR]) was 59 (44-77) years (n = 38), 72% (47/65) were male, and the mortality rate was 30.9% (21/68). Results Long-term corticosteroid use was noted in 45.1% (23/51), advanced HIV infection (defined as a CD4 count <200 cells/μL) in 17.6% (9/51), and antineoplastic chemotherapy in 13.7% (7/51), consistent with known PCP risk factors. Notably, 56.7% (38/47) had verifiable risk factors for PCP (high-dose corticosteroids, immunosuppressive therapy, and HIV infection) before COVID-19 infection. A median absolute lymphocyte count (IQR) of 0.61 (0.28-0.92) ×103 cells/mm3 (n = 23) and CD4 count (IQR) of 66 (33-291.5) cells/mm3 (n = 20) were also discovered among the study population. Conclusions These findings suggest a need for greater attention to PCP risk factors among COVID-19 patients and consideration of PCP prophylaxis in these high-risk populations.
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Affiliation(s)
- Paul Amstutz
- School of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Nathan C Bahr
- Division of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Karen Snyder
- Division of Infectious Diseases, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - D Matthew Shoemaker
- Correspondence: D. Matthew Shoemaker, DO, 3901 Rainbow Boulevard, Kansas City, KS 66103 ()
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33
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Iacovelli A, Oliva A, Siccardi G, Tramontano A, Pellegrino D, Mastroianni CM, Venditti M, Palange P. Risk factors and effect on mortality of superinfections in a newly established COVID-19 respiratory sub-intensive care unit at University Hospital in Rome. BMC Pulm Med 2023; 23:30. [PMID: 36670381 PMCID: PMC9854038 DOI: 10.1186/s12890-023-02315-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Little is known on the burden of co-infections and superinfections in a specific setting such as the respiratory COVID-19 sub-intensive care unit. This study aims to (i) assess the prevalence of concurrent and superinfections in a respiratory sub-intensive care unit, (ii) evaluate the risk factors for superinfections development and (iii) assess the impact of superinfections on in-hospital mortality. METHODS Single-center retrospective analysis of prospectively collected data including COVID-19 patients hospitalized in a newly established respiratory sub-intensive care unit managed by pneumologists which has been set up from September 2020 at a large (1200 beds) University Hospital in Rome. Inclusion criteria were: (i) COVID-19 respiratory failure and/or ARDS; (ii) hospitalization in respiratory sub-intensive care unit and (iii) age > 18 years. Survival was analyzed by Kaplan-Meier curves and the statistical significance of the differences between the two groups was assessed using the log-rank test. Multivariable logistic regression and Cox regression model were performed to tease out the independent predictors for superinfections' development and for mortality, respectively. RESULTS A total of 201 patients were included. The majority (106, 52%) presented severe COVID-19. Co-infections were 4 (1.9%), whereas 46 patients (22%) developed superinfections, mostly primary bloodstream infections and pneumonia. In 40.6% of cases, multi-drug resistant pathogens were detected, with carbapenem-resistant Acinetobacter baumannii (CR-Ab) isolated in 47%. Overall mortality rate was 30%. Prior (30-d) infection and exposure to antibiotic therapy were independent risk factors for superinfection development whereas the development of superinfections was an independent risk factors for in-hospital mortality. CR-Ab resulted independently associated with 14-d mortality. CONCLUSION In a COVID-19 respiratory sub-intensive care unit, superinfections were common and represented an independent predictor of mortality. CR-Ab infections occurred in almost half of patients and were associated with high mortality. Infection control rules and antimicrobial stewardship are crucial in this specific setting to limit the spread of multi-drug resistant organisms.
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Affiliation(s)
- Alessandra Iacovelli
- grid.7841.aDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy ,grid.417007.5Pulmonology Respiratory and Critical Care Unit, Policlinico Umberto I Hospital Rome, Rome, Italy
| | - Alessandra Oliva
- grid.7841.aDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy ,grid.417007.5Infective Diseases Unit, Policlinico Umberto I Hospital Rome, 00185 Rome, Lazio Italy
| | - Guido Siccardi
- grid.7841.aDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy ,grid.417007.5Infective Diseases Unit, Policlinico Umberto I Hospital Rome, 00185 Rome, Lazio Italy
| | - Angela Tramontano
- grid.7841.aDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy ,grid.417007.5Pulmonology Respiratory and Critical Care Unit, Policlinico Umberto I Hospital Rome, Rome, Italy
| | - Daniela Pellegrino
- grid.7841.aDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy ,grid.417007.5Pulmonology Respiratory and Critical Care Unit, Policlinico Umberto I Hospital Rome, Rome, Italy
| | - Claudio Maria Mastroianni
- grid.7841.aDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy ,grid.417007.5Infective Diseases Unit, Policlinico Umberto I Hospital Rome, 00185 Rome, Lazio Italy
| | - Mario Venditti
- grid.7841.aDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy ,grid.417007.5Infective Diseases Unit, Policlinico Umberto I Hospital Rome, 00185 Rome, Lazio Italy
| | - Paolo Palange
- grid.7841.aDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy ,grid.417007.5Pulmonology Respiratory and Critical Care Unit, Policlinico Umberto I Hospital Rome, Rome, Italy
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Alsayed AR, Hasoun L, Khader HA, Abu-Samak MS, Al-Shdifat LM, Al-Shammari B, Maqbali MA. Co-infection of COVID-19 patients with atypical bacteria: A study based in Jordan. Pharm Pract (Granada) 2023; 21:2753. [PMID: 37090467 PMCID: PMC10117357 DOI: 10.18549/pharmpract.2023.1.2753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 04/25/2023] Open
Abstract
Objective The aim of this work was to know the prevalence of Chlamydophila pneumoniae and Mycoplasma pneumoniae in coronavirus disease 2019 (COVID-19) patients in Jordan. Also, to assess a TaqMan real-time polymerase chain reaction (PCR) assay in detecting these two bacteria. Methods This is a retrospective study performed over the last five months of the 2021. All nasopharyngeal specimens from COVID-19 patients were tested for C. pneumonia, and M. pneumoniae. The C. pneumoniae Pst-1 gene and M. pneumoniae P1 cytadhesin protein gene were the targets. Results In this study, 14 out of 175 individuals with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (8.0%) were co-infected with C. pneumoniae or M. pneumoniae. Co-infection with SARS-CoV-2 and C. pneumoniae was reported in 5 (2.9%) patients, while 9 (5.1%) patients had M. pneumoniae and SARS-CoV-2 co-infection. The mean (± std) of the correlation coefficient of the calibration curve for real-time PCR analysis was -0.993 (± 0.001) for C. pneumoniae and -0.994 (± 0.003) for M. pneumoniae. The mean amplification efficiencies of C. pneumoniae and M. Pneumoniae were 187.62% and 136.86%, respectively. Conclusion In this first study based in Jordan, patients infected with COVID-19 have a low rate of atypical bacterial co-infection. However, clinicians should suspect co-infections with both common and uncommon bacteria in COVID-19 patients. Large prospective investigations are needed to give additional insight on the true prevalence of these co-infections and their impact on the clinical course of COVID-19 patients.
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Affiliation(s)
- Ahmad R Alsayed
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931-166, Jordan. ,
| | - Luai Hasoun
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931-166, Jordan.
| | - Heba A Khader
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmaceutical Sciences, The Hashemite University, PO Box 330127, Zarqa 13133, Jordan.
| | - Mahmoud S Abu-Samak
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931-166, Jordan.
| | - Laith Mh Al-Shdifat
- Department of Pharmaceutical Chemistry and Pharmacognosy, Faculty of Pharmacy, Applied Science Private University, Amman 11931-166, Jordan.
| | - Basheer Al-Shammari
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931-166, Jordan.
| | - Mohammed Al Maqbali
- Department of Nursing Midwifery and Health, Northumbria University, Newcastle-Upon-Tyne, UK.
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Huang SF, Ying-Jung Wu A, Shin-Jung Lee S, Huang YS, Lee CY, Yang TL, Wang HW, Chen HJ, Chen YC, Ho TS, Kuo CF, Lin YT. COVID-19 associated mold infections: Review of COVID-19 associated pulmonary aspergillosis and mucormycosis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022:S1684-1182(22)00285-7. [PMID: 36586744 PMCID: PMC9751001 DOI: 10.1016/j.jmii.2022.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 12/03/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
COVID-19-associated mold infection (CAMI) is defined as development of mold infections in COVID-19 patients. Co-pathogenesis of viral and fungal infections include the disruption of tissue barrier following SARS CoV-2 infection with the damage in the alveolar space, respiratory epithelium and endothelium injury and overwhelming inflammation and immune dysregulation during severe COVID-19. Other predisposing risk factors permissive to fungal infections during COVID-19 include the administration of immune modulators such as corticosteroids and IL-6 antagonist. COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) is increasingly reported during the COVID-19 pandemic. CAPA usually developed within the first month of COVID infection, and CAM frequently arose 10-15 days post diagnosis of COVID-19. Diagnosis is challenging and often indistinguishable during the cytokine storm in COVID-19, and several diagnostic criteria have been proposed. Development of CAPA and CAM is associated with a high mortality despiteappropriate anti-mold therapy. Both isavuconazole and amphotericin B can be used for treatment of CAPA and CAM; voriconazole is the primary agent for CAPA and posaconazole is an alternative for CAM. Aggressive surgery is recommended for CAM to improve patient survival. A high index of suspicion and timely and appropriate treatment is crucial to improve patient outcome.
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Affiliation(s)
- Shiang-Fen Huang
- Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,School of Internal Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan
| | - Alice Ying-Jung Wu
- Division of Infectious Diseases, Department of Medicine, MacKay Memorial Hospital, Taipei, Taiwan,MacKay Medical College, New Taipei City, Taiwan
| | - Susan Shin-Jung Lee
- School of Internal Medicine, National Yang Ming Chao Tung University, Taipei, Taiwan,Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Yuan Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,M.Sc. Program in Tropical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Te-Liang Yang
- Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan,Department of Pediatrics, National Taiwan University Children's Hospital, Taipei, Taiwan
| | - Hsiao-Wei Wang
- Division of Infectious Diseases, Department of Internal Medicine, Shin Kong Wu Ho- Su Memorial Hospital, Taipei, Taiwan
| | - Hung Jui Chen
- Department of Infectious Diseases, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yi Ching Chen
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan,College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzong-Shiann Ho
- Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan,Department of Pediatrics, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
| | - Chien-Feng Kuo
- Division of Infectious Diseases, Department of Medicine, MacKay Memorial Hospital, Taipei, Taiwan,MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan,Corresponding author
| | - Yi-Tsung Lin
- Division of Infectious Disease, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan,Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Corresponding author
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36
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Candida Species Isolation from Hospitalized Patients with COVID-19-A Retrospective Study. Diagnostics (Basel) 2022; 12:diagnostics12123065. [PMID: 36553072 PMCID: PMC9776868 DOI: 10.3390/diagnostics12123065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), a disease characterized by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has so far led to hundreds of millions of infections and millions of deaths. Fungal infections are known to complicate COVID-19 patients and are associated with significant morbidity and mortality. The aim of this study was to assess the incidence of positive cultures for Candida spp. among patients hospitalized with COVID-19, describe their characteristics and identify factors associated with overall mortality in this patient population. Hospitalized COVID-19 patients with Candida spp. isolation were retrospectively assessed and their clinical, laboratory and microbiological characteristics were assessed and evaluated. In total, 69 patients with COVID-19 had a positive culture for Candida spp., representing a rate of 4.5% among all hospitalized COVID-19 patients. Their median age was 78 years (IQR 67-85 years) and 44.9% were male. Hospitalized patients with COVID-19 and Candida spp. isolation who died were older, were more likely to have a diagnosis of dementia, and had higher Charlson comorbidity index, higher Candida score and higher 4C score. Candida score was identified with a multivariate logistic regression analysis model to be independently associated with mortality. The most commonly identified Candida species was C. albicans, followed by C. tropicalis and C. glabrata and the most common source was the urine, even though in most cases the positive culture was not associated with a true infection. Thus, Candida score may be used in COVID-19 patients with isolation of Candida spp. from different body specimens for mortality risk stratification.
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Lee SO. Diagnosis and Treatment of Invasive Mold Diseases. Infect Chemother 2022; 55:10-21. [PMID: 36603818 PMCID: PMC10079437 DOI: 10.3947/ic.2022.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
Although invasive fungal diseases are relatively less common than superficial diseases, there has been an overall increase in their incidence. Here, I review the epidemiology, diagnosis, and treatment of invasive mold diseases (IMDs) such as aspergillosis, mucormycosis, hyalohyphomycosis, and phaeohyphomycosis. Histopathologic demonstration of tissue invasion by hyphae or recovery of mold by the culture of a specimen obtained by a sterile procedure provides definitive evidence of IMD. If IMD cannot be confirmed through invasive procedures, IMD can be diagnosed through clinical criteria such as the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Instituteof Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) definitions. For initial primary therapy of invasive aspergillosis, voriconazole or isavuconazole is recommended and lipid formulations of amphotericin B are useful primary alternatives. Echinocandins are representative antifungal agents for salvage therapy. Treatment of invasive mucormycosis involves a combination of urgent surgical debridement of involved tissues and antifungal therapy. Lipid formulations of amphotericin B are the drug of choice for initial therapy. Isavuconazole or posaconazole can be used as salvage or step-down therapy. IMDs other than aspergillosis and mucormycosis include hyalohyphomycosis and phaeohyphomycosis, for which there is no standard therapy and the treatment depends on the clinical disease and status of the patient.
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Affiliation(s)
- Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Hawes AM, Permpalung N. Diagnosis and Antifungal Prophylaxis for COVID-19 Associated Pulmonary Aspergillosis. Antibiotics (Basel) 2022; 11:antibiotics11121704. [PMID: 36551361 PMCID: PMC9774425 DOI: 10.3390/antibiotics11121704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
The COVID-19 pandemic has redemonstrated the importance of the fungal-after-viral phenomenon, and the question of whether prophylaxis should be used to prevent COVID-19-associated pulmonary aspergillosis (CAPA). A distinct pathophysiology from invasive pulmonary aspergillosis (IPA), CAPA has an incidence that ranges from 5% to 30%, with significant mortality. The aim of this work was to describe the current diagnostic landscape of CAPA and review the existing literature on antifungal prophylaxis. A variety of definitions for CAPA have been described in the literature and the performance of the diagnostic tests for CAPA is limited, making diagnosis a challenge. There are only six studies that have investigated antifungal prophylaxis for CAPA. The two studied drugs have been posaconazole, either a liquid formulation via an oral gastric tube or an intravenous formulation, and inhaled amphotericin. While some studies have revealed promising results, they are limited by small sample sizes and bias inherent to retrospective studies. Additionally, as the COVID-19 pandemic changes and we see fewer intubated and critically ill patients, it will be more important to recognize these fungal-after-viral complications among non-critically ill, immunocompromised patients. Randomized controlled trials are needed to better understand the role of antifungal prophylaxis.
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Affiliation(s)
- Armani M. Hawes
- Correspondence: ; Tel.: +1-410-955-5000; Fax: +1-210-892-3847
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Serin I, Baltali S, Cinli TA, Goze H, Demir B, Yokus O. Lateral flow assay (LFA) in the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA): a single-center experience. BMC Infect Dis 2022; 22:822. [PMCID: PMC9644000 DOI: 10.1186/s12879-022-07828-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Invasive pulmonary aspergillosis (IPA) is seen during coronavirus-2019 (COVID-19), has been reported in different incidences, and is defined as COVID-19-associated pulmonary aspergillosis (CAPA). Detection of galactomannan antigen is an important diagnostic step in diagnosing IPA. Enzyme-linked immunoassay (ELISA) is the most frequently used method, and lateral flow assay (LFA) is increasingly used with high sensitivity and specificity for rapid diagnosis. The present study aimed to compare the sensitivity of LFA and ELISA in the diagnosis of CAPA in COVID-19 patients followed in our hospital's ICU for pandemic (ICU-P).
Methods
This study included patients with a diagnosis of COVID-19 cases confirmed by polymerase chain reaction and were followed up in ICU-P between August 2021 and February 2022 with acute respiratory failure. The diagnosis of CAPA was based on the European Confederation of Medical Mycology (ECMM) and the International Society for Human and Animal Mycology 2020 (ECMM/ ISHAM) guideline. Galactomannan levels were determined using LFA and ELISA in serum samples taken simultaneously from the patients.
Results
Out of the 174 patients followed in the ICU-P, 56 did not meet any criteria for CAPA and were excluded from the analysis. The rate of patients diagnosed with proven CAPA was 5.7% (10 patients). A statistically significant result was obtained with LFA for the cut-off value of 0.5 ODI in the diagnosis of CAPA (p < 0.001). The same significant statistical relationship was found for the cut-off value of 1.0 ODI for the ELISA (p < 0.01). The sensitivity of LFA was 80% (95% CI: 0.55–1.05, p < 0.05), specificity 94% (95% CI: 0.89–0.98, p < 0.05); PPV 53% (95% CI: 0.28–0.79, p > 0.05) and NPV was 98% (95% CI: 0.95–1.01, p < 0.05). The risk of death was 1.66 (HR: 1.66, 95% CI: 1.02–2.86, p < 0.05) times higher in patients with an LFA result of ≥ 0.5 ODI than those with < 0.5 (p < 0.05).
Conclusions
It is reckoned that LFA can be used in future clinical practice, particularly given its effectiveness in patients with hematological malignancies and accuracy in diagnosing CAPA.
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Pruthi HS. When to Initiate Antifungal Treatment in COVID-19 Patients with Secondary Fungal Co-infection. CURRENT CLINICAL MICROBIOLOGY REPORTS 2022; 9:60-68. [PMID: 36345368 PMCID: PMC9630809 DOI: 10.1007/s40588-022-00184-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
Purpose of Review Severe-acute respiratory coronavirus 2 (SARS-CoV-2) has been driving the health care delivery system for over 2 years. With time, many issues related to co-infections in COVID-19 patients are constantly surfacing. There have been numerous reports about various fungal co-infections in patients with COVID-19. The extent of severity of fungal pathogens has been recognized as a substantial cause of morbidity and mortality in this population. Awareness, understanding, and a systematic approach to managing fungal co-infections in COVID-19 patients are important. No guidelines have enumerated the stepwise approach to managing the fungal infections co-occurring with COVID-19. This review is intended to present an overview of the fungal co-infections in COVID-19 patients and their stepwise screening and management. Recent Findings The most common fungal infections that have been reported to co-exist with COVID-19 are Candidemia, Aspergillosis, and Mucormycosis. Prevalence of co-infections in COVID-19 patients has been reported to be much higher in hospitalized COVID-19 patients, especially those in intensive care units. While clear pathogenetic mechanisms have not been delineated, COVID-19 patients are at a high risk of invasive fungal infections. Summary As secondary fungal infections have been challenging to treat in COVID-19 patients, as they tend to affect the critically ill or immunocompromised patients, a delay in diagnosis and treatment may be fatal. Antifungal drugs should be initiated with caution after carefully assessing the immune status of the patients, drug interactions, and adverse effects. The crucial factors in successfully treating fungal infections in COVID-19 patients are optimal diagnostic approach, routine screening, and timely initiation of antifungal therapy.
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Affiliation(s)
- Harnoor Singh Pruthi
- Deparment of Cardiology, Capitol Hospital, Pathankot Road (NH-44), Jalandhar, Punjab 144012 India
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Antimicrobial stewardship in the post COVID-19 pandemic era: an opportunity for renewed focus on controlling the threat of antimicrobial resistance. J Hosp Infect 2022; 129:121-123. [PMID: 36280374 PMCID: PMC9585509 DOI: 10.1016/j.jhin.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Trevijano-Contador N, Torres-Cano A, Carballo-González C, Puig-Asensio M, Martín-Gómez MT, Jiménez-Martínez E, Romero D, Nuvials FX, Olmos-Arenas R, Moretó-Castellsagué MC, Fernández-Delgado L, Rodríguez-Sevilla G, Aguilar-Sánchez MM, Ayats-Ardite J, Ardanuy-Tisaire C, Sanchez-Romero I, Muñoz-Algarra M, Merino-Amador P, González-Romo F, Megías-Lobón G, García-Campos JA, Mantecón-Vallejo MÁ, Alcoceba E, Escribano P, Guinea J, Durán-Valle MT, Fraile-Torres AM, Roiz-Mesones MP, Lara-Plaza I, de Ayala AP, Simón-Sacristán M, Collazos-Blanco A, Nebreda-Mayoral T, March-Roselló G, Alcázar-Fuoli L, Zaragoza O. Global Emergence of Resistance to Fluconazole and Voriconazole in Candida parapsilosis in Tertiary Hospitals in Spain During the COVID-19 Pandemic. Open Forum Infect Dis 2022; 9:ofac605. [PMID: 36467290 PMCID: PMC9709632 DOI: 10.1093/ofid/ofac605] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/03/2022] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Candida parapsilosis is a frequent cause of candidemia worldwide. Its incidence is associated with the use of medical implants, such as central venous catheters or parenteral nutrition. This species has reduced susceptibility to echinocandins, and it is susceptible to polyenes and azoles. Multiple outbreaks caused by fluconazole-nonsusceptible strains have been reported recently. A similar trend has been observed among the C. parapsilosis isolates received in the last 2 years at the Spanish Mycology Reference Laboratory. METHODS Yeast were identified by molecular biology, and antifungal susceptibility testing was performed using the European Committee on Antimicrobial Susceptibility Testing protocol. The ERG11 gene was sequenced to identify resistance mechanisms, and strain typing was carried out by microsatellite analysis. RESULTS We examined the susceptibility profile of 1315 C. parapsilosis isolates available at our reference laboratory between 2000 and 2021, noticing an increase in the number of isolates with acquired resistance to fluconazole, and voriconazole has increased in at least 8 different Spanish hospitals in 2020-2021. From 121 recorded clones, 3 were identified as the most prevalent in Spain (clone 10 in Catalonia and clone 96 in Castilla-Leon and Madrid, whereas clone 67 was found in 2 geographically unrelated regions, Cantabria and the Balearic Islands). CONCLUSIONS Our data suggest that concurrently with the coronavirus disease 2019 pandemic, a selection of fluconazole-resistant C. parapsilosis isolates has occurred in Spain, and the expansion of specific clones has been noted across centers. Further research is needed to determine the factors that underlie the successful expansion of these clones and their potential genetic relatedness.
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Affiliation(s)
- Nuria Trevijano-Contador
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III. Carretera Majadahonda-Pozuelo, Madrid, Spain
| | - Alba Torres-Cano
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III. Carretera Majadahonda-Pozuelo, Madrid, Spain
| | - Cristina Carballo-González
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III. Carretera Majadahonda-Pozuelo, Madrid, Spain
| | - Mireia Puig-Asensio
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-Institut d´Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
- Center for Biomedical Research in Network in Infectious Diseases (CIBERINFEC, CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - María Teresa Martín-Gómez
- Department of Microbiology, Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Emilio Jiménez-Martínez
- Department of Infectious Diseases, Hospital Universitari de Bellvitge-Institut d´Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Daniel Romero
- Department of Microbiology, Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Xavier Nuvials
- Intensive Care Unit, Vall D'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roberto Olmos-Arenas
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | | | | | | | | | - Josefina Ayats-Ardite
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
| | - Carmen Ardanuy-Tisaire
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
- Center for Biomedical Research Network in Respiratory Diseases (CIBERES-CB06/06/0037), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Sanchez-Romero
- Microbiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - María Muñoz-Algarra
- Microbiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Paloma Merino-Amador
- Microbiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Medicine, Universidad Complutense School of Medicine, Madrid, Spain
| | - Fernando González-Romo
- Microbiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Medicine, Universidad Complutense School of Medicine, Madrid, Spain
| | - Gregoria Megías-Lobón
- Department of Clinical Microbiology, Hospital Universitario de Burgos, Burgos, Castilla y León, Spain
| | - Jose Angel García-Campos
- Department of Clinical Microbiology, Hospital Universitario de Burgos, Burgos, Castilla y León, Spain
| | | | - Eva Alcoceba
- Clinical Microbiology Department, Hospital Universitari Son Espases, Mallorca, Spain
| | - Pilar Escribano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Jesús Guinea
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Center for Biomedical Research Network in Respiratory Diseases (CIBERES-CB06/06/0058), Madrid, Spain
| | | | | | - María Pía Roiz-Mesones
- Microbiology Department, Marqués de Valdecilla Universitary Hospital and Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria,Spain
| | - Isabel Lara-Plaza
- Microbiology Department, Marqués de Valdecilla Universitary Hospital and Instituto de Investigación Valdecilla (IDIVAL), Santander, Cantabria,Spain
| | | | - María Simón-Sacristán
- Microbiology and Parasitology Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - Ana Collazos-Blanco
- Microbiology and Parasitology Department, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - Teresa Nebreda-Mayoral
- Microbiology and Immunology Unit, Universitary Clinic Hospital of Valladolid, Valladolid, Spain
| | - Gabriel March-Roselló
- Microbiology and Immunology Unit, Universitary Clinic Hospital of Valladolid, Valladolid, Spain
| | - Laura Alcázar-Fuoli
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III. Carretera Majadahonda-Pozuelo, Madrid, Spain
- Center for Biomedical Research in Network in Infectious Diseases (CIBERINFEC-CB21/13/00105), Instituto de Salud Carlos III, Madrid, Spain
| | - Oscar Zaragoza
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III. Carretera Majadahonda-Pozuelo, Madrid, Spain
- Center for Biomedical Research in Network in Infectious Diseases (CIBERINFEC-CB21/13/00105), Instituto de Salud Carlos III, Madrid, Spain
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Vaccination with Live or Heat-Killed Aspergillus fumigatus Δ sglA Conidia Fully Protects Immunocompromised Mice from Invasive Aspergillosis. mBio 2022; 13:e0232822. [PMID: 36066100 PMCID: PMC9600187 DOI: 10.1128/mbio.02328-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aspergillus fumigatus causes invasive aspergillosis (IA) in immunocompromised patients, resulting in high mortality rates. Currently, no vaccine formulations to promote immune protection in at-risk individuals have been developed. In this work, we deleted the sterylglucosidase-encoding gene, sglA, in Aspergillus fumigatus and investigated its role in fungal virulence and host vaccine protection. The ΔsglA mutant accumulated sterylglucosides (SGs), newly studied immunomodulatory glycolipids, and exhibited reduced hyphal growth and altered compositions of cell wall polysaccharides. Interestingly, the ΔsglA mutant was avirulent in two murine models of IA and was fully eliminated from the lungs. Both corticosteroid-induced immunosuppressed and cyclophosphamide-induced leukopenic mice vaccinated with live or heat-killed ΔsglA conidia were fully protected against a lethal wild-type A. fumigatus challenge. These results highlight the potential of SG-accumulating strains as safe and promising vaccine formulations against invasive fungal infections. IMPORTANCE Infections by Aspergillus fumigatus occur by the inhalation of environmental fungal spores called conidia. We found that live mutant conidia accumulating glycolipids named sterylglucosides are not able to cause disease when injected into the lung. Interestingly, these animals are now protected against a secondary challenge with live wild-type conidia. Remarkably, protection against a secondary challenge persists even with vaccination with heat-killed mutant conidia. These results will significantly advance the field of the research and development of a safe fungal vaccine for protection against the environmental fungus A. fumigatus.
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Iqbal N, Khanum I, Kazi MAI, Riaz SU, Khawaja UA, Awan S, Irfan M, Zubairi ABS, Khan JA. Post COVID-19 sequelae of the respiratory system. A single center experience reporting the compromise of the airway, alveolar and vascular components. Monaldi Arch Chest Dis 2022. [DOI: 10.4081/monaldi.2022.2412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
The long-term sequelae of COVID-19 have now become more common and appreciable. The SARS-CoV-2 virus can cause a variety of infectious and non-infectious pulmonary complications. The purpose of this study is to raise awareness about post-COVID-19 pulmonary sequelae, both infectious and non-infectious, in this geographical area. A retrospective study was conducted from July 1st 2020 to December 20th 2020. A total of 1200 patients were evaluated, with 83 suffering from post-COVID-19 pulmonary complications. The patients' mean age was 62 years (IQR 55-69), with 63 (75.9%) being male. The most common co-morbid illnesses were hypertension (49, 59%) and diabetes (45, 54.2%). The majority of them (37, 44.6%) had severe COVID-19, followed by critical COVID-19 (33, 39.8%). There was no statistically significant difference in recurrence of respiratory symptoms or duration of current illness between non-severe, severe, and critical COVID-19 patients. Non-infectious complications were observed in the majority of patients (n=76, 91.5%), including organizing pneumonia/ground glass opacities in 71 (88%) patients, fibrosis in 44 (55%), pulmonary embolism in 10 (12.5%), pneumomediastinum in 6 (7.4%) and pneumothorax in 7 (8.6%). Infective complications (25, 30.1%) included aspergillus infection in 10 (12.0%) and bacterial infection in 5 (8.47%), with more gram-negative infections and one patient developing Mycobacterium tuberculosis. Post COVID-19 mortality was 11 (13.3%). The long-term pulmonary sequelae of COVID-19 are not rare. Cryptogenic organizing pneumonia, ground glass opacities, and fibrosis were common post-COVID-19 sequelae in our patients. This necessitates frequent close monitoring of these patients in order to initiate early appropriate management and prevent further morbidity and eventual mortality.
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Nasir N, Farooqi J, Zubair SM, Ayub M, Khan S, Wiqar MH, Mahmood SF, Jabeen K. Comparison of risk factors and outcome of patients with and without
COVID
‐19 associated pulmonary aspergillosis from Pakistan: A case‐control study. Mycoses 2022; 66:69-74. [PMID: 36111367 PMCID: PMC9537972 DOI: 10.1111/myc.13529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 11/30/2022]
Abstract
Background Early identification of COVID‐19‐associated pulmonary aspergillosis (CAPA) is particularly challenging in low‐ middle‐income countries where diagnostic capabilities are limited, and risk factors for CAPA have not been identified. It is also essential to recognise CAPA patients who are likely to have a poorer outcome to decide on aggressive management approaches. Therefore, this study aimed to identify risk factors and outcomes for CAPA among admitted moderate to critical COVID‐19 patients at our centre in Pakistan. Methods An unmatched case–control study with ratio of 1:2 was conducted on hospitalised adult patients with COVID‐19 from March 2020–July 2021. Cases were defined according to European Confederation of Medical Mycology and the International Society for Human and Animal Mycology consensus criteria. Controls were defined as patients hospitalised with moderate, severe or critical COVID‐19 without CAPA. Results A total of 100 CAPA cases (27 probable CAPA; 73 possible CAPA) were compared with 237 controls. Critical disease at presentation (aOR 5.04; 95% CI 2.18–11.63), age ≥ 60 years (aOR 2.00; 95% CI 1.20–3.35) and underlying co‐morbid of chronic kidney disease (CKD) (aOR 3.78; 95% CI 1.57–9.08) were identified as risk factors for CAPA. Patients with CAPA had a significantly greater proportion of complications and longer length of hospital stay (p‐value < .001). Mortality was higher in patients with CAPA (48%) as compared to those without CAPA (13.5%) [OR = 6.36(95% CI 3.6–11)]. Conclusions CAPA was significantly associated with advanced age, CKD and critical illness at presentation, along with a greater frequency of complications and higher mortality.
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Affiliation(s)
- Nosheen Nasir
- Department of Medicine Aga Khan University Karachi Pakistan
| | - Joveria Farooqi
- Department of Pathology & Laboratory Medicine Aga Khan University Karachi Pakistan
| | | | - Maaha Ayub
- Medical College Aga Khan University Karachi Pakistan
| | - Shahmeer Khan
- Medical College Aga Khan University Karachi Pakistan
| | | | | | - Kauser Jabeen
- Department of Pathology & Laboratory Medicine Aga Khan University Karachi Pakistan
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Liu A, Li Z, Su G, Li Y, Zhang Y, Liang J, Cheng X, Wang X, Li Y, Ye F. Mycotic infection as a risk factor for COVID-19: A meta-analysis. Front Public Health 2022; 10:943234. [PMID: 36159283 PMCID: PMC9489839 DOI: 10.3389/fpubh.2022.943234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/11/2022] [Indexed: 01/21/2023] Open
Abstract
More than 405 million people have contracted coronavirus disease 2019 (COVID-19) worldwide, and mycotic infection may be related to COVID-19 development. There are a large number of reports showing that COVID-19 patients with mycotic infection have an increased risk of mortality. However, whether mycotic infection can be considered a risk factor for COVID-19 remains unknown. We searched the PubMed and Web of Science databases for studies published from inception to December 27, 2021. Pooled effect sizes were calculated according to a random-effects model or fixed-effect model, depending on heterogeneity. We also performed subgroup analyses to identify differences in mortality rates between continents and fungal species. A total of 20 articles were included in this study. Compared with the controls, patients with mycotic infection had an odds ratio (OR) of 2.69 [95% confidence interval (CI): 2.22-3.26] for mortality and an OR of 2.28 (95% CI: 1.65-3.16) for renal replacement therapy (RRT). We also conducted two subgroup analyses based on continent and fungal species, and we found that Europe and Asia had the highest ORs, while Candida was the most dangerous strain of fungi. We performed Egger's test and Begg's test to evaluate the publication bias of the included articles, and the p-value was 0.423, which indicated no significant bias. Mycotic infection can be regarded as a risk factor for COVID-19, and decision makers should be made aware of this risk.
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Affiliation(s)
- Anlin Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,Nanshan School of Guangzhou Medical University, Guangzhou, China
| | - Zhengtu Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Guansheng Su
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ya Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,Nanshan School of Guangzhou Medical University, Guangzhou, China
| | - Yuzhuo Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,Nanshan School of Guangzhou Medical University, Guangzhou, China
| | - Jinkai Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,Nanshan School of Guangzhou Medical University, Guangzhou, China
| | - Xiaoxue Cheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,Nanshan School of Guangzhou Medical University, Guangzhou, China
| | - Xidong Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yongming Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Feng Ye
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,*Correspondence: Feng Ye ;
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Amaral RG, Santana RRR, Barbosa BO, Araújo YB, Lauton Santos S, Andrade LN. The The use of corticosteroid therapy for COVID-19 patients: an evidence-based overview. REVISTA CIÊNCIAS EM SAÚDE 2022. [DOI: 10.21876/rcshci.v12i3.1264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Since the World Health Organization declared COVID-19 as a pandemic, huge efforts to promote better treatment for the patients raised from the scientific community. One of the most effective treatment is the administration of corticosteroid in specific stages of the disease, once that severe COVID-19 pathophysiology evolves an exuberant inflammatory response, resulting in uncontrolled pulmonary inflammation and multisystem damage. However, it is still discussed whether some drugs, such as dexamethasone, are more effective than others, such as hydrocortisone and methylprednisolone. Therefore, we constructed here a comprehensive overview, based on clinical studies with detailed methodological procedures, regarding the role of corticosteroids in COVID-19 treatment. We aimed to address how the current evidence support their use in this scenario.
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Casalini G, Giacomelli A, Galimberti L, Colombo R, Ballone E, Pozza G, Zacheo M, Galimberti M, Oreni L, Carsana L, Longo M, Gismondo MR, Tonello C, Nebuloni M, Antinori S. Challenges in Diagnosing COVID-19-Associated Pulmonary Aspergillosis in Critically Ill Patients: The Relationship between Case Definitions and Autoptic Data. J Fungi (Basel) 2022; 8:jof8090894. [PMID: 36135619 PMCID: PMC9504285 DOI: 10.3390/jof8090894] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Critically ill COVID-19 patients can develop invasive pulmonary aspergillosis (CAPA). Considering the weaknesses of diagnostic tests/case definitions, as well as the results from autoptic studies, there is a debate on the real burden of aspergillosis in COVID-19 patients. We performed a retrospective observational study on mechanically ventilated critically ill COVID-19 patients in an intensive care unit (ICU). The primary objective was to determine the burden of CAPA by comparing clinical diagnosis (through case definitions/diagnostic algorithms) with autopsy results. Twenty patients out of 168 (11.9%) developed probable CAPA. Seven (35%) were females, and the median age was 66 [IQR 59–72] years. Thirteen CAPA patients (65%) died and, for six, an autopsy was performed providing a proven diagnosis in four cases. Histopathology findings suggest a focal pattern, rather than invasive and diffuse fungal disease, in the context of prominent viral pneumonia. In a cohort of mechanically ventilated patients with probable CAPA, by performing a high rate of complete autopsies, invasive aspergillosis was not always proven. It is still not clear whether aspergillosis is the major driver of mortality in patients with CAPA.
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Affiliation(s)
- Giacomo Casalini
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Andrea Giacomelli
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Laura Galimberti
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Riccardo Colombo
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Elisabetta Ballone
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Giacomo Pozza
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
| | - Martina Zacheo
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Miriam Galimberti
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Letizia Oreni
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Luca Carsana
- Pathology Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Margherita Longo
- Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Maria Rita Gismondo
- Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Cristina Tonello
- Pathology Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Manuela Nebuloni
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
- Pathology Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
- Correspondence: ; Tel.: +39-025-031-9765; Fax: +39-025-031-9758
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Madney Y, Shalaby L, Hammad M, Elanany M, Hassan R, Youssef A, Abdo I, Zaki A, Khedr R. COVID-19-Associated Pulmonary Fungal Infection among Pediatric Cancer Patients, a Single Center Experience. J Fungi (Basel) 2022; 8:jof8080850. [PMID: 36012838 PMCID: PMC9409978 DOI: 10.3390/jof8080850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 12/12/2022] Open
Abstract
Patients with COVID-19 are at risk of developing secondary complications such as invasive pulmonary aspergillosis and mucormycosis. This is a retrospective study including all cancer children diagnosed with COVID-19-associated pulmonary fungal infection (CAPFI) during the period 2020–2021. A total of 200 patients were diagnosed with COVID-19, out of which 21 (10%) patients were diagnosed with CAPFI, 19 patients (90%) with COVID-aspergillosis (CAPA), and 2 (10%) patients with COVID-mucormycosis (CAM). Patients with CAPFI were classified using the “2020 ECMM/ISHAM consensus criteria”; proven in 2 (10%) patients, probable in 12 (57%), and possible in 7 (33%) patients. Although the hematological malignancy patients were already on antifungal prophylaxis, breakthrough fungal infection was reported in 16/21 (75%), 14 (65%) patients had CAPA while on echinocandin prophylaxis, while 2 (10%) patients had CAM while on voriconazole prophylaxis. Overall mortality was reported in 8 patients (38%) while CAPFI-attributable mortality was reported in 4 patients (20%). In conclusion, clinicians caring for pediatric cancer patients with COVID-19 should consider invasive pulmonary fungal infection, even if they are on antifungal prophylaxis, especially with worsening of the clinical chest condition. A better understanding of risk factors for adverse outcomes may improve clinical management in these patients.
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Affiliation(s)
- Youssef Madney
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
- Correspondence:
| | - Lobna Shalaby
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Mahmoud Hammad
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Mervat Elanany
- Clinical Pathology Department, Faculty of Medicine, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Reem Hassan
- Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Ayda Youssef
- Radiodiagnosis Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Ibrahim Abdo
- Clinical Pharmacology Department, Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Abeer Zaki
- Clinical Research Department, Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
| | - Reham Khedr
- Pediatric Oncology Department, National Cancer Institute, Cairo University and Children’s Cancer Hospital Egypt (57357), Cairo 11311, Egypt
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50
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Long-Term Follow-Up of Patients Diagnosed with COVID-19-Associated Pulmonary Aspergillosis (CAPA). J Fungi (Basel) 2022; 8:jof8080840. [PMID: 36012828 PMCID: PMC9409906 DOI: 10.3390/jof8080840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
COVID-19-associated pulmonary aspergillosis (CAPA) have been documented during the COVID-19 pandemic. The vast majority of these patients do not meet the classic EORTC/MSGERC criteria for invasive pulmonary aspergillosis. The question arises as to whether there may have been an over-diagnosis of this disease. Here we review our experience and analyze the evolution of 27 patients who were diagnosed with CAPA during hospital admission. Surviving patients were followed-up for a mean time of 15 months (SD 3.78) by a group of experts and clinical records of diseased patients were reviewed. After expert evaluation and follow-up, 10 patients were finally assumed as CAPA according to expert opinion. These cases represent 40% of the initially CAPA assumed cases. Our data suggest the need to reconsider actual diagnosis criteria for CAPA what could drive to better identification of these patients.
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