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Khan A, El Hosseiny A, Siam R. Assessing and Reassessing the Association of Comorbidities and Coinfections in COVID-19 Patients. Cureus 2023; 15:e36683. [PMID: 37113367 PMCID: PMC10126732 DOI: 10.7759/cureus.36683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2023] [Indexed: 03/28/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has posed an enormous global health and economic burden. To date, 324 million confirmed cases and over 5.5 million deaths have been reported. Several studies have reported comorbidities and coinfections associated with complicated and serious COVID-19 infections. Data from retrospective, prospective, case series, and case reports from various geographical locations were assessed, which included ~ 2300 COVID-19 patients with varying comorbidities and coinfection. We report that Enterobacterales with Staphylococcus aureus was the most while Mycoplasma pneumoniae was the least prevalent coinfection in COVID-19 patients with a comorbidity. In this order, hypertension, diabetes, cardiovascular disease, and pulmonary disease were the prevalent comorbidities observed in COVID-19 patients. There was a statistically significant difference in the prevalent comorbidities observed in patients coinfected with Staphylococcus aureus and COVID-19 and a statistically non-significant difference in the prevalent comorbidities in patients coinfected with Mycoplasma pneumoniae and COVID-19 as compared to similar infections in non-COVID-19 coinfection. We report a significant difference in the prevalent comorbidities recorded in COVID-19 patients with varying coinfections and varying geographic study regions. Our study provides informative data on the prevalence of comorbidities and coinfections in COVID-19 patients to aid in evidence-based patient management and care.
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Baral PK, Aziz MA, Islam MS. Comparative risk assessment of COVID-19 associated mucormycosis and aspergillosis: A systematic review. Health Sci Rep 2022; 5:e789. [PMID: 36000078 PMCID: PMC9387898 DOI: 10.1002/hsr2.789] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022] Open
Abstract
COVID-19 is not only limited to a defined array but also has expanded with several secondary infections. Two uncommon opportunistic fungal infections, COVID-19 associated mucormycosis (CAM) and aspergillosis (CAA), have recently been highly acquainted by many worldwide cases. Two immune response deteriorating factors are considered to be responsible for immunosuppression: comorbidities and medication. Due to unlike infection sites and patterns, CAM and CAA-associated factors deflect a few degrees of proximity, and the present study is for its assessment. The study evaluated 351 CAM cases and 191 CAA cases retrieved from 65 and 53 articles based on inclusion criteria, respectively. Most of the CAM reported from India and CAA were from four South-European and West-European neighbor countries. The mean ages of CAM and CAA were 52.72 ± 13.74 and 64.81 ± 11.14, correspondingly. Mortality of CAA (56.28%) was two times greater than CAM (26.02%). Nevertheless, the count of diabetes cases was very high in CAM compared to CAA. The main comorbidities of CAM were diabetes (nearly 80%) and hypertension (more than 38%). All noticeable complications were higher in CAA except diabetes, and these were diabetes (34.55%), hypertension (45.03%), and obesity (18.32%). Moreover, pre-existing respiratory complications like asthma and chronic obstructive pulmonary disease are visible in CAA. The uses of steroids in CAM and CAA were nearly 70% and 66%, respectively. Almost one-fourth of CAA cases were reported using immunosuppressant monoclonal antibodies, whereas only 7.69% were for CAM. The overall finding highlights diabetes, hypertension, and steroids as the risk factors for CAM, whereas obesity, chronic pulmonary disease, and immunosuppressants for CAA.
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Affiliation(s)
- Prodip Kumar Baral
- Department of PharmacyNoakhali Science and Technology UniversityNoakhaliBangladesh
| | - Md. Abdul Aziz
- Department of PharmacyState University of BangladeshDhakaBangladesh
| | - Mohammad Safiqul Islam
- Department of PharmacyNoakhali Science and Technology UniversityNoakhaliBangladesh
- Laboratory of Pharmacogenomics and Molecular BiologyNoakhali Science and Technology UniversityNoakhaliBangladesh
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Antifungal therapy in the management of fungal secondary infections in COVID-19 patients: A systematic review and meta-analysis. PLoS One 2022; 17:e0271795. [PMID: 35901069 PMCID: PMC9333218 DOI: 10.1371/journal.pone.0271795] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 07/07/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The prevalence of fungal secondary infections among COVID-19 patients and efficacy of antifungal therapy used in such patients is still unknown. Hence, we conducted this study to find the prevalence of fungal secondary infections among COVID-19 patients and patient outcomes in terms of recovery or all-cause mortality following antifungal therapy (AFT) in such patients. Methods We performed a comprehensive literature search in PubMed®, Scopus®, Web of Sciences™, The Cochrane Library, ClinicalTrial.gov, MedRxiv.org, bioRxiv.org, and Google scholar to identify the literature that used antifungal therapy for the management fungal secondary infections in COVID-19 patients. We included case reports, case series, prospective & retrospective studies, and clinical trials. Mantel Haenszel random-effect model was used for estimating pooled risk ratio for required outcomes. Results A total of 33 case reports, 3 case series, and 21 cohort studies were selected for final data extraction and analysis. The prevalence of fungal secondary infections among COVID-19 patients was 28.2%. Azoles were the most commonly (65.1%) prescribed AFT. Study shows that high survival frequency among patients using AFT, received combination AFT and AFT used for >28 days. The meta-analysis showed, no significant difference in all-cause mortality between patients who received AFT and without AFT (p = 0.17), between types of AFT (p = 0.85) and the duration of AFT (p = 0.67). Conclusion The prevalence of fungal secondary infections among COVID-19 patients was 28.2%. The survival frequency was high among patients who used AFT for fungal secondary infections, received combination AFT and AFT used for >28 days. However, meta-analysis results found that all-cause mortality in COVID-19 patients with fungal secondary infections is not significantly associated with type and duration of AFT, mostly due to presence of confounding factors such as small number of events, delay in diagnosis of fungal secondary infections, presence of other co-infections and multiple comorbidities.
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Seyedjavadi SS, Bagheri P, Nasiri MJ, Razzaghi-Abyaneh M, Goudarzi M. Fungal Infection in Co-infected Patients With COVID-19: An Overview of Case Reports/Case Series and Systematic Review. Front Microbiol 2022; 13:888452. [PMID: 35875562 PMCID: PMC9298665 DOI: 10.3389/fmicb.2022.888452] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/03/2022] [Indexed: 01/08/2023] Open
Abstract
Fungal co-infections are frequent in patients with coronavirus disease 2019 (COVID-19) and can affect patient outcomes and hamper therapeutic efforts. Nonetheless, few studies have investigated fungal co-infections in this population. This study was performed to assess the rate of fungal co-infection in patients with COVID-19 as a systematic review. EMBASE, MEDLINE, and Web of Science were searched considering broad-based search criteria associated with COVID-19 and fungal co-infection. We included case reports and case series studies, published in the English language from January 1, 2020 to November 30, 2021, that reported clinical features, diagnosis, and outcomes of fungal co-infection in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Totally, 54 case reports and 17 case series were identified, and 181 patients (132 men, 47 women, and 2 not mentioned) co-infected with COVID-19 and fungal infection enrolled. The frequency of fungal co-infection among patients with COVID-19 was 49.7, 23.2, 19.8, 6.6, and 0.5% in Asia, America, Europe, Africa, and Australia, respectively. Diabetes (59.6%) and hypertension (35.9%) were found as the most considered comorbidities in COVID-19 patients with fungal infections. These patients mainly suffered from fever (40.8%), cough (30.3%), and dyspnea (23.7%). The most frequent findings in the laboratory results of patients and increase in C-reactive protein (CRP) (33.1%) and ferritin (18.2%), and lymphopenia (16%) were reported. The most common etiological agents of fungal infections were Aspergillus spp., Mucor spp., Rhizopus spp., and Candida spp. reported in study patients. The mortality rate was 54.6%, and the rate of discharged patients was 45.3%. Remdesivir and voriconazole were the most commonly used antiviral and antifungal agents for the treatment of patients. The global prevalence of COVID-19-related deaths is 6.6%. Our results showed that 54.6% of COVID-19 patients with fungal co-infections died. Thus, this study indicated that fungal co-infection and COVID-19 could increase mortality. Targeted policies should be considered to address this raised risk in the current pandemic. In addition, fungal infections are sometimes diagnosed late in patients with COVID-19, and the severity of the disease worsens, especially in patients with underlying conditions. Therefore, patients with fungal infections should be screened regularly during the COVID-19 pandemic to prevent the spread of the COVID-19 patients with fungal co-infection.
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Affiliation(s)
| | - Parmida Bagheri
- Department of Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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5
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Hashim Z, Nath A, Khan A, Neyaz Z, Marak RSK, Areekkara P, Tiwari A, Srivastava S, Agarwal V, Saxena S, Tripathy N, Azim A, Gupta M, Mishra DP, Mishra P, Singh RK, Gupta D, Gupta A, Sanjeev OP, Ghatak T, Ghoshal U, Dhiman RK, Tripathy NK. New Insights into Development and Mortality of COVID-19-Associated Pulmonary Aspergillosis in a Homogenous Cohort of 1161 Intensive Care Patients. Mycoses 2022; 65:1010-1023. [PMID: 35716344 PMCID: PMC9349548 DOI: 10.1111/myc.13485] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND COVID-19-associated pulmonary aspergillosis (CAPA) has been widely reported but homogenous large cohort studies are needed to gain real-world insights about the disease. METHODS We collected clinical and laboratory data of 1161 patients hospitalized at our Institute from March 2020 to August 2021, defined their CAPA pathology, and analyzed the data of CAPA/non-CAPA and deceased/survived CAPA patients using univariable and multivariable models. RESULTS The overall prevalence and mortality of CAPA in our homogenous cohort of 1161 patients was 6.4% and 47.3%, respectively. The mortality of CAPA was higher than that of non-CAPA patients (Hazard ratio: 1.8 [95% confidence interval: 1.1-2.8]). Diabetes (odds ratio 1.92 [1.15-3.21]); persistent fever (2.54 [1.17- 5.53]); hemoptysis (7.91[4.45-14.06]); and lung lesions of cavitation (8.78 [2.27-34.03]), consolidation (9.06 [2.03-40.39]), and nodules (8.26 [2.39-28.58]) were associated with development of CAPA by multivariable analysis. Acute respiratory distress syndrome (ARDS) (2.68 [1.09-6.55]), a high computed tomography score index (OR 1.18 [1.08-1.29]; p<0.001), and pulse glucocorticoid treatment (HR 4.0 [1.3-9.2]) were associated with mortality of the disease. Whereas neutrophilic leukocytosis (development: 1.09 [1.03-1.15]; mortality: 1.17 [1.08-1.28]) and lymphopenia (development: 0.68 [0.51-0.91]; mortality: 0.40 [0.20-0.83]) were associated with the development as well as mortality of CAPA. CONCLUSION We observed a low but likely underestimated prevalence of CAPA in our study. CAPA is a disease with highly mortality and diabetes is a significant factor for its development while ARDS and pulse glucocorticoid treatment are significant factors for its mortality. The cellular immune dysregulation may have a central role in CAPA from its development to mortality.
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Affiliation(s)
- Zia Hashim
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow-226014, India
| | - Alok Nath
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow-226014, India
| | - Ajmal Khan
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow-226014, India
| | - Zafar Neyaz
- Department of Radiodiagnosis, SGPGIMS, Raebareli Road, Lucknow-226014, India
| | - Rungmei S K Marak
- Department of Microbiology, SGPGIMS, Raebareli Road, Lucknow-226014, India
| | - Prasant Areekkara
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow-226014, India
| | - Atul Tiwari
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow-226014, India
| | - Shivani Srivastava
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow-226014, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Raebareli Road, Lucknow-226014, India
| | - Swati Saxena
- Department of Molecular Medicine, SGPGIMS, Raebareli Road, Lucknow-226014, India
| | - Nidhi Tripathy
- Department of Endocrinology, SGPGIMS, Raebareli Road, Lucknow-226014, India
| | - Afzal Azim
- Department of Critical Care Medicine, SGPGIMS, Raebareli Road, Lucknow-226014, India
| | - Mansi Gupta
- Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Raebareli Road, Lucknow-226014, India
| | - Durga Prasanna Mishra
- Department of Clinical Immunology and Rheumatology, SGPGIMS, Raebareli Road, Lucknow-226014, India
| | - Prabhakar Mishra
- Department of Biostatistics and Health Informatics, SGPGIMS, Raebareli Road, Lucknow-226014, India
| | - Ratender Kumar Singh
- Department of Emergency Medicine, SGPGIMS, Raebareli Road, Lucknow-226014, India
| | - Devender Gupta
- Department of Anesthesiology, SGPGIMS, Raebareli Road, Lucknow-226014, India
| | - Anshul Gupta
- Department of Hematology, SGPGIMS, Raebareli Road, Lucknow-226014, India
| | - Om Prakash Sanjeev
- Department of Emergency Medicine, SGPGIMS, Raebareli Road, Lucknow-226014, India
| | - Tanmoy Ghatak
- Department of Emergency Medicine, SGPGIMS, Raebareli Road, Lucknow-226014, India
| | - Ujjala Ghoshal
- Department of Microbiology, SGPGIMS, Raebareli Road, Lucknow-226014, India
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Vitale RG, Afeltra J, Seyedmousavi S, Giudicessi SL, Romero SM. An overview of COVID-19 related to fungal infections: what do we know after the first year of pandemic? Braz J Microbiol 2022; 53:759-775. [PMID: 35315001 PMCID: PMC8936386 DOI: 10.1007/s42770-022-00704-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/01/2022] [Indexed: 02/07/2023] Open
Abstract
In 2019, severe acute respiratory syndrome caused by CoV-2 virus became a pandemic worldwide, being the fast spread of the disease due to the movement of infected people from one country to another, from one continent to another, or within the same country. Associated comorbidities are important factors that predispose to any fungal coinfections. Because of the importance of fungal infections in COVID-19 patients, the aim of this work was to collect data of the more encountered mycoses related to patients undergoing this disease. Aspergillosis was the first COVID-19-related fungal infection reported, being A. fumigatus the most frequent species for CAPA. Other fungal infections related include mainly candidiasis and mucormycosis, being Rhizopus spp. the more prevalent species found. Influenza-associated pulmonary aspergillosis is well documented; thus, similar complications are expected in severe forms of COVID-19 pneumonia. Therefore, in patients with COVID-19, it is important to take special attention to the surveillance and suspicion of fungal coinfections that might worsen the patient's prognosis.
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Affiliation(s)
- R G Vitale
- Consejo Nacional de Investigaciones Científicas Y Tecnológicas (CONICET), Buenos Aires, Argentina.
- Unidad de Parasitología. Sector Micología. Hospital J.M. Ramos Mejía, Buenos Aires, Argentina.
| | - J Afeltra
- Unidad de Parasitología. Sector Micología. Hospital J.M. Ramos Mejía, Buenos Aires, Argentina
| | - S Seyedmousavi
- Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - S L Giudicessi
- Facultad de Farmacia Y Bioquímica, Cátedra de Biotecnología, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina
- Instituto de Nanobiotecnología (NANOBIOTEC), CONICET-UBA, Buenos Aires, Argentina
| | - S M Romero
- Consejo Nacional de Investigaciones Científicas Y Tecnológicas (CONICET), Buenos Aires, Argentina
- Instituto Multidisciplinario de Biología Vegetal (IMBIV), CONICET, FCEFyN, Universidad Nacional de Córdoba, Córdoba, Argentina
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7
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Giusiano G, Fernández NB, Vitale RG, Alvarez C, Ochiuzzi ME, Santiso G, Cabeza MS, Tracogna F, Farías L, Afeltra J, Noblega LM, Giuliano CV, Garcia-Effron G. Usefulness of Sōna Aspergillus Galactomannan LFA with digital readout as diagnostic and as screening tool of COVID-19 associated pulmonary aspergillosis in critically ill patients. Data from a multicenter prospective study performed in Argentina. Med Mycol 2022; 60:6565285. [PMID: 35394043 PMCID: PMC9051581 DOI: 10.1093/mmy/myac026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/17/2022] [Accepted: 04/06/2022] [Indexed: 11/14/2022] Open
Abstract
COVID-19 associated pulmonary aspergillosis (CAPA) incidence varies depending on the country. Serum galactomannan quantification is a promising diagnostic tool since samples are easy to obtain with low biosafety issues. A multicenter prospective study was performed to evaluate the CAPA incidence in Argentina and to assess the performance of the lateral flow assay with digital readout (Sōna Aspergillus LFA) as a CAPA diagnostic and screening tool. The correlation between the values obtained with Sōna Aspergillus LFA and Platelia® EIA was evaluated. In total, 578 serum samples were obtained from 185 critically ill COVID patients. CAPA screening was done weekly starting from the first week of ICU stay. Probable CAPA incidence in critically ill patients was 10.27% (19/185 patients when LFA was used as mycological criteria) and 9% (9/100 patients when EIA was used as mycological criteria). We found a very good correlation between the two evaluated galactomannan quantification methods (overall agreement of 92.16% with a Kappa statistic value of 0.721). CAPA diagnosis (>0.5 readouts in LFA) were done during the first week of ICU stay in 94.7% of the probable CAPA patients. The overall mortality was 36.21%. CAPA patients' mortality and length of ICU stay were not statistically different from for COVID (non-CAPA) patients (42.11% vs 33.13% and 29 vs 24 days, respectively). These indicators were lower than in other reports. LFA-IMMY with digital readout is a reliable tool for early diagnosis of CAPA using serum samples in critically ill COVID patients. It has a good agreement with Platelia® EIA.
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Affiliation(s)
- Gustavo Giusiano
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Argentina.,Instituto de Medicina Regional, Universidad Nacional del Nordeste, Resistencia (Chaco). Argentina
| | - Norma B Fernández
- Laboratorio de Micología, División Infectología, Hospital de Clínicas "José de San Martín" Universidad de Buenos Aires, Argentina
| | - Roxana G Vitale
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Argentina.,Unidad de Parasitología, Sector Micología, Hospital JM Ramos Mejía, Buenos Aires, Argentina
| | - Christian Alvarez
- División Micología, - Laboratorio de Salud Pública de Tucumán, San Miguel de Tucumán, Argentina
| | | | - Gabriela Santiso
- Centro de Estudios Micológicos, Ciudad Autónoma de Buenos Aires, Argentina; Unidad Micología del Hospital de Infecciosas F. J. Muñiz, Buenos Aires, Argentina
| | - Matías Sebastián Cabeza
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Argentina.,Laboratorio de Micología y Diagnóstico Molecular, Cátedra de Parasitología y Micología, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe, Argentina
| | | | - Luciana Farías
- Laboratorio de Micología, División Infectología, Hospital de Clínicas "José de San Martín" Universidad de Buenos Aires, Argentina
| | - Javier Afeltra
- Unidad de Parasitología, Sector Micología, Hospital JM Ramos Mejía, Buenos Aires, Argentina
| | - Luciana María Noblega
- División Micología, - Laboratorio de Salud Pública de Tucumán, San Miguel de Tucumán, Argentina
| | | | - Guillermo Garcia-Effron
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Argentina.,Laboratorio de Micología y Diagnóstico Molecular, Cátedra de Parasitología y Micología, Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe, Argentina
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8
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Rovina N, Koukaki E, Romanou V, Ampelioti S, Loverdos K, Chantziara V, Koutsoukou A, Dimopoulos G. Fungal Infections in Critically Ill COVID-19 Patients: Inevitabile Malum. J Clin Med 2022; 11:2017. [PMID: 35407625 PMCID: PMC8999371 DOI: 10.3390/jcm11072017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023] Open
Abstract
Patients with severe COVID-19 belong to a population at high risk of invasive fungal infections (IFIs), with a reported incidence of IFIs in critically ill COVID-19 patients ranging between 5% and 26.7%. Common factors in these patients, such as multiple organ failure, immunomodulating/immunocompromising treatments, the longer time on mechanical ventilation, renal replacement therapy or extracorporeal membrane oxygenation, make them vulnerable candidates for fungal infections. In addition to that, SARS-CoV2 itself is associated with significant dysfunction in the patient's immune system involving both innate and acquired immunity, with reduction in both CD4+ T and CD8+ T lymphocyte counts and cytokine storm. The emerging question is whether SARS-CoV-2 inherently predisposes critically ill patients to fungal infections or the immunosuppressive therapy constitutes the igniting factor for invasive mycoses. To approach the dilemma, one must consider the unique pathogenicity of SARS-CoV-2 with the deranged immune response it provokes, review the well-known effects of immunosuppressants and finally refer to current literature to probe possible causal relationships, synergistic effects or independent risk factors. In this review, we aimed to identify the prevalence, risk factors and mortality associated with IFIs in mechanically ventilated patients with COVID-19.
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Affiliation(s)
- Nikoletta Rovina
- 1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and “Sotiria” Chest Disease Hospital, 152 Mesogeion Ave, 11527 Athens, Greece; (E.K.); (V.R.); (S.A.); (K.L.); (V.C.); (A.K.); (G.D.)
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9
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Kaya T, Dilek A, Ozaras R, Balcik OS, Leblebicioglu H. COVID 19 and febrile neutropenia: Case report and systematic review. Travel Med Infect Dis 2022; 47:102305. [PMID: 35272019 PMCID: PMC8901240 DOI: 10.1016/j.tmaid.2022.102305] [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: 11/13/2021] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022]
Abstract
Objectives In pandemic conditions, patients with febrile neutropenia are also at risk of COVID-19. Aim of this systematic review is to evaluate COVID-19 cases presented with febrile neutropenia and provide information regarding incidence, clinical course and prognosis. Methods We systematically searched on COVID-19 and febrile neutropenia cases in PubMed, SCOPUS and Web of Science. Results A total of 19 febrile neutropenic patients were analyzed. A male predominance was noted. Eleven cases had hematological malignancies. Fourteen of the cases were previously received chemotherapy. Five patients had severe neutropenia: 3 had hematologic cancer and none died. 17 (89.5%) cases have pulmonary involvement and seven of them had severe disease with acute respiratory distress syndrome (ARDS). Three cases with ARDS were died. 12 of them received G-CSF for treatment. Five cases were developed respiratory failure after G-CSF use. Overall mortality was 15.8%, while death was not observed in patients without malignancy and solid organ tumors, the mortality rate was 27% in cases with hematological malignancies. Conclusion In ongoing pandemic, febrile neutropenic patients should be precisely evaluated for COVID-19 disease. It should be remembered that there may not be typical signs and symptoms and laboratory findings of COVID-19 disease because of the immunosuppression.
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Affiliation(s)
- Taner Kaya
- Department of Internal Medicine, VM Medicalpark Samsun Hospital, Samsun, Turkey.
| | - Ahmet Dilek
- Intensive Care Unit, VM Medicalpark Samsun Hospital, Samsun, Turkey; Istinye University, Faculty of Medicine, Istanbul, Turkey.
| | - Resat Ozaras
- Department of Infectious Diseases, Medilife Health Group, Istanbul, Turkey.
| | - Ozlem Sahin Balcik
- Department of Hematology, VM Medicalpark Samsun Hospital, Samsun, Turkey.
| | - Hakan Leblebicioglu
- Department of Infectious Diseases, VM Medicalpark Samsun Hospital, Samsun, Turkey.
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10
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Okoye C, Finamore P, Bellelli G, Coin A, Del Signore S, Fumagalli S, Gareri P, Malara A, Mossello E, Trevisan C, Volpato S, Zia G, Monzani F, Incalzi RA. Computed tomography findings and prognosis in older COVID-19 patients. BMC Geriatr 2022; 22:166. [PMID: 35227201 PMCID: PMC8885320 DOI: 10.1186/s12877-022-02837-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 02/08/2022] [Indexed: 12/12/2022] Open
Abstract
Background In older and multimorbid patients, chronic conditions may affect the prognostic validity of computed tomography (CT) findings in COVID-19. This study aims at assessing to which extent CT findings have prognostic implications in COVID-19 older patients. Methods Hospitalized COVID-19 patients aged 60 years or more enrolled in the multicenter, observational and longitudinal GeroCovid study who underwent chest CT were included. Patients were stratified by tertiles of age and pneumonia severity to compare CT findings. Hierarchical clustering based on CT findings was performed to identify CT-related classificatory constructs, if any. The hazard ratio (HR) of mortality was calculated for individual CT findings and for clusters, after adjusting for potential confounders. Results 380 hospitalized COVID-19 patients, with a mean age of 78 (SD:9) years, underwent chest CT scan. Ground glass opacity (GGO), consolidation, and pleural effusion were the three most common CT findings, with GGO prevalence decreasing from younger to older patients and pleural effusion increasing. More severe the pneumonia more prevalent were GGO, consolidation and pleural effusion. HR of mortality was 1.94 (95%CI 1.24–3.06) for pleural effusion and 13 (95%CI 6.41–27) for cluster with a low prevalence of GGO and a high prevalence of pleural effusion (“LH”), respectively. Out of the three CT based clusters, “LH” was the only independent predictor in the multivariable model. Conclusions Pleural effusion qualifies as a distinctive prognostic marker in older COVID-19 patients. Research is needed to verify whether pleural effusion reflects COVID-19 severity or a coexisting chronic condition making the patient at special risk of death. Trial registration ClinicalTrials.gov: NCT04379440 Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02837-7.
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Affiliation(s)
- Chukwuma Okoye
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Panaiotis Finamore
- Geriatrics Unit, Department of Medicine, Campus Bio-Medico University and Teaching Hospital, Rome, Italy.
| | - Giuseppe Bellelli
- School of Medicine and Surgery, Acute Geriatric Unit, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Alessandra Coin
- Geriatrics Unit and the GeroCovid Working Group, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | | | - Stefano Fumagalli
- Geriatric Intensive Care Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Pietro Gareri
- Center for Cognitive Disorders and Dementia - Catanzaro Lido, ASP Catanzaro, Italy
| | | | - Enrico Mossello
- Geriatric Intensive Care Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Caterina Trevisan
- Geriatrics Unit and the GeroCovid Working Group, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Raffaele Antonelli Incalzi
- Geriatrics Unit, Department of Medicine, Campus Bio-Medico University and Teaching Hospital, Rome, Italy
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11
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Defining COVID-19 associated pulmonary aspergillosis: systematic review and meta-analysis. Clin Microbiol Infect 2022; 28:920-927. [PMID: 35150878 PMCID: PMC8828380 DOI: 10.1016/j.cmi.2022.01.027] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 01/06/2023]
Abstract
Background Pulmonary aspergillosis may complicate coronavirus disease 2019 (COVID-19) and contribute to excess mortality in intensive care unit (ICU) patients. The disease is poorly understood, in part due to discordant definitions across studies. Objectives We sought to review the prevalence, diagnosis, treatment, and outcomes of COVID-19–associated pulmonary aspergillosis (CAPA) and compare research definitions. Data sources PubMed, Embase, Web of Science, and MedRxiv were searched from inception to October 12, 2021. Study eligibility criteria ICU cohort studies and CAPA case series including ≥3 patients were included. Participants Adult patients in ICUs with COVID-19. Interventions Patients were reclassified according to four research definitions. We assessed risk of bias with an adaptation of the Joanna Briggs Institute cohort checklist tool for systematic reviews. Methods We calculated CAPA prevalence using the Freeman-Tukey random effects method. Correlations between definitions were assessed with Spearman's rank test. Associations between antifungals and outcome were assessed with random effects meta-analysis. Results Fifty-one studies were included. Among 3297 COVID-19 patients in ICU cohort studies, 313 were diagnosed with CAPA (prevalence 10%; 95% CI 8%–13%). Two hundred seventy-seven patients had patient-level data allowing reclassification. Definitions had limited correlation with one another (ρ = 0.268–0.447; p < 0.001), with the exception of Koehler and Verweij (ρ = 0.893; p < 0.001); 33.9% of patients reported to have CAPA did not fulfill any research definitions. Patients were diagnosed after a median of 8 days (interquartile range 5–14) in ICUs. Tracheobronchitis occurred in 3% of patients examined with bronchoscopy. The mortality rate was high (59.2%). Applying CAPA research definitions did not strengthen the association between mould-active antifungals and survival. Conclusions The reported prevalence of CAPA is significant but may be exaggerated by nonstandard definitions.
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12
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Lu LY, Feng PH, Yu MS, Chen MC, Lin AJH, Chen JL, Yu LHL. Current utilization of interferon alpha for the treatment of coronavirus disease 2019: A comprehensive review. Cytokine Growth Factor Rev 2022; 63:34-43. [PMID: 35115233 PMCID: PMC8755267 DOI: 10.1016/j.cytogfr.2022.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/03/2022] [Accepted: 01/06/2022] [Indexed: 12/14/2022]
Abstract
Recent studies have identified an association between perturbed type I interferon (IFN) responses and the severity of coronavirus disease 2019 (COVID-19). IFNα intervention may normalize the dysregulated innate immunity of COVID-19. However, details regarding its utilization and therapeutic evidence have yet to be systematically evaluated. The aim of this comprehensive review was to summarize the current utilization of IFNα for COVID-19 treatment and to explore the evidence on safety and efficacy. A comprehensive review of clinical studies in the literature prior to December 1st, 2021, was performed to identify the current utilization of IFNα, which included details on the route of administration, the number of patients who received the treatment, the severity at the initiation of treatment, age range, the time from the onset of symptoms to treatment, dose, frequency, and duration as well as safety and efficacy. Encouragingly, no evidence was found against the safety of IFNα treatment for COVID-19. Early intervention, either within five days from the onset of symptoms or at hospital admission, confers better clinical outcomes, whereas late intervention may result in prolonged hospitalization.
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Affiliation(s)
- Ling-Ying Lu
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Kaohsiung Veterans General Hospital, No.386, Dazhong 1st Rd., Zuoying District, Kaohsiung City, Taiwan
| | - Po-Hao Feng
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, Taiwan,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City, Taiwan
| | - Ming-Sun Yu
- Division of Hematology, Conde S. Januário Hospital, Estrada do Visconde de São Januário, Macau, China
| | - Min-Chi Chen
- Graduate Institute of Biomedical Sciences, Chang Gung University, No. 259, Wenhua 1st Road, Guishan District, Taoyuan City, Taiwan
| | - Alex Jia-Hong Lin
- Medical Affairs Department, Panco Healthcare Co., Ltd., a PharmaEssentia Company, 2F-5 No. 3 Park Street, Nangang District, Taipei, Taiwan
| | - Justin L. Chen
- Medical Affairs Department, Panco Healthcare Co., Ltd., a PharmaEssentia Company, 2F-5 No. 3 Park Street, Nangang District, Taipei, Taiwan
| | - Lennex Hsueh-Lin Yu
- Medical Affairs Department, Panco Healthcare Co., Ltd., a PharmaEssentia Company, 2F-5 No. 3 Park Street, Nangang District, Taipei, Taiwan,Corresponding author
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13
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Khodavaisy S, Khajavirad N, Hashemi SJ, Izadi A, Dehghan Manshadi SA, Abdollahi A, Aliramezani A, Sasani E, Abdorahimi M, Kiyaeie RS, Khosravany Z, Getso MI, Salehi M. Proven pulmonary aspergillosis in a COVID-19 patient: A case report. Curr Med Mycol 2022; 7:39-42. [PMID: 35028484 PMCID: PMC8740855 DOI: 10.18502/cmm.7.2.7031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/20/2021] [Accepted: 07/04/2021] [Indexed: 01/08/2023] Open
Abstract
Background and Purpose: Coronavirus disease 2019 (COVID-19) has become a significant clinical challenge in healthcare settings all over the world. Critically ill COVID-19 patients with acute respiratory distress syndrome
may be at increased risk of co-infection with pulmonary aspergillosis. This study aimed to describe a clinical case of proven pulmonary aspergillosis caused by Aspergillus tubingensis
in a 59-year-old man with a history of hospitalization due to COVID-19 infection. Case report: The Covid-19 infection was confirmed by positive nasopharyngeal polymerase chain reaction. He had a cavitary lesion measured 20 mm in diameter with intracavitary soft tissue
density in the left lung in the first chest computerized tomography scan. After 25 days, he showed two cavitary lesions in both lungs which raised suspicion of fungal infection;
hence, the patient underwent a trans-thoracic biopsy of the cavitary lesion. The direct examination and culture of the biopsy material revealed Aspergillus species.
To confirm the Aspergillus species identification, the beta-tubulin region was sequenced. The patient was treated with oral voriconazole. Conclusion: This report underlined the importance of early diagnosis and management of invasive fungal infections in severe COVID-19 patients.
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Affiliation(s)
- Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Khajavirad
- Department of Internal Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Jamal Hashemi
- Department of Medical Parasitology and Mycology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Izadi
- Department of Medical Parasitology and Mycology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Dehghan Manshadi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Abdollahi
- Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Aliramezani
- Central Laboratory, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Elahe Sasani
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mahsa Abdorahimi
- Department of Microbiology, Shahr-e-Qods Branch, Islamic Azad University, Tehran, Iran
| | - Reyhaneh Sadat Kiyaeie
- Department of Medical Parasitology and Mycology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohre Khosravany
- Department of Medical Parasitology and Mycology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Muhammad Ibrahim Getso
- Department of Medical Parasitology and Mycology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Department of Medical Microbiology and Parasitology, College of Health Sciences, Faculty of Clinical Sciences, Bayero University, Kano, Nigeria
| | - Mohammadreza Salehi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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14
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Jiang Z, Chen S, Zhu Q, Xiao Y, Qu J. COVID-19-associated pulmonary aspergillosis in a tertiary care center in Shenzhen City. J Infect Public Health 2022; 15:222-227. [PMID: 35032951 PMCID: PMC8733224 DOI: 10.1016/j.jiph.2021.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 12/30/2022] Open
Abstract
Objectives The severe coronavirus disease 2019 (COVID-19) is characterized by acute respiratory distress syndrome (ARDS) and risk of fungal co-infection, pulmonary aspergillosis in particular. However, COVID-19 associated pulmonary aspergillosis (CAPA) cases remain limited due to the difficulty in diagnosis. Methods We describe presumptive invasive aspergillosis in eight patients diagnosed with COVID-19 in a single center in Shenzhen, China. Data collected include underlying conditions, mycological findings, immunodetection results, therapies and outcomes. Results Four of the eight patients had tested positive for Aspergillus by either culture or Next-generation sequencing analysis of sputum or bronchoalveolar lavage fluid (BALF), while the rest of patients had only positive results in antigen or antibody detection. Although all patients received antifungal therapies, six of these eight patients (66.7%) died. Conclusion Due to the high mortality rate of CAPA, clinical care in patients with CAPA deserves more attention.
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Affiliation(s)
- Zhaofang Jiang
- The Third People's Hospital of Shenzhen, Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - Shuyan Chen
- The Third People's Hospital of Shenzhen, Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - Qing Zhu
- The Third People's Hospital of Shenzhen, Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - Yanyu Xiao
- The Third People's Hospital of Shenzhen, Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - Jiuxin Qu
- The Third People's Hospital of Shenzhen, Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China.
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15
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Feys S, Almyroudi MP, Braspenning R, Lagrou K, Spriet I, Dimopoulos G, Wauters J. A Visual and Comprehensive Review on COVID-19-Associated Pulmonary Aspergillosis (CAPA). J Fungi (Basel) 2021; 7:1067. [PMID: 34947049 PMCID: PMC8708864 DOI: 10.3390/jof7121067] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 19 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a severe fungal infection complicating critically ill COVID-19 patients. Numerous retrospective and prospective studies have been performed to get a better grasp on this lethal co-infection. We performed a qualitative review and summarized data from 48 studies in which 7047 patients had been included, of whom 820 had CAPA. The pooled incidence of proven, probable or putative CAPA was 15.1% among 2953 ICU-admitted COVID-19 patients included in 18 prospective studies. Incidences showed great variability due to multiple factors such as discrepancies in the rate and depth of the fungal work-up. The pathophysiology and risk factors for CAPA are ill-defined, but therapy with corticosteroids and anti-interleukin-6 therapy potentially confer the biggest risk. Sampling for mycological work-up using bronchoscopy is the cornerstone for diagnosis, as imaging is often aspecific. CAPA is associated with an increased mortality, but we do not have conclusive data whether therapy contributes to an increased survival in these patients. We conclude our review with a comparison between influenza-associated pulmonary aspergillosis (IAPA) and CAPA.
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Affiliation(s)
- Simon Feys
- Medical Intensive Care Unit, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium;
| | - Maria Panagiota Almyroudi
- Department of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Reinout Braspenning
- Medical Intensive Care Unit, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium;
- Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
| | - George Dimopoulos
- ICU of 1st Department of Critical Care, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Joost Wauters
- Medical Intensive Care Unit, University Hospitals Leuven, 3000 Leuven, Belgium;
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium;
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16
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Banfalvi G. Janus-Faced Molecules against Plant Pathogenic Fungi. Int J Mol Sci 2021; 22:12323. [PMID: 34830204 PMCID: PMC8623416 DOI: 10.3390/ijms222212323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
The high cytotoxicity of the secondary metabolites of mycotoxins is capable of killing microbes and tumour cells alike, similarly to the genotoxic effect characteristic of Janus-faced molecules. The "double-edged sword" effect of several cytotoxins is known, and these agents have, therefore, been utilized only reluctantly against fungal infections. In this review, consideration was given to (a) toxins that could be used against plant and human pathogens, (b) animal models that measure the effect of antifungal agents, (c) known antifungal agents that have been described and efficiently prevent the growth of fungal cells, and (d) the chemical interactions that are characteristic of antifungal agents. The utilization of apoptotic effects against tumour growth by agents that, at the same time, induce mutations may raise ethical issues. Nevertheless, it deserves consideration despite the mutagenic impact of Janus-faced molecules for those patients who suffer from plant pathogenic fungal infections and are older than their fertility age, in the same way that the short-term cytotoxicity of cancer treatment is favoured over the long-term mutagenic effect.
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Affiliation(s)
- Gaspar Banfalvi
- Department of Molecular Biotechnology and Microbiology, Faculty of Science and Technology, University of Debrecen, 1 Egyetem Square, 4010 Debrecen, Hungary
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17
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Sivasubramanian G, Ghanem H, Maison-Fomotar M, Jain R, Libke R. COVID-19-Associated Pulmonary Aspergillosis: A Single-Center Experience in Central Valley, California, January 2020-March 2021. J Fungi (Basel) 2021; 7:jof7110948. [PMID: 34829235 PMCID: PMC8618928 DOI: 10.3390/jof7110948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022] Open
Abstract
Reports of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) have been widely published across the world since the onset of the pandemic with varying incidence rates. We retrospectively studied all patients with severe COVID-19 infection who were admitted to our tertiary care center′s intensive care units between January 2020 and March 2021, who also had respiratory cultures positive for Aspergillus species. Among a large cohort of 970 patients admitted to the ICU with severe COVID-19 infections during our study period, 48 patients had Aspergillus species growing in respiratory cultures. Based on the 2020 European Confederation of Medical Mycology and the International Society for Human and Animal Mycology (ECMM/ISHAM) consensus criteria, 2 patients in the study had proven CAPA, 9 had probable CAPA, and 37 had possible CAPA. The incidence of CAPA was 5%. The mean duration from a positive COVID-19 test to Aspergillus spp. being recovered from the respiratory cultures was 16 days, and more than half of the patients had preceding fever or worsening respiratory failure despite adequate support and management. Antifungals were given for treatment in 44% of the patients for a mean duration of 13 days. The overall mortality rate in our study population was extremely high with death occurring in 40/48 patients (83%).
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Affiliation(s)
- Geetha Sivasubramanian
- Division of Infectious Diseases, Department of Internal Medicine, University of California, San Francisco, CA 93701, USA; (H.G.); (M.M.-F.); (R.L.)
- Correspondence: ; Tel.: +1-559-499-6484; Fax: +1-559-499-6501
| | - Hebah Ghanem
- Division of Infectious Diseases, Department of Internal Medicine, University of California, San Francisco, CA 93701, USA; (H.G.); (M.M.-F.); (R.L.)
| | - Michele Maison-Fomotar
- Division of Infectious Diseases, Department of Internal Medicine, University of California, San Francisco, CA 93701, USA; (H.G.); (M.M.-F.); (R.L.)
| | - Ratnali Jain
- UCSF Fresno Research Institute, University of California, San Francisco, CA 93701, USA;
| | - Robert Libke
- Division of Infectious Diseases, Department of Internal Medicine, University of California, San Francisco, CA 93701, USA; (H.G.); (M.M.-F.); (R.L.)
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18
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Casalini G, Giacomelli A, Ridolfo A, Gervasoni C, Antinori S. Invasive Fungal Infections Complicating COVID-19: A Narrative Review. J Fungi (Basel) 2021; 7:921. [PMID: 34829210 PMCID: PMC8620819 DOI: 10.3390/jof7110921] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
Invasive fungal infections (IFIs) can complicate the clinical course of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients admitted to an intensive care unit (ICU). This narrative review concerns 4099 cases of IFIs in 58,784 COVID-19 patients involved in 168 studies. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is a diagnostic challenge because its non-specific clinical/imaging features and the fact that the proposed clinically diagnostic algorithms do not really apply to COVID-19 patients. Forty-seven observational studies and 41 case reports have described a total of 478 CAPA cases that were mainly diagnosed on the basis of cultured respiratory specimens and/or biomarkers/molecular biology, usually without histopathological confirmation. Candidemia is a widely described secondary infection in critically ill patients undergoing prolonged hospitalisation, and the case reports and observational studies of 401 cases indicate high crude mortality rates of 56.1% and 74.8%, respectively. COVID-19 patients are often characterised by the presence of known risk factors for candidemia such as in-dwelling vascular catheters, mechanical ventilation, and broad-spectrum antibiotics. We also describe 3185 cases of mucormycosis (including 1549 cases of rhino-orbital mucormycosis (48.6%)), for which the main risk factor is a history of poorly controlled diabetes mellitus (>76%). Its diagnosis involves a histopathological examination of tissue biopsies, and its treatment requires anti-fungal therapy combined with aggressive surgical resection/debridement, but crude mortality rates are again high: 50.8% in case reports and 16% in observational studies. The presence of other secondary IFIs usually diagnosed in severely immunocompromised patients show that SARS-CoV-2 is capable of stunning the host immune system: 20 cases of Pneumocystis jirovecii pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to Fusarium spp., and 1 case of pulmonary infection due to Scedosporium.
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Affiliation(s)
- Giacomo Casalini
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (G.C.); (A.G.)
| | - Andrea Giacomelli
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (G.C.); (A.G.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.R.); (C.G.)
| | - Annalisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.R.); (C.G.)
| | - Cristina Gervasoni
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.R.); (C.G.)
| | - Spinello Antinori
- Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy; (G.C.); (A.G.)
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.R.); (C.G.)
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19
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Singh S, Verma N, Kanaujia R, Chakrabarti A, Rudramurthy SM. Mortality in critically ill patients with coronavirus disease 2019-associated pulmonary aspergillosis: A systematic review and meta-analysis. Mycoses 2021; 64:1015-1027. [PMID: 34057252 DOI: 10.1111/myc.13328] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/19/2021] [Accepted: 05/22/2021] [Indexed: 12/15/2022]
Abstract
Reports of COVID-19 associated pulmonary aspergillosis (CAPA) are rising, but the associated mortality and factors affecting it are not well-characterised. We performed a systematic review including 20 peer-reviewed English language studies reporting mortality in CAPA published till 18 February 2021from PubMed, Ovid SP, Web of Science, Embase and CINHAL. The pooled mortality in CAPA was 51.2% (95% CI: 43.1-61.1, I2 = 38%). The leave one out sensitivity analysis and influential case diagnostics revealed one outlier and its exclusion resulted in a mortality estimate of 54% (95% CI: 45-62). Higher odds of mortality: 2.83 (95% CI: 1.8-4.5) were seen in CAPA compared to controls. No significant difference in various subgroups according to the country of study, the continent of study, income category of country and quality of the included study was seen. None of the host risk factors, mycological test results, therapy for COVID-19 and antifungal therapy affected mortality. Thus, patients with CAPA have a high probability of mortality and early diagnosis with prompt therapy must be ensured to optimally manage these patients. However, more prospective studies with global and multi-centre coordination may help to address CAPA in a better way.
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Affiliation(s)
- Shreya Singh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nipun Verma
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rimjhim Kanaujia
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Ezeokoli OT, Gcilitshana O, Pohl CH. Risk Factors for Fungal Co-Infections in Critically Ill COVID-19 Patients, with a Focus on Immunosuppressants. J Fungi (Basel) 2021; 7:545. [PMID: 34356924 PMCID: PMC8304654 DOI: 10.3390/jof7070545] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/15/2022] Open
Abstract
Severe cases of coronavirus disease 2019 (COVID-19) managed in the intensive care unit are prone to complications, including secondary infections with opportunistic fungal pathogens. Systemic fungal co-infections in hospitalized COVID-19 patients may exacerbate COVID-19 disease severity, hamper treatment effectiveness and increase mortality. Here, we reiterate the role of fungal co-infections in exacerbating COVID-19 disease severity as well as highlight emerging trends related to fungal disease burden in COVID-19 patients. Furthermore, we provide perspectives on the risk factors for fungal co-infections in hospitalized COVID-19 patients and highlight the potential role of prolonged immunomodulatory treatments in driving fungal co-infections, including COVID-19-associated pulmonary aspergillosis (CAPA), COVID-19-associated candidiasis (CAC) and mucormycosis. We reiterate the need for early diagnosis of suspected COVID-19-associated systemic mycoses in the hospital setting.
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Affiliation(s)
| | | | - Carolina H. Pohl
- Yeast Research Group, Department of Microbiology and Biochemistry, University of the Free State, Bloemfontein 9300, South Africa or (O.T.E.); (O.G.)
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21
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Johnson AK, Ghazarian Z, Cendrowski KD, Persichino JG. Pulmonary aspergillosis and mucormycosis in a patient with COVID-19. Med Mycol Case Rep 2021; 32:64-67. [PMID: 33842203 PMCID: PMC8025540 DOI: 10.1016/j.mmcr.2021.03.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 12/21/2022] Open
Abstract
Invasive pulmonary mucormycosis and aspergillosis are rare, life-threatening fungal infections. Most documented cases have been reported in patients with diabetes mellitus, neutropenia, or treatment with corticosteroids. Both infections have been recognized as secondary complications of COVID-19, especially among critically ill patients. We report the first case of combined probable pulmonary aspergillosis and possible mucormycosis in a male with COVID-19 in the ICU.
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Affiliation(s)
- Andre K Johnson
- Riverside Community Hospital, Division of Infectious Diseases, 4445 Magnolia Avenue, Riverside, CA, 92501, USA
| | - Zeron Ghazarian
- Riverside Community Hospital, Division of Pulmonary and Critical Care, 4445 Magnolia Avenue, Riverside, CA, 92501, USA
| | - Kristina D Cendrowski
- Riverside Community Hospital, Department of Pathology, 4445 Magnolia Avenue, Riverside, CA, 92501, USA
| | - Jon G Persichino
- Riverside Community Hospital, Division of Infectious Diseases, 4445 Magnolia Avenue, Riverside, CA, 92501, USA
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