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Koulenti D, Papathanakos G, Blot S. Invasive pulmonary aspergillosis in the ICU: tale of a broadening risk profile. Curr Opin Crit Care 2023; 29:463-469. [PMID: 37641513 DOI: 10.1097/mcc.0000000000001070] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW In the absence of histopathological proof, the diagnosis of invasive pulmonary aspergillosis (IPA) is usually based on mycology (not on tissue), medical imaging, and the patient's risk profile for acquiring invasive fungal disease. Here, we review the changes in risk profile for IPA that took place over the past decades. RECENT FINDINGS In the early 2000s IPA was considered exclusively a disease of immunocompromised patients. Particularly in the context of critical illness, the risk profile has been broadened steadily. Acute viral infection by influenza or SARS-Cov-2 are now well recognized risk factors for IPA. SUMMARY The classic risk profile ('host factors') reflecting an immunocompromised status was first enlarged by a spectrum of chronic conditions such as AIDS, cirrhosis, and chronic obstructive pulmonary disease. In the presence of critical illness, especially characterized by sepsis and/or severe respiratory distress, any chronic condition could add to the risk profile. Recently, acute viral infections have been associated with IPA leading to the concepts of influenza-associated IPA and COVID-19-associated IPA. These viral infections may affect patients without underlying disease. Hence, the risk for IPA is now a reality for ICU patients, even in the absence of any chronic conditions.
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Affiliation(s)
- Despoina Koulenti
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece
- UQCCR, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Georgios Papathanakos
- Department of Intensive Care Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - Stijn Blot
- UQCCR, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
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Smith DJ, Gold JAW, Benedict K, Wu K, Lyman M, Jordan A, Medina N, Lockhart SR, Sexton DJ, Chow NA, Jackson BR, Litvintseva AP, Toda M, Chiller T. Public Health Research Priorities for Fungal Diseases: A Multidisciplinary Approach to Save Lives. J Fungi (Basel) 2023; 9:820. [PMID: 37623591 PMCID: PMC10455901 DOI: 10.3390/jof9080820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
Fungal infections can cause severe disease and death and impose a substantial economic burden on healthcare systems. Public health research requires a multidisciplinary approach and is essential to help save lives and prevent disability from fungal diseases. In this manuscript, we outline the main public health research priorities for fungal diseases, including the measurement of the fungal disease burden and distribution and the need for improved diagnostics, therapeutics, and vaccines. Characterizing the public health, economic, health system, and individual burden caused by fungal diseases can provide critical insights to promote better prevention and treatment. The development and validation of fungal diagnostic tests that are rapid, accurate, and cost-effective can improve testing practices. Understanding best practices for antifungal prophylaxis can optimize prevention in at-risk populations, while research on antifungal resistance can improve patient outcomes. Investment in vaccines may eliminate certain fungal diseases or lower incidence and mortality. Public health research priorities and approaches may vary by fungal pathogen.
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Affiliation(s)
- Dallas J. Smith
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.A.W.G.); (K.B.); (K.W.); (M.L.); (A.J.); (N.M.); (S.R.L.); (D.J.S.); (N.A.C.); (B.R.J.); (A.P.L.); (M.T.)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Tom Chiller
- Mycotic Diseases Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (J.A.W.G.); (K.B.); (K.W.); (M.L.); (A.J.); (N.M.); (S.R.L.); (D.J.S.); (N.A.C.); (B.R.J.); (A.P.L.); (M.T.)
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3
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Waldeck F, Boroli F, Zingg S, Walti LN, Wendel‐Garcia PD, Conen A, Pagani J, Boggian K, Schnorf M, Siegemund M, Abed‐Maillard S, Michot M, Que Y, Bättig V, Suh N, Kleger G, Albrich WC. Higher risk for influenza-associated pulmonary aspergillosis (IAPA) in asthmatic patients: A Swiss multicenter cohort study on IAPA in critically ill influenza patients. Influenza Other Respir Viruses 2022; 17:e13059. [PMID: 36394086 PMCID: PMC9835444 DOI: 10.1111/irv.13059] [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: 09/01/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Influenza-associated pulmonary aspergillosis (IAPA) is an important complication of severe influenza with high morbidity and mortality. METHODS We conducted a retrospective multicenter study in tertiary hospitals in Switzerland during 2017/2018 and 2019/2020 influenza seasons. All adults with PCR-confirmed influenza infection and treatment on intensive-care unit (ICU) for >24 h were included. IAPA was diagnosed according to previously published clinical, radiological, and microbiological criteria. We assessed risk factors for IAPA and predictors for poor outcome, which was a composite of in-hospital mortality, ICU length of stay ≥7 days, mechanical ventilation ≥7 days, or extracorporeal membrane oxygenation. RESULTS One hundred fifty-eight patients (median age 64 years, 45% females) with influenza were included, of which 17 (10.8%) had IAPA. Asthma was more common in IAPA patients (17% vs. 4% in non-IAPA, P = 0.05). Asthma (OR 12.0 [95% CI 2.1-67.2]) and days of mechanical ventilation (OR 1.1 [1.1-1.2]) were associated with IAPA. IAPA patients frequently required organ supportive therapies including mechanical ventilation (88% in IAPA vs. 53% in non-IAPA, P = 0.001) and vasoactive support (75% vs. 45%, P = 0.03) and had more complications including ARDS (53% vs. 26%, P = 0.04), respiratory bacterial infections (65% vs. 37%, P = 0.04), and higher ICU-mortality (35% vs. 16.4%, P = 0.05). IAPA (OR 28.8 [3.3-253.4]), influenza A (OR 3.3 [1.4-7.8]), and higher SAPS II score (OR 1.07 [1.05-1.10]) were independent predictors of poor outcome. INTERPRETATION High clinical suspicion, early diagnostics, and therapy are indicated in IAPA because of high morbidity and mortality. Asthma is likely an underappreciated risk factor for IAPA.
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Affiliation(s)
- Frederike Waldeck
- Division of Infectious Diseases and MicrobiologyUniversity Hospital Schleswig Holstein, Campus LübeckLübeckGermany
| | - Filippo Boroli
- Division of Intensive CareGeneva University HospitalsGenevaSwitzerland
| | - Sandra Zingg
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselBaselSwitzerland
| | - Laura N. Walti
- Division of Infectious Diseases, InselspitalBern University HospitalBernSwitzerland
| | | | - Anna Conen
- Division of Infectious Diseases and Infection PreventionCantonal Hospital AarauAarauSwitzerland
| | - Jean‐Luc Pagani
- Division of Intensive CareUniversity Hospital LausanneLausanneSwitzerland
| | - Katia Boggian
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St. GallenSt. GallenSwitzerland
| | - Madeleine Schnorf
- Division of Intensive CareUniversity Hospital LausanneLausanneSwitzerland
| | - Martin Siegemund
- Intensive Care Unit, Department of Acute CareUniversity Hospital BaselBaselSwitzerland
| | | | - Marc Michot
- Division of Intensive CareCantonal Hospital ThunThunSwitzerland
| | - Yok‐Ai Que
- Division of Intensive Care, InselspitalBern University Hospital, University of BernBernSwitzerland
| | - Veronika Bättig
- Division of Infectious Diseases and Hospital EpidemiologyUniversity Hospital BaselBaselSwitzerland
| | - Noémie Suh
- Division of Intensive CareGeneva University HospitalsGenevaSwitzerland
| | - Gian‐Reto Kleger
- Division of Intensive CareCantonal Hospital St. GallenSt. GallenSwitzerland
| | - Werner C. Albrich
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St. GallenSt. GallenSwitzerland
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Er B, Er AG, Gülmez D, Şahin TK, Halaçlı B, Durhan G, Ersoy EO, Alp A, Metan G, Saribas Z, Arikan‐Akdagli S, Hazırolan G, Akıncı SB, Arıyürek M, Topeli A, Uzun Ö. A screening study for
COVID
‐19‐associated pulmonary aspergillosis in critically ill patients during the third wave of the pandemic. Mycoses 2022; 65:724-732. [PMID: 35531631 PMCID: PMC9348343 DOI: 10.1111/myc.13466] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/01/2022] [Accepted: 05/03/2022] [Indexed: 12/15/2022]
Abstract
Background COVID‐19‐associated pulmonary aspergillosis (CAPA) has been reported as an important cause of mortality in critically ill patients with an incidence rate ranging from 5% to 35% during the first and second pandemic waves. Objectives We aimed to evaluate the incidence, risk factors for CAPA by a screening protocol and outcome in the critically ill patients during the third wave of the pandemic. Patients/Methods This prospective cohort study was conducted in two intensive care units (ICU) designated for patients with COVID‐19 in a tertiary care university hospital between 18 November 2020 and 24 April 2021. SARS‐CoV‐2 PCR‐positive adult patients admitted to the ICU with respiratory failure were included in the study. Serum and respiratory samples were collected periodically from ICU admission up to CAPA diagnosis, patient discharge or death. ECMM/ISHAM consensus criteria were used to diagnose and classify CAPA cases. Results A total of 302 patients were admitted to the two ICUs during the study period, and 213 were included in the study. CAPA was diagnosed in 43 (20.1%) patients (12.2% probable, 7.9% possible). In regression analysis, male sex, higher SOFA scores at ICU admission, invasive mechanical ventilation and longer ICU stay were significantly associated with CAPA development. Overall ICU mortality rate was higher significantly in CAPA group compared to those with no CAPA (67.4% vs 29.4%, p < .001). Conclusions One fifth of critically ill patients in COVID‐19 ICUs developed CAPA, and this was associated with a high mortality.
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Affiliation(s)
- Berrin Er
- Division of Intensive Care, Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
- Ankara City Hospital, Intensive Care Unit Ankara
| | - Ahmet Görkem Er
- Department of Infectious Diseases and Clinical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Dolunay Gülmez
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Taha Koray Şahin
- Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Burçin Halaçlı
- Division of Intensive Care, Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Gamze Durhan
- Department of Radiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Ebru Ortaç Ersoy
- Division of Intensive Care, Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Alpaslan Alp
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Zeynep Saribas
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Sevtap Arikan‐Akdagli
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Seda Banu Akıncı
- Division of Intensive Care, Department of Anaestesiology and Reanimation Hacettepe University Faculty of Medicine Ankara Turkey
| | - Macit Arıyürek
- Department of Radiology Hacettepe University Faculty of Medicine Ankara Turkey
| | - Arzu Topeli
- Division of Intensive Care, Department of Internal Medicine Hacettepe University Faculty of Medicine Ankara Turkey
| | - Ömrüm Uzun
- Department of Infectious Diseases and Clinical Microbiology Hacettepe University Faculty of Medicine Ankara Turkey
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Gold JAW, Revis A, Thomas S, Perry L, Blakney RA, Chambers T, Bentz ML, Berkow EL, Lockhart SR, Lysen C, Nunnally NS, Jordan A, Kelly HC, Montero AJ, Farley MM, Oliver NT, Pouch SM, Webster AS, Jackson BR, Beer KD. Clinical Characteristics, Healthcare Utilization, and Outcomes among Patients in a Pilot Surveillance System for Invasive Mold Disease—Georgia, United States, 2017–2019. Open Forum Infect Dis 2022; 9:ofac215. [DOI: 10.1093/ofid/ofac215] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/19/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Invasive mold diseases (IMD) cause severe illness, but public health surveillance data are lacking. We describe data collected from a laboratory-based, pilot IMD surveillance system.
Methods
During 2017–2019, the Emerging Infections Program conducted active IMD surveillance at three Atlanta-area hospitals. We ascertained potential cases by reviewing histopathology, culture, and Aspergillus galactomannan results and classified patients as having an IMD case (based on European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group [MSG] criteria) or a non-MSG IMD case (based on the treating clinician’s diagnosis and use of mold-active antifungal therapy). We described patient features and compared patients with MSG versus non-MSG IMD cases.
Results
Among 304 patients with potential IMD, 104 (34.2%) met an IMD case definition (41 MSG, 63 non-MSG). The most common IMD types were invasive aspergillosis (n = 66, 63.5%), mucormycosis (n = 8, 7.7%), and fusariosis (n = 4, 3.8%); the most frequently affected body sites were pulmonary (n = 66, 63.5%), otorhinolaryngologic (n = 17, 16.3%), and cutaneous/deep tissue (n = 9, 8.7%). Forty-five (43.3%) IMD patients received intensive care unit-level care, and 90-day all-cause mortality was 32.7%; these outcomes did not differ significantly between MSG and non-MSG IMD patients.
Conclusions
IMD patients had high mortality rates and a variety of clinical presentations. Comprehensive IMD surveillance is needed to assess emerging trends, and strict application of MSG criteria for surveillance might exclude > one-half of clinically significant IMD cases.
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Affiliation(s)
| | - Andrew Revis
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | - Stepy Thomas
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lewis Perry
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | - Rebekah A. Blakney
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | - Taylor Chambers
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
| | | | | | | | | | | | | | | | | | - Monica M. Farley
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nora T. Oliver
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stephanie M. Pouch
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrew S. Webster
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
- Georgia Emerging Infections, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Clinical Characteristics and Outcomes of Influenza-Associated Pulmonary Aspergillosis Among Critically Ill Patients: A Systematic Review and Meta-Analysis. J Hosp Infect 2021; 120:98-109. [PMID: 34843812 DOI: 10.1016/j.jhin.2021.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/27/2021] [Accepted: 11/21/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Invasive pulmonary aspergillosis is increasingly identified as a complication of influenza infection, termed influenza-associated pulmonary aspergillosis (IAPA). AIMS Assess the morbidity and mortality of critically ill influenza patients with and without IAPA. METHODS We searched the Pubmed, Cochrane Library, Scopus, and Embase databases for studies containing comparative data of critically ill influenza patients with IAPA. Primary outcomes were all-cause in-hospital and ICU mortality. The secondary outcomes were clinical characteristics, invasive mechanical ventilation (IMV) duration, ICU and hospital length of stay (LOS), requirement of vasopressor, renal replacement therapy (RRT), and extracorporeal membrane oxygenation (ECMO). FINDINGS IAPA incidence was 28.8% in 853 critically ill influenza patients, with an overall mortality rate of 33.4%. No difference in age and comorbidities were observed. IAPA patients were predominantly male and received chronic corticosteroids. In-hospital (49.2% vs. 27.0%; P= 0.002) and ICU (46.8% vs. 20.8%; P< 0.001) mortality rates were higher among IAPA patients than non-IAPA patients. Greater proportion of IAPA patients required IMV and prolonged IMV duration (mean 17.3 vs. 10.5 days; P< 0.001), ICU (mean 26.8 vs. 12.8 days; P= 0.001) and hospital LOS (mean 38.7 vs. 27.0 days; P= 0.003). IAPA patients had greater disease severity requiring a significant amount of vasopressor (76.4% vs. 57.9%; P< 0.001), RRT (45.7% vs. 19.1%; P< 0.001), and ECMO (25.9% vs. 12.8%; P= 0.004) support than non-IAPA patients. CONCLUSIONS IAPA diagnosis in critically ill patients is associated with greater morbidity and mortality. Early recognition and more research are needed to determine better diagnostic and treatment strategies.
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