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Castro-Fuentes CA, Reyes-Montes MDR, Frías-De-León MG, Valencia-Ledezma OE, Acosta-Altamirano G, Duarte-Escalante E. Aspergillus-SARS-CoV-2 Coinfection: What Is Known? Pathogens 2022; 11:1227. [PMID: 36364979 PMCID: PMC9694759 DOI: 10.3390/pathogens11111227] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/17/2022] [Accepted: 10/21/2022] [Indexed: 07/30/2023] Open
Abstract
COVID-19-associated pulmonary aspergillosis (CAPA) has had a high incidence. In addition, it has been associated with prolonged hospital stays, as well as several predisposing risk factors, such as fungal factors (nosocomial organism, the size of the conidia, and the ability of the Aspergillus spp. of colonizing the respiratory tract), environmental factors (remodeling in hospitals, use of air conditioning and negative pressure in intensive care units), comorbidities, and immunosuppressive therapies. In addition to these factors, SARS-CoV-2 per se is associated with significant dysfunction of the patient's immune system, involving both innate and acquired immunity, with reduced CD4+ and CD8+ T cell counts and cytokine storm. Therefore, this review aims to identify the factors influencing the fungus so that coinfection with SARS-CoV-2 can occur. In addition, we analyze the predisposing factors in the fungus, host, and the immune response alteration due to the pathogenicity of SARS-CoV-2 that causes the development of CAPA.
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Affiliation(s)
- Carlos Alberto Castro-Fuentes
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, Mexico City 04510, Mexico
| | - María del Rocío Reyes-Montes
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, Mexico City 04510, Mexico
| | - María Guadalupe Frías-De-León
- Hospital Regional de Alta Especialidad de Ixtapaluca, Carretera Federal México-Puebla Km. 34.5, Pueblo de Zoquiapan, Ixtapaluca 56530, Mexico
| | - Omar E. Valencia-Ledezma
- Hospital Regional de Alta Especialidad de Ixtapaluca, Carretera Federal México-Puebla Km. 34.5, Pueblo de Zoquiapan, Ixtapaluca 56530, Mexico
| | - Gustavo Acosta-Altamirano
- Hospital Regional de Alta Especialidad de Ixtapaluca, Carretera Federal México-Puebla Km. 34.5, Pueblo de Zoquiapan, Ixtapaluca 56530, Mexico
| | - Esperanza Duarte-Escalante
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Avenida Universidad 3000, Ciudad Universitaria, Coyoacán, Mexico City 04510, Mexico
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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] [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 Pharmacy Noakhali Science and Technology University Noakhali Bangladesh
| | - Md. Abdul Aziz
- Department of Pharmacy State University of Bangladesh Dhaka Bangladesh
| | - Mohammad Safiqul Islam
- Department of Pharmacy Noakhali Science and Technology University Noakhali Bangladesh
- Laboratory of Pharmacogenomics and Molecular Biology Noakhali Science and Technology University Noakhali Bangladesh
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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: 0] [Impact Index Per Article: 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: 16] [Impact Index Per Article: 8.0] [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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Fischer T, El Baz Y, Graf N, Wildermuth S, Leschka S, Kleger GR, Pietsch U, Frischknecht M, Scanferla G, Strahm C, Wälti S, Dietrich TJ, Albrich WC. Clinical and Imaging Features of COVID-19-Associated Pulmonary Aspergillosis. Diagnostics (Basel) 2022; 12:diagnostics12051201. [PMID: 35626356 PMCID: PMC9140144 DOI: 10.3390/diagnostics12051201] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
Background: COVID-19 superinfection by Aspergillus (COVID-19-associated aspergillosis, CAPA) is increasingly observed due to increased awareness and use of corticosteroids. The aim of this study is to compare clinical and imaging features between COVID-19 patients with and without associated pulmonary aspergillosis. Material and Methods: In this case–control study, hospitalized patients between March 2020 and March 2021 were evaluated. Two observers independently compared 105 chest CTs of 52 COVID-19 patients without pulmonary aspergillosis to 40 chest CTs of 13 CAPA patients. The following features were evaluated: lung involvement, predominant main pattern (ground glass opacity, crazy paving, consolidation) and additional lung and chest findings. Chronological changes in the abnormal extent upon CT and chronological changes in the main patterns were compared with mixed models. Patient-wise comparisons of additional features and demographic and clinical data were performed using Student’s t-test, Chi-squared test, Fisher’s exact tests and Wilcoxon rank-sum tests. Results: Compared to COVID-19 patients without pulmonary aspergillosis, CAPA patients were older (mean age (±SD): 70.3 (±7.8) versus 63.5 (±9.5) years (p = 0.01). The time-dependent evolution rates for consolidation (p = 0.02) and ground glass (p = 0.006) differed. In early COVID-19 disease, consolidation was associated with CAPA, whereas ground glass was less common. Chronological changes in the abnormal extent upon CT did not differ (p = 0.29). Regardless of the time point, bronchial wall thickening was observed more frequently in CAPA patients (p = 0.03). Conclusions: CAPA patients showed a tendency for consolidation in early COVID-19 disease. Bronchial wall thickening and higher patient age were associated with CAPA. The overall lung involvement was similar between both groups.
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Affiliation(s)
- Tim Fischer
- Division of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, 9007 St. Gallen, Switzerland; (Y.E.B.); (S.W.); (S.L.); (S.W.); (T.J.D.)
- Correspondence: ; Tel.: +41-71-494-2185
| | - Yassir El Baz
- Division of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, 9007 St. Gallen, Switzerland; (Y.E.B.); (S.W.); (S.L.); (S.W.); (T.J.D.)
| | - Nicole Graf
- Clinical Trials Unit, St. Gallen Cantonal Hospital, 9007 St. Gallen, Switzerland;
| | - Simon Wildermuth
- Division of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, 9007 St. Gallen, Switzerland; (Y.E.B.); (S.W.); (S.L.); (S.W.); (T.J.D.)
| | - Sebastian Leschka
- Division of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, 9007 St. Gallen, Switzerland; (Y.E.B.); (S.W.); (S.L.); (S.W.); (T.J.D.)
| | - Gian-Reto Kleger
- Division of Intensive Care, St. Gallen Cantonal Hospital, 9007 St. Gallen, Switzerland;
| | - Urs Pietsch
- Department of Anesthesia, Intensive Care, Emergency and Pain Medicine, St. Gallen Cantonal Hospital, 9007 St. Gallen, Switzerland;
| | - Manuel Frischknecht
- Division of Infectious Diseases and Hospital Epidemiology, St. Gallen Cantonal Hospital, 9007 St. Gallen, Switzerland; (M.F.); (G.S.); (C.S.); (W.C.A.)
| | - Giulia Scanferla
- Division of Infectious Diseases and Hospital Epidemiology, St. Gallen Cantonal Hospital, 9007 St. Gallen, Switzerland; (M.F.); (G.S.); (C.S.); (W.C.A.)
| | - Carol Strahm
- Division of Infectious Diseases and Hospital Epidemiology, St. Gallen Cantonal Hospital, 9007 St. Gallen, Switzerland; (M.F.); (G.S.); (C.S.); (W.C.A.)
| | - Stephan Wälti
- Division of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, 9007 St. Gallen, Switzerland; (Y.E.B.); (S.W.); (S.L.); (S.W.); (T.J.D.)
| | - Tobias Johannes Dietrich
- Division of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, 9007 St. Gallen, Switzerland; (Y.E.B.); (S.W.); (S.L.); (S.W.); (T.J.D.)
| | - Werner C. Albrich
- Division of Infectious Diseases and Hospital Epidemiology, St. Gallen Cantonal Hospital, 9007 St. Gallen, Switzerland; (M.F.); (G.S.); (C.S.); (W.C.A.)
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Hoyek NE, Ghorayeb J, Daou I, Jamal D, Mahfoud N, Nawfal G. A post-COVID-19 Aspergillus fumigatus posterior mediastinitis: Case report. SAGE Open Med Case Rep 2022; 10:2050313X221081386. [PMID: 35251662 PMCID: PMC8891915 DOI: 10.1177/2050313x221081386] [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: 07/27/2021] [Accepted: 02/01/2022] [Indexed: 11/24/2022] Open
Abstract
Invasive aspergillosis is a life-threatening condition of the immunocompromised, with a low occurrence reported in the immunocompetent. Although usually made by invasive methods, its early diagnosis is the cornerstone of a better prognosis as it yields a timely management and thus a lower mortality risk. Mediastinal invasion by Aspergillus is, like any fungal mediastinitis, uncommon and usually results from a hematogeneous or a contiguous spread, a postoperative fungal infection, a complication of a descending necrotizing fasciitis, or from an esophageal perforation. We report a case of a diabetic patient with a previous history of hospitalization 2 months earlier for a COVID-19 infection, otherwise healthy, presenting with an unresolving dorsal pain. A malignancy was expected but further work-up showed in fine a posterior mediastinitis due to Aspergillus fumigatus. Thus, fungal etiologies are to be included as a differential while diagnosing a posterior mediastinitis even in a relatively immunocompetent patient and with no evident route of entry.
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Affiliation(s)
- Nadine El Hoyek
- Department of Radiology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jacques Ghorayeb
- Department of Orthopedic Surgery, Saint Joseph University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Iskandar Daou
- Department of Radiology, Saint Joseph University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Dany Jamal
- Department of Intensive Care Unit, Saint Joseph University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Nathalie Mahfoud
- Department of Pathology, Saint Joseph University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Georges Nawfal
- Department of Radiology, Saint Joseph University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
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Salazar F, Bignell E, Brown GD, Cook PC, Warris A. Pathogenesis of Respiratory Viral and Fungal Coinfections. Clin Microbiol Rev 2022; 35:e0009421. [PMID: 34788127 PMCID: PMC8597983 DOI: 10.1128/cmr.00094-21] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Individuals suffering from severe viral respiratory tract infections have recently emerged as "at risk" groups for developing invasive fungal infections. Influenza virus is one of the most common causes of acute lower respiratory tract infections worldwide. Fungal infections complicating influenza pneumonia are associated with increased disease severity and mortality, with invasive pulmonary aspergillosis being the most common manifestation. Strikingly, similar observations have been made during the current coronavirus disease 2019 (COVID-19) pandemic. The copathogenesis of respiratory viral and fungal coinfections is complex and involves a dynamic interplay between the host immune defenses and the virulence of the microbes involved that often results in failure to return to homeostasis. In this review, we discuss the main mechanisms underlying susceptibility to invasive fungal disease following respiratory viral infections. A comprehensive understanding of these interactions will aid the development of therapeutic modalities against newly identified targets to prevent and treat these emerging coinfections.
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Affiliation(s)
- Fabián Salazar
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Elaine Bignell
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Gordon D. Brown
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Peter C. Cook
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
| | - Adilia Warris
- Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
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Invasive Fungal Infections Complicating COVID-19: A Narrative Review. J Fungi (Basel) 2021; 7:jof7110921. [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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Gregoire E, Pirotte BF, Moerman F, Altdorfer A, Gaspard L, Firre E, Moonen M, Fraipont V, Ernst M, Darcis G. Incidence and Risk Factors of COVID-19-Associated Pulmonary Aspergillosis in Intensive Care Unit-A Monocentric Retrospective Observational Study. Pathogens 2021; 10:pathogens10111370. [PMID: 34832526 PMCID: PMC8623919 DOI: 10.3390/pathogens10111370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is an increasingly recognized complication of COVID-19 and is associated with significant over-mortality. We performed a retrospective monocentric study in patients admitted to the intensive care unit (ICU) for respiratory insufficiency due to COVID-19 from March to December 2020, in order to evaluate the incidence of CAPA and the associated risk factors. We also analysed the diagnostic approach used in our medical centre for CAPA diagnosis. We defined CAPA using recently proposed consensus definitions based on clinical, radiological and microbiological criteria. Probable cases of CAPA occurred in 9 out of 141 patients included in the analysis (6.4%). All cases were diagnosed during the second wave of the pandemic. We observed a significantly higher realization rate of bronchoalveolar lavage (BAL) (51.1% vs. 28.6%, p = 0.01) and Aspergillus testing (through galactomannan, culture, PCR) on BAL samples during the second wave (p < 0.0001). The testing for Aspergillus in patients meeting the clinical and radiological criteria of CAPA increased between the two waves (p < 0.0001). In conclusion, we reported a low but likely underestimated incidence of CAPA in our population. A greater awareness and more systematic testing for Aspergillus are necessary to assess the real incidence and characteristics of CAPA.
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Affiliation(s)
- Emilien Gregoire
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier Régional (CHR) de Liège, 4000 Liège, Belgium; (B.F.P.); (F.M.); (A.A.); (L.G.); (E.F.); (M.M.)
- Correspondence:
| | - Benoit François Pirotte
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier Régional (CHR) de Liège, 4000 Liège, Belgium; (B.F.P.); (F.M.); (A.A.); (L.G.); (E.F.); (M.M.)
| | - Filip Moerman
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier Régional (CHR) de Liège, 4000 Liège, Belgium; (B.F.P.); (F.M.); (A.A.); (L.G.); (E.F.); (M.M.)
| | - Antoine Altdorfer
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier Régional (CHR) de Liège, 4000 Liège, Belgium; (B.F.P.); (F.M.); (A.A.); (L.G.); (E.F.); (M.M.)
| | - Laura Gaspard
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier Régional (CHR) de Liège, 4000 Liège, Belgium; (B.F.P.); (F.M.); (A.A.); (L.G.); (E.F.); (M.M.)
| | - Eric Firre
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier Régional (CHR) de Liège, 4000 Liège, Belgium; (B.F.P.); (F.M.); (A.A.); (L.G.); (E.F.); (M.M.)
| | - Martial Moonen
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier Régional (CHR) de Liège, 4000 Liège, Belgium; (B.F.P.); (F.M.); (A.A.); (L.G.); (E.F.); (M.M.)
| | - Vincent Fraipont
- Intensive Care Unit, Centre Hospitalier Régional (CHR) de Liège, 4000 Liège, Belgium;
| | - Marie Ernst
- Biostatistics and Medico-Economic Information Department, Centre Hospitalier Universitaire (CHU) de Liège, 4000 Liege, Belgium;
| | - Gilles Darcis
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier Universitaire (CHU) de Liège, 4000 Liège, Belgium;
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Dimopoulos G, Almyroudi MP, Myrianthefs P, Rello J. COVID-19-Associated Pulmonary Aspergillosis (CAPA). JOURNAL OF INTENSIVE MEDICINE 2021; 1:71-80. [PMID: 36785564 PMCID: PMC8346330 DOI: 10.1016/j.jointm.2021.07.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/02/2021] [Accepted: 07/07/2021] [Indexed: 04/24/2023]
Abstract
Invasive Pulmonary Aspergillosis (IPA) has been recognized as a possible secondary infection complicating Coronavirus disease 2019 (COVID-19) and increasing mortality. The aim of this review was to report and summarize the available data in the literature concerning the incidence, pathophysiology, diagnosis, and treatment of COVID-19-Associated Pulmonary Aspergillosis (CAPA). Currently, the incidence of CAPA is unclear due to different definitions and diagnostic criteria used among the studies. It was estimated that approximately 8.6% (206/2383) of mechanically ventilated patients were diagnosed with either proven, probable, or putative CAPA. Classical host factors of invasive aspergillosis are rarely recognized in patients with CAPA, who are mainly immuno-competent presenting with comorbidities, while the role of steroids warrants further investigation. Direct epithelial injury and diffuse pulmonary micro thrombi in combination with immune dysregulation, hyper inflammatory response, and immunosuppressive treatment may be implicated. Discrimination between two forms of CAPA (e.g., tracheobronchial and parenchymal) is required, whereas radiological signs of aspergillosis are not typically evident in patients with severe COVID-19 pneumonia. In previous studies, the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria, a clinical algorithm to diagnose Invasive Pulmonary Aspergillosis in intensive care unit patients (AspICU algorithm), and influenza-associated pulmonary aspergillosis (IAPA) criteria were used for the diagnosis of proven/probable and putative CAPA, as well as the differentiation from colonization, which can be challenging. Aspergillus fumigatus is the most commonly isolated pathogen in respiratory cultures. Bronchoalveolar lavage (BAL) and serum galactomannan (GM), β-d-glucan (with limited specificity), polymerase chain reaction (PCR), and Aspergillus-specific lateral-flow device test can be included in the diagnostic work-up; however, these approaches are characterized by low sensitivity. Early treatment of CAPA is necessary, and 71.4% (135/189) of patients received antifungal therapy, mainly with voriconazole, isavuconazole, and liposomal amphotericin B . Given the high mortality rate among patients with Aspergillus infection, the administration of prophylactic treatment is debated. In conclusion, different diagnostic strategies are necessary to differentiate colonization from bronchial or parenchymal infection in intubated COVID-19 patients with Aspergillus spp. in their respiratory specimens vs. those not infected with severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). Following confirmation, voriconazole or isavuconazole should be used for the treatment of CAPA.
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Affiliation(s)
- George Dimopoulos
- Department of Critical Care, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens 12462, Greece
- Corresponding authors: Jordi Rello, Universitat Internacional de Catalunya, Barcelona 08035, Spain; George Dimopoulos, Department of Critical Care, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens 12462, Greece. Email addresses: ;
| | - Maria-Panagiota Almyroudi
- Department of Emergency Medicine, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens 12462, Greece
| | - Pavlos Myrianthefs
- Department of Critical Care, Agioi Anargyroi Hospital, National and Kapodistrian University of Athens, Athens 14564, Greece
| | - Jordi Rello
- Universitat Internacional de Catalunya, Barcelona 08035, Spain
- Corresponding authors: Jordi Rello, Universitat Internacional de Catalunya, Barcelona 08035, Spain; George Dimopoulos, Department of Critical Care, University Hospital ATTIKON, National and Kapodistrian University of Athens, Athens 12462, Greece. Email addresses: ;
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11
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Overview on the Prevalence of Fungal Infections, Immune Response, and Microbiome Role in COVID-19 Patients. J Fungi (Basel) 2021; 7:jof7090720. [PMID: 34575758 PMCID: PMC8466761 DOI: 10.3390/jof7090720] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 01/08/2023] Open
Abstract
Patients with severe COVID-19, such as individuals in intensive care units (ICU), are exceptionally susceptible to bacterial and fungal infections. The most prevalent fungal infections are aspergillosis and candidemia. Nonetheless, other fungal species (for instance, Histoplasma spp., Rhizopus spp., Mucor spp., Cryptococcus spp.) have recently been increasingly linked to opportunistic fungal diseases in COVID-19 patients. These fungal co-infections are described with rising incidence, severe illness, and death that is associated with host immune response. Awareness of the high risks of the occurrence of fungal co-infections is crucial to downgrade any arrear in diagnosis and treatment to support the prevention of severe illness and death directly related to these infections. This review analyses the fungal infections, treatments, outcome, and immune response, considering the possible role of the microbiome in these patients. The search was performed in Medline (PubMed), using the words "fungal infections COVID-19", between 2020-2021.
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12
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Silva JT, Ruiz-Camps I, Aguado JM. [Invasive fungal infection over the last 30 years]. Rev Iberoam Micol 2021; 38:47-51. [PMID: 34294520 DOI: 10.1016/j.riam.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/03/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Abstract
Clinical mycology is in continuous development. The appearance of new clinical guidelines has made it possible to improve the approach to opportunistic fungal infections, especially in immunosuppressed patients (oncohematological and/or transplant recipients). At the same time, the development of new diagnostic tools and new antifungals with a greater spectrum of action and fewer side effects have led to faster diagnoses and treatments that are more effective. Along with these advances, there has been a change in the epidemiology of invasive fungal infection (IFI), with the appearance of new patients (e.g., COPD, liver cirrhosis, post-influenza) and new microorganisms (Candida auris, Lomentospora prolificans, mucorales), and resistant fungi (isolates of Aspergillus resistant to azoles) which the clinician must take into account when choosing the treatment of a patient with an IFI. In this paper we will briefly review the advances in recent decades and the emerging problems.
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Affiliation(s)
- José Tiago Silva
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre. Instituto de Investigación Hospital 12 de Octubre (i+12). Universidad Complutense de Madrid
| | - Isabel Ruiz-Camps
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona
| | - José María Aguado
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre. Instituto de Investigación Hospital 12 de Octubre (i+12). Universidad Complutense de Madrid.
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13
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Frías-De-León MG, Pinto-Almazán R, Hernández-Castro R, García-Salazar E, Meza-Meneses P, Rodríguez-Cerdeira C, Arenas R, Conde-Cuevas E, Acosta-Altamirano G, Martínez-Herrera E. Epidemiology of Systemic Mycoses in the COVID-19 Pandemic. J Fungi (Basel) 2021; 7:jof7070556. [PMID: 34356935 PMCID: PMC8307417 DOI: 10.3390/jof7070556] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 02/06/2023] Open
Abstract
The physiopathologic characteristics of COVID-19 (high levels of inflammatory cytokines and T-cell reduction) promote fungal colonization and infection, which can go unnoticed because the symptoms in both diseases are very similar. The objective of this work was to study the current epidemiology of systemic mycosis in COVID-19 times. A literature search on the subject (January 2020–February 2021) was performed in PubMed, Embase, Cochrane Library, and LILACS without language restrictions. Demographic data, etiological agent, risk factors, diagnostic methods, antifungal treatment, and fatality rate were considered. Eighty nine publications were found on co-infection by COVID-19 and pneumocystosis, candidiasis, aspergillosis, mucormycosis, coccidioidomycosis, or histoplasmosis. In general, the co-infections occurred in males over the age of 40 with immunosuppression caused by various conditions. Several species were identified in candidiasis and aspergillosis co-infections. For diagnosis, diverse methods were used, from microbiological to molecular. Most patients received antifungals; however, the fatality rates were 11–100%. The latter may result because the clinical picture is usually attributed exclusively to SARS-CoV-2, preventing a clinical suspicion for mycosis. Diagnostic tests also have limitations beginning with sampling. Therefore, in the remainder of the pandemic, these diagnostic limitations must be overcome to achieve a better patient prognosis.
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Affiliation(s)
- María Guadalupe Frías-De-León
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ciudad de México PC 56530, Estado de México, Mexico; (M.G.F.-D.-L.); (R.P.-A.); (E.G.-S.); (G.A.-A.)
| | - Rodolfo Pinto-Almazán
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ciudad de México PC 56530, Estado de México, Mexico; (M.G.F.-D.-L.); (R.P.-A.); (E.G.-S.); (G.A.-A.)
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomas, Alcaldía Miguel Hidalgo, Ciudad de México PC 11340, Estado de México, Mexico
| | - Rigoberto Hernández-Castro
- Departamento de Ecología de Agentes Patógenos, Hospital General “Dr. Manuel Gea González”, Ciudad de México PC 14080, Estado de México, Mexico;
| | - Eduardo García-Salazar
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ciudad de México PC 56530, Estado de México, Mexico; (M.G.F.-D.-L.); (R.P.-A.); (E.G.-S.); (G.A.-A.)
- Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomas, Alcaldía Miguel Hidalgo, Ciudad de México PC 11340, Estado de México, Mexico; (P.M.-M.); (E.C.-C.)
| | - Patricia Meza-Meneses
- Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomas, Alcaldía Miguel Hidalgo, Ciudad de México PC 11340, Estado de México, Mexico; (P.M.-M.); (E.C.-C.)
- Servicio de Infectología, Hospital Regional de Alta Especialidad de Ixtapaluca, Ciudad de México PC 56530, Estado de México, Mexico
| | - Carmen Rodríguez-Cerdeira
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, PC 36213 Vigo, Spain; (C.R.-C.); (R.A.)
- Dermatology Department, Hospital Vithas Ntra. Sra. de Fátima and University of Vigo, PC 36206 Vigo, Spain
- Campus Universitario, University of Vigo, PC 36310 Vigo, Spain
| | - Roberto Arenas
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, PC 36213 Vigo, Spain; (C.R.-C.); (R.A.)
- Sección de Micología, Hospital General “Dr. Manuel Gea González”, Ciudad de México PC 14080, Estado de México, Mexico
| | - Esther Conde-Cuevas
- Maestría en Ciencias de la Salud, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomas, Alcaldía Miguel Hidalgo, Ciudad de México PC 11340, Estado de México, Mexico; (P.M.-M.); (E.C.-C.)
| | - Gustavo Acosta-Altamirano
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ciudad de México PC 56530, Estado de México, Mexico; (M.G.F.-D.-L.); (R.P.-A.); (E.G.-S.); (G.A.-A.)
| | - Erick Martínez-Herrera
- Unidad de Investigación, Hospital Regional de Alta Especialidad de Ixtapaluca, Ciudad de México PC 56530, Estado de México, Mexico; (M.G.F.-D.-L.); (R.P.-A.); (E.G.-S.); (G.A.-A.)
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Plan de San Luis y Díaz Mirón s/n, Col. Casco de Santo Tomas, Alcaldía Miguel Hidalgo, Ciudad de México PC 11340, Estado de México, Mexico
- Efficiency, Quality, and Costs in Health Services Research Group (EFISALUD), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, PC 36213 Vigo, Spain; (C.R.-C.); (R.A.)
- Correspondence: ; Tel.: +52-555-972-9800
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14
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Pasquier G, Bounhiol A, Robert Gangneux F, Zahar JR, Gangneux JP, Novara A, Bougnoux ME, Dannaoui E. A review of significance of Aspergillus detection in airways of ICU COVID-19 patients. Mycoses 2021; 64:980-988. [PMID: 34143533 PMCID: PMC8447125 DOI: 10.1111/myc.13341] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/31/2021] [Accepted: 06/05/2021] [Indexed: 01/20/2023]
Abstract
It is now well known that patients with SARS-CoV-2 infection admitted in ICU and mechanically ventilated are at risk of developing invasive pulmonary aspergillosis (IPA). Nevertheless, symptomatology of IPA is often atypical in mechanically ventilated patients, and radiological aspects in SARS-CoV-2 pneumonia and IPA are difficult to differentiate. In this context, the significance of the presence of Aspergillus in airway specimens (detected by culture, galactomannan antigen or specific PCR) remains to be fully understood. To decipher the relevance of the detection of Aspergillus, we performed a comprehensive review of all published cases of respiratory Aspergillus colonisation and IPA in COVID-19 patients. The comparison of patients receiving or not antifungal treatment allowed us to highlight the most important criteria for the decision to treat. The comparison of surviving and non-surviving patients made it possible to unveil criteria associated with mortality that should be taken into account in the treatment decision.
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Affiliation(s)
- Grégoire Pasquier
- Microbiology Department, Parasitology-Mycology Unit, Faculty of Medicine, Paris University, Necker-Enfants maladies Hospital, Paris, France
| | - Agathe Bounhiol
- Microbiology Department, Parasitology-Mycology Unit, Faculty of Medicine, Paris University, AP-HP, European Georges-Pompidou Hospital, Paris, France
| | - Florence Robert Gangneux
- Parasitology-Mycology Department, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, University Rennes, Rennes, France
| | | | - Jean Pierre Gangneux
- Parasitology-Mycology Department, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, University Rennes, Rennes, France
| | - Ana Novara
- Medical Intensive Care Unit, Faculty of Medicine, Paris-Descartes University, AP-HP, European Georges-Pompidou Hospital, Paris, France
| | - Marie-Elisabeth Bougnoux
- Microbiology Department, Parasitology-Mycology Unit, Faculty of Medicine, Paris University, Necker-Enfants maladies Hospital, Paris, France.,Fungal biology and Pathogenicity. Institut Pasteur, Paris, France
| | - Eric Dannaoui
- Microbiology Department, Parasitology-Mycology Unit, Faculty of Medicine, Paris University, AP-HP, European Georges-Pompidou Hospital, Paris, France.,Dynamyc EA 7380, Paris-Créteil University, Créteil, France
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15
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Chong WH, Saha BK, Ananthakrishnan Ramani, Chopra A. State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia. Infection 2021; 49:591-605. [PMID: 33709380 PMCID: PMC7951131 DOI: 10.1007/s15010-021-01602-z] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/03/2021] [Indexed: 01/08/2023]
Abstract
Background The incidence of secondary pulmonary infections is not well described in hospitalized COVID-19 patients. Understanding the incidence of secondary pulmonary infections and the associated bacterial and fungal microorganisms identified can improve patient outcomes. Objective This narrative review aims to determine the incidence of secondary bacterial and fungal pulmonary infections in hospitalized COVID-19 patients, and describe the bacterial and fungal microorganisms identified. Method We perform a literature search and select articles with confirmed diagnoses of secondary bacterial and fungal pulmonary infections that occur 48 h after admission, using respiratory tract cultures in hospitalized adult COVID-19 patients. We exclude articles involving co-infections defined as infections diagnosed at the time of admission by non-SARS-CoV-2 viruses, bacteria, and fungal microorganisms. Results The incidence of secondary pulmonary infections is low at 16% (4.8–42.8%) for bacterial infections and lower for fungal infections at 6.3% (0.9–33.3%) in hospitalized COVID-19 patients. Secondary pulmonary infections are predominantly seen in critically ill hospitalized COVID-19 patients. The most common bacterial microorganisms identified in the respiratory tract cultures are Pseudomonas aeruginosa, Klebsiella species, Staphylococcus aureus, Escherichia coli, and Stenotrophomonas maltophilia. Aspergillus fumigatus is the most common microorganism identified to cause secondary fungal pulmonary infections. Other rare opportunistic infection reported such as PJP is mostly confined to small case series and case reports. The overall time to diagnose secondary bacterial and fungal pulmonary infections is 10 days (2–21 days) from initial hospitalization and 9 days (4–18 days) after ICU admission. The use of antibiotics is high at 60–100% involving the studies included in our review. Conclusion The widespread use of empirical antibiotics during the current pandemic may contribute to the development of multidrug-resistant microorganisms, and antimicrobial stewardship programs are required for minimizing and de-escalating antibiotics. Due to the variation in definition across most studies, a large, well-designed study is required to determine the incidence, risk factors, and outcomes of secondary pulmonary infections in hospitalized COVID-19 patients.
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Affiliation(s)
- Woon H Chong
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, USA.
| | - Biplab K Saha
- Department of Pulmonary and Critical Care, Ozarks Medical Center, West Plains, MO, USA
| | | | - Amit Chopra
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, USA
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16
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Salehi M, Khajavirad N, Seifi A, Salahshour F, Jahanbin B, Kazemizadeh H, Hashemi SJ, Dehghan Manshadi SA, Kord M, Verweij PE, Khodavaisy S. Proven Aspergillus flavus pulmonary aspergillosis in a COVID-19 patient: A case report and review of the literature. Mycoses 2021; 64:809-816. [PMID: 33576014 PMCID: PMC8014135 DOI: 10.1111/myc.13255] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/03/2021] [Accepted: 02/08/2021] [Indexed: 01/01/2023]
Abstract
Severe COVID‐19 patients complicated with aspergillosis are increasingly reported. We present a histopathological proven case of fatal COVID‐19–associated pulmonary aspergillosis (CAPA), due to Aspergillus flavus. This report and existing published literature indicate diagnostic challenges and poor outcomes of CAPA in ICU patients.
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Affiliation(s)
- Mohammadreza Salehi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasim Khajavirad
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Seifi
- Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Faeze Salahshour
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Jahanbin
- Pathology Department, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Kazemizadeh
- Advanced Thoracic Research Center, Occupational Sleep Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Jamal Hashemi
- Department of Medical Parasitology and Mycology, School 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
| | - Mohammad Kord
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Paul E Verweij
- Department of Medical Microbiology and Center of Expertise in Mycology Radboudumc/CWZ, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sadegh Khodavaisy
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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17
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Trovato L, Calvo M, Migliorisi G, Astuto M, Oliveri F, Oliveri S. Fatal VAP-related pulmonary aspergillosis by Aspergillus niger in a positive COVID-19 patient. Respir Med Case Rep 2021; 32:101367. [PMID: 33619451 PMCID: PMC7890353 DOI: 10.1016/j.rmcr.2021.101367] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/08/2021] [Accepted: 02/13/2021] [Indexed: 12/16/2022] Open
Abstract
Invasive pulmonary aspergillosis, known as a complication in patients with severe respiratory syndromes, recently showed a correlation with COVID-19 pneumonia, and the clinical characteristics of COVID-19 associated pulmonary aspergillosis (CAPA) have been described. Unfortunately, infections by the Aspergillus genus are often diagnosed in post-mortem time, because of diagnostic delays and a rapid worsening of respiratory conditions. Literature data document, in fact, only few cases of COVID-19 Aspergillus niger coinfection. The aim of this study was to describe a case of a VAP-related probable pulmonary aspergillosis by Aspergillus niger in a COVID-19 patient. Despite the definition of fungal etiology and the rapid administration of antifungal therapy, the patient died while on ventilator support because of severe respiratory impairment.
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Affiliation(s)
- Laura Trovato
- U.O.C. Laboratory Analysis Unit, A.O.U. "Policlinico-Vittorio Emanuele", Via S. Sofia 78, Catania, 95123, Italy.,Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 97, Catania, 95123, Italy
| | - Maddalena Calvo
- U.O.C. Laboratory Analysis Unit, A.O.U. "Policlinico-Vittorio Emanuele", Via S. Sofia 78, Catania, 95123, Italy
| | - Giuseppe Migliorisi
- U.O.C. Laboratory Analysis Unit, A.O.U. "Policlinico-Vittorio Emanuele", Via S. Sofia 78, Catania, 95123, Italy
| | - Marinella Astuto
- Department of Anesthesia and Intensive Care, A.O.U. "Policlinico -Vittorio Emanuele", Via S. Sofia 78, Catania, 95123, Italy
| | - Francesco Oliveri
- Department of Anesthesia and Intensive Care, A.O.U. "Policlinico -Vittorio Emanuele", Via S. Sofia 78, Catania, 95123, Italy
| | - Salvatore Oliveri
- U.O.C. Laboratory Analysis Unit, A.O.U. "Policlinico-Vittorio Emanuele", Via S. Sofia 78, Catania, 95123, Italy.,Department of Biomedical and Biotechnological Sciences, University of Catania, Via S. Sofia 97, Catania, 95123, Italy
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18
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Salmanton-García J, Sprute R, Stemler J, Bartoletti M, Dupont D, Valerio M, Garcia-Vidal C, Falces-Romero I, Machado M, de la Villa S, Schroeder M, Hoyo I, Hanses F, Ferreira-Paim K, Giacobbe DR, Meis JF, Gangneux JP, Rodríguez-Guardado A, Antinori S, Sal E, Malaj X, Seidel D, Cornely OA, Koehler P. COVID-19-Associated Pulmonary Aspergillosis, March-August 2020. Emerg Infect Dis 2021; 27:1077-1086. [PMID: 33539721 PMCID: PMC8007287 DOI: 10.3201/eid2704.204895] [Citation(s) in RCA: 169] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Because of the severe immunomodulation and lymphocyte depletion caused by this virus and the subsequent administration of drugs directed at the immune system, we anticipated that patients might experience fungal superinfection. We collected data from 186 patients who had coronavirus disease-associated pulmonary aspergillosis (CAPA) worldwide during March-August 2020. Overall, 182 patients were admitted to the intensive care unit (ICU), including 180 with acute respiratory distress syndrome and 175 who received mechanical ventilation. CAPA was diagnosed a median of 10 days after coronavirus disease diagnosis. Aspergillus fumigatus was identified in 80.3% of patient cultures, 4 of which were azole-resistant. Most (52.7%) patients received voriconazole. In total, 52.2% of patients died; of the deaths, 33.0% were attributed to CAPA. We found that the cumulative incidence of CAPA in the ICU ranged from 1.0% to 39.1%.
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