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Siasios P, Arvaniti K, Zachrou E, Poulopoulou A, Pisanidou P, Vasileiadou G, Kaimakamis E, Georgopoulou A, Renta F, Lathyris D, Veroniki F, Geka E, Soultati I, Argiriadou E, Apostolidou E, Amoiridou P, Ioannou K, Kouras L, Mimitou I, Stokkos K, Flioni E, Pertsas E, Sileli M, Iasonidou C, Sourla E, Pitsiou G, Vyzantiadis TA. COVID-19-Associated Pulmonary Aspergillosis (CAPA) in Northern Greece during 2020-2022: A Comparative Study According to the Main Consensus Criteria and Definitions. J Fungi (Basel) 2023; 9:jof9010081. [PMID: 36675902 PMCID: PMC9863007 DOI: 10.3390/jof9010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) has emerged as an important complication among patients with acute respiratory failure due to SARS-CoV-2 infection. Almost 2.5 years since the start of the COVID-19 pandemic, it continues to raise concerns as an extra factor that contributes to increased mortality, which is mostly because its diagnosis and management remain challenging. The present study utilises the cases of forty-three patients hospitalised between August 2020 and February 2022 whose information was gathered from ten ICUs and special care units based in northern Greece. The main aim was to describe the gained experience in diagnosing CAPA, according to the implementation of the main existing diagnostic consensus criteria and definitions, and present the different classification of the clinical cases due to the alternative algorithms.
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Affiliation(s)
- Panagiotis Siasios
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
- Correspondence:
| | - Kostoula Arvaniti
- ICU, “Papageorgiou” General Hospital of Thessaloniki, 56403 Thessaloniki, Greece
| | - Evangelia Zachrou
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Aikaterini Poulopoulou
- Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Pinelopi Pisanidou
- ICU, “Papageorgiou” General Hospital of Thessaloniki, 56403 Thessaloniki, Greece
| | - Georgia Vasileiadou
- First ICU, “G. Papanikolaou” General Hospital of Thessaloniki, 57010 Thessaloniki, Greece
| | - Evangelos Kaimakamis
- First ICU, “G. Papanikolaou” General Hospital of Thessaloniki, 57010 Thessaloniki, Greece
| | - Athina Georgopoulou
- First ICU, “G. Papanikolaou” General Hospital of Thessaloniki, 57010 Thessaloniki, Greece
| | - Foteini Renta
- ICU, “G. Gennimatas” General Hospital of Thessaloniki, 54635 Thessaloniki, Greece
| | - Dimitrios Lathyris
- ICU, “G. Gennimatas” General Hospital of Thessaloniki, 54635 Thessaloniki, Greece
| | - Foteini Veroniki
- First ICU, “AHEPA” University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece
| | - Eleni Geka
- First ICU, “AHEPA” University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece
| | - Ioanna Soultati
- Second ICU, “AHEPA” University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece
| | - Eleni Argiriadou
- Second ICU, “AHEPA” University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece
| | - Eleni Apostolidou
- ICU, “Bodossakio” General Hospital of Ptolemaida, 50200 Ptolemaida, Greece
| | - Pinelopi Amoiridou
- ICU, “Bodossakio” General Hospital of Ptolemaida, 50200 Ptolemaida, Greece
| | | | - Leonidas Kouras
- ICU, “Mamatsio” General Hospital of Kozani, 50100 Kozani, Greece
| | - Ioanna Mimitou
- ICU, “Mamatsio” General Hospital of Kozani, 50100 Kozani, Greece
| | | | - Elliniki Flioni
- ICU, “Agios Pavlos” General Hospital of Thessaloniki, 55134 Thessaloniki, Greece
| | - Evangelos Pertsas
- ICU, “Agios Pavlos” General Hospital of Thessaloniki, 55134 Thessaloniki, Greece
| | - Maria Sileli
- Second ICU, “G. Papanikolaou” General Hospital of Thessaloniki, 57010 Thessaloniki, Greece
| | - Christina Iasonidou
- Second ICU, “G. Papanikolaou” General Hospital of Thessaloniki, 57010 Thessaloniki, Greece
| | - Evdokia Sourla
- Respiratory Failure Unit, “G. Papanikolaou” General Hospital of Thessaloniki, 57010 Thessaloniki, Greece
| | - Georgia Pitsiou
- Respiratory Failure Unit, “G. Papanikolaou” General Hospital of Thessaloniki, 57010 Thessaloniki, Greece
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Katal S, Eibschutz LS, Radmard AR, Naderpour Z, Gupta A, Hejal R, Gholamrezanezhad A. Black Fungus and beyond: COVID-19 associated infections. Clin Imaging 2022; 90:97-109. [PMID: 36007282 PMCID: PMC9308173 DOI: 10.1016/j.clinimag.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 12/15/2022]
Abstract
Globally, many hospitalized COVID-19 patients can experience an unexpected acute change in status, prompting rapid and expert clinical assessment. Superimposed infections can be a significant cause of clinical and radiologic deviations in this patient population, further worsening clinical outcome and muddling the differential diagnosis. As thrombotic, inflammatory, and medication-induced complications can also trigger an acute change in COVID-19 patient status, imaging early and often plays a vital role in distinguishing the cause of patient decline and monitoring patient outcome. While the common radiologic findings of COVID-19 infection are now widely reported, little is known about the clinical manifestations and imaging findings of superimposed infection. By discussing case studies of patients who developed bacterial, fungal, parasitic, and viral co-infections and identifying the most frequently reported imaging findings of superimposed infections, physicians will be more familiar with common infectious presentations and initiate a directed workup sooner. Ultimately, any abrupt changes in the expected COVID-19 imaging presentation, such as the presence of new consolidations or cavitation, should prompt further workup to exclude superimposed opportunistic infection.
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Affiliation(s)
- Sanaz Katal
- Department of Nuclear Medicine, Shiraz Kowsar Hospital, Tehran University of Medical Sciences
| | - Liesl S Eibschutz
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, United States of America
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Iran
| | - Zeinab Naderpour
- Department of Pulmonology, Shariati Hospital, Tehran University of Medical Sciences, Iran
| | - Amit Gupta
- Department of Radiology, University Hospital Cleveland Medical Center, Cleveland, OH, United States of America
| | - Rana Hejal
- Department of Internal Medicine, Division of Pulmonary Critical Care, University Hospital Cleveland Medical Center, Cleveland, OH, United States of America
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, United States of America.
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COVID-19-Associated Pulmonary Aspergillosis in a Tertiary Hospital. J Fungi (Basel) 2022; 8:jof8020097. [PMID: 35205852 PMCID: PMC8874611 DOI: 10.3390/jof8020097] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/12/2022] [Accepted: 01/15/2022] [Indexed: 12/15/2022] Open
Abstract
Our study aims to assess the prevalence of CAPA (COVID-19-associated pulmonary aspergillosis) and describe the associated risk factors and their impact on mortality. A prospective study was conducted. We included patients with COVID-19 disease who were admitted to the ICU with a diagnosis of respiratory failur. Mycological culture and other biomarkers (calcofluor staining, LFD, LFA, PCR, GM, and B-D-glucan) were performed. A total of 300 patients were included in the study. Thirty-five patients were diagnosed with CAPA (prevalence 11.7%). During admission, 57 patients died (19%), and, in the group of CAPA patients, mortality was 31.4%. In multivariate analysis, independent risk factors associated with CAPA diagnosis were age (OR: 1.05; 95% CI 1.01–1.09; p = 0.037), chronic lung disease (OR: 3.85; 95% CI 1.02–14.9; p = 0.049) and treatment with tocilizumab during admission (OR: 14.5; 95% 6.1–34.9; p = 0.001). Factors independently associated with mortality were age (OR: 1.06; 95% CI 1.01–1.11; p = 0.014) and CAPA diagnosis during admission (OR: 3.34; 95% CI 1.38–8.08; p = 0.007). CAPA is an infection that appears in many patients with COVID-19 disease. CAPA is associated with high mortality rates, which may be reduced by early diagnosis and initiation of appropriate antifungal therapy, so screening of COVID-19 ARDS (acute respiratory distress syndrome) patients for CAPA is essential.
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Abstract
PURPOSE OF REVIEW This review will comment on the current knowledge for the diagnosis of the main causes of COVID-19-associated invasive fungal disease (IFD); it will discuss the optimal strategies and limitations and wherever available, will describe international recommendations. RECENT FINDINGS A range of secondary IFDs complicating COVID-19 infection have been described and while COVID-19-associated pulmonary aspergillosis was predicted, the presentation of significant numbers of COVID-19-associated candidosis and COVID-19-associated mucormycosis was somewhat unexpected. Given the range of IFDs and prolonged duration of risk, diagnostic strategies need to involve multiple tests for detecting and differentiating various causes of IFD. Although performance data for a range of tests to diagnose COVID-19-associated pulmonary aspergillosis is emerging, the performance of tests to diagnose other IFD is unknown or based on pre-COVID performance data. SUMMARY Because of the vast numbers of COVID-19 infections, IFD in COVID-19 critical-care patients represents a significant burden of disease, even if incidences are less than 5%. Optimal diagnosis of COVID-19-associated IFD requires a strategic approach. The pandemic has highlighted the potential impact of IFD outside of the typical high-risk clinical cohorts, given the ever-increasing population at risk of IFD and enhanced surveillance of fungal infections is required.
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Affiliation(s)
- P Lewis White
- Public Health Wales, Microbiology Cardiff, UHW, Heath Park, Cardiff, UK
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