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Kriegl L, Hatzl S, Schilcher G, Zollner-Schwetz I, Boyer J, Geiger C, Hoenigl M, Krause R. Antifungals in Patients With Extracorporeal Membrane Oxygenation: Clinical Implications. Open Forum Infect Dis 2024; 11:ofae270. [PMID: 38887481 PMCID: PMC11181180 DOI: 10.1093/ofid/ofae270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 05/05/2024] [Indexed: 06/20/2024] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a life-saving technique used in critical care medicine for patients with severe respiratory or cardiac failure. This review examines the treatment and prophylaxis of fungal infections in ECMO patients, proposing specific regimens based on available data for different antifungals (azoles, echinocandins, amphotericin B/liposomal amphotericin B) and invasive fungal infections. Currently, isavuconazole and posaconazole have the most supported data, while modified dosages of isavuconazole are recommended in ECMO. Echinocandins are preferred for invasive candidiasis. However, choosing echinocandins is challenging due to limited and varied data on concentration loss in the ECMO circuit. Caution is likewise advised when using liposomal amphotericin B due to uncertain concentrations and potential ECMO dysfunction based on scarce data. We further conclude with the importance of further research on the impact of ECMO on antifungal drug concentrations to optimize dosing regimens in critically ill patients.
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Affiliation(s)
- Lisa Kriegl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Stefan Hatzl
- BioTechMed-Graz, Graz, Austria
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | | | - Ines Zollner-Schwetz
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Johannes Boyer
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Christina Geiger
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
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Hatzl S, Scholz L, Posch F, Eller P, Reisinger AC, Zacharias M, Gorkiewicz G, Hoenigl M, Zollner-Schwetz I, Krause R. Invasive Pulmonary Aspergillosis in Critically Ill Patients with Hantavirus Infection, Austria. Emerg Infect Dis 2024; 30:1275-1278. [PMID: 38782377 PMCID: PMC11138969 DOI: 10.3201/eid3006.231720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
We investigated a cohort of 370 patients in Austria with hantavirus infections (7.8% ICU admission rate) and detected 2 cases (cumulative incidence 7%) of invasive pulmonary aspergillosis; 1 patient died. Hantavirus-associated pulmonary aspergillosis may complicate the course of critically ill patients who have hemorrhagic fever with renal syndrome.
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Park JH, Hong SB, Huh JW, Jung J, Kim MJ, Chong YP, Sung H, Do KH, Kim SH, Lee SO, Kim YS, Lim CM, Koh Y, Choi SH. Severe Human Parainfluenza Virus Community- and Healthcare-Acquired Pneumonia in Adults at Tertiary Hospital, Seoul, South Korea, 2010-2019. Emerg Infect Dis 2024; 30:1088-1095. [PMID: 38781685 PMCID: PMC11138994 DOI: 10.3201/eid3006.230670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
The characteristics of severe human parainfluenza virus (HPIV)-associated pneumonia in adults have not been well evaluated. We investigated epidemiologic and clinical characteristics of 143 patients with severe HPIV-associated pneumonia during 2010-2019. HPIV was the most common cause (25.2%) of severe virus-associated hospital-acquired pneumonia and the third most common cause (15.7%) of severe virus-associated community-acquired pneumonia. Hematologic malignancy (35.0%), diabetes mellitus (23.8%), and structural lung disease (21.0%) were common underlying conditions. Co-infections occurred in 54.5% of patients admitted to an intensive care unit. The 90-day mortality rate for HPIV-associated pneumonia was comparable to that for severe influenza virus-associated pneumonia (55.2% vs. 48.4%; p = 0.22). Ribavirin treatment was not associated with lower mortality rates. Fungal co-infections were associated with 82.4% of deaths. Clinicians should consider the possibility of pathogenic co-infections in patients with HPIV-associated pneumonia. Contact precautions and environmental cleaning are crucial to prevent HPIV transmission in hospital settings.
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Fernández-Ruiz M, Gioia F, Bodro M, Gutiérrez Martín I, Sabé N, Rodriguez-Álvarez R, Corbella L, López-Viñau T, Valerio M, Illaro A, Salto-Alejandre S, Cordero E, Arnaiz de Las Revillas F, Fariñas MC, Muñoz P, Vidal E, Carratalà J, Goikoetxea J, Ramos-Martínez A, Moreno A, Martín-Dávila P, Fortún J, Aguado JM. Isavuconazole Versus Voriconazole as the First-line Therapy for Solid Organ Transplant Recipients With Invasive Aspergillosis: Comparative Analysis of 2 Multicenter Cohort Studies. Transplantation 2024:00007890-990000000-00775. [PMID: 38773846 DOI: 10.1097/tp.0000000000005082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
BACKGROUND Isavuconazole (ISA) and voriconazole (VORI) are recommended as the first-line treatment for invasive aspergillosis (IA). Despite theoretical advantages of ISA, both triazole agents have not been compared in solid organ transplant recipients. METHODS We performed a post hoc analysis of 2 retrospective multicenter cohorts of solid organ transplant recipients with invasive fungal disease (the SOTIS [Solid Organ Transplantation and ISavuconazole] and DiasperSOT [DIagnosis of ASPERgillosis in Solid Organ Transplantation] studies). We selected adult patients with proven/probable IA that were treated for ≥48 h with ISA (n = 57) or VORI (n = 77) as first-line therapy, either in monotherapy or combination regimen. The primary outcome was the rate of clinical response at 12 wk from the initiation of therapy. Secondary outcomes comprised 12-wk all-cause and IA-attributable mortality and the rates of treatment-emergent adverse events and premature treatment discontinuation. RESULTS Both groups were comparable in their demographics and major clinical and treatment-related variables. There were no differences in the rate of 12-wk clinical response between the ISA and VORI groups (59.6% versus 59.7%, respectively; odds ratio [OR], 0.99; 95% confidence interval [CI], 0.49-2.00). This result was confirmed after propensity score adjustment (OR, 0.81; 95% CI, 0.32-2.05) and matching (OR, 0.79; 95% CI, 0.31-2.04). All-cause and IA-attributable mortality were also similar. Patients in the ISA group were less likely to experience treatment-emergent adverse events (17.5% versus 37.7%; P = 0.011) and premature treatment discontinuation (8.8% versus 23.4%; P = 0.027). CONCLUSIONS Front-line treatment with ISA for posttransplant IA led to similar clinical outcomes than VORI, with better tolerability and higher treatment completion.
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Affiliation(s)
- Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre," Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Francesca Gioia
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Marta Bodro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Clinic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Isabel Gutiérrez Martín
- Department of Internal Medicine, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahona, Spain
| | - Núria Sabé
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Laura Corbella
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre," Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Teresa López-Viñau
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Unit of Pharmacy, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Maricela Valerio
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Aitziber Illaro
- Department of Pharmacy, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Sonsoles Salto-Alejandre
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville, Virgen del Rocío and Virgen Macarena University Hospitals/CSIC/University of Seville, Seville, Spain
| | - Elisa Cordero
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville, Virgen del Rocío and Virgen Macarena University Hospitals/CSIC/University of Seville, Seville, Spain
| | - Francisco Arnaiz de Las Revillas
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - María Carmen Fariñas
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
- Department of Medicine, School of Medicine, Universidad de Cantabria, Santander, Spain
| | - Patricia Muñoz
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa Vidal
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
- Department of Medicine, School of Medicine, University of Córdoba, Córdoba, Spain
| | - Jordi Carratalà
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Josune Goikoetxea
- Unit of Infectious Diseases, Hospital Universitario de Cruces, Baracaldo, Spain
| | - Antonio Ramos-Martínez
- Unit of Infectious Diseases, Hospital Universitario Puerta de Hierro-Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHSA), Majadahonda, Spain
- Department of Medicine, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Asunción Moreno
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Clinic, Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Pilar Martín-Dávila
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Jesús Fortún
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad de Alcalá, Alcalá de Henares, Spain
| | - José María Aguado
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre," Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Iacovelli A, Oliva A, Mirabelli FM, Giannone S, Laguardia M, Morviducci M, Nicolardi ML, Repaci E, Sanzari MT, Leanza C, Raponi G, Mastroianni C, Palange P. Risk factors for COVID-19 associated pulmonary aspergillosis and outcomes in patients with acute respiratory failure in a respiratory sub-intensive care unit. BMC Infect Dis 2024; 24:392. [PMID: 38605300 PMCID: PMC11007928 DOI: 10.1186/s12879-024-09283-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND COVID-19-associated pulmonary aspergillosis (CAPA) is burdened by high mortality. Data are lacking about non-ICU patients. Aims of this study were to: (i) assess the incidence and prevalence of CAPA in a respiratory sub-intensive care unit, (ii) evaluate its risk factors and (iii) impact on in-hospital mortality. Secondary aims were to: (i) assess factors associated to mortality, and (ii) evaluate significant features in hematological patients. MATERIALS AND METHODS This was a single-center, retrospective study of COVID-19 patients with acute respiratory failure. A cohort of CAPA patients was compared to a non-CAPA cohort. Among patients with CAPA, a cohort of hematological patients was further compared to another of non-hematological patients. RESULTS Three hundred fifty patients were included in the study. Median P/F ratio at the admission to sub-intensive unit was 225 mmHg (IQR 155-314). 55 (15.7%) developed CAPA (incidence of 5.5%). Eighteen had probable CAPA (37.3%), 37 (67.3%) possible CAPA and none proven CAPA. Diagnosis of CAPA occurred at a median of 17 days (IQR 12-31) from SARS-CoV-2 infection. Independent risk factors for CAPA were hematological malignancy [OR 1.74 (95%CI 0.75-4.37), p = 0.0003], lymphocytopenia [OR 2.29 (95%CI 1.12-4.86), p = 0.02], and COPD [OR 2.74 (95%CI 1.19-5.08), p = 0.014]. Mortality rate was higher in CAPA cohort (61.8% vs 22.7%, p < 0.0001). CAPA resulted an independent risk factor for in-hospital mortality [OR 2.92 (95%CI 1.47-5.89), p = 0.0024]. Among CAPA patients, age > 65 years resulted a predictor of mortality [OR 5.09 (95% CI 1.20-26.92), p = 0.035]. No differences were observed in hematological cohort. CONCLUSION CAPA is a life-threatening condition with high mortality rates. It should be promptly suspected, especially in case of hematological malignancy, COPD and lymphocytopenia.
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Affiliation(s)
- Alessandra Iacovelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Italy Pulmonology Respiratory and Critical Care Unit, Policlinico Umberto I Hospital Rome, Rome, Italy.
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Flavio Marco Mirabelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Italy Pulmonology Respiratory and Critical Care Unit, Policlinico Umberto I Hospital Rome, Rome, Italy
| | - Silvia Giannone
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Italy Pulmonology Respiratory and Critical Care Unit, Policlinico Umberto I Hospital Rome, Rome, Italy
| | - Marianna Laguardia
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Italy Pulmonology Respiratory and Critical Care Unit, Policlinico Umberto I Hospital Rome, Rome, Italy
| | - Matteo Morviducci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Italy Pulmonology Respiratory and Critical Care Unit, Policlinico Umberto I Hospital Rome, Rome, Italy
| | - Maria Luisa Nicolardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Italy Pulmonology Respiratory and Critical Care Unit, Policlinico Umberto I Hospital Rome, Rome, Italy
| | - Emma Repaci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Italy Pulmonology Respiratory and Critical Care Unit, Policlinico Umberto I Hospital Rome, Rome, Italy
| | - Maria Teresa Sanzari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Italy Pulmonology Respiratory and Critical Care Unit, Policlinico Umberto I Hospital Rome, Rome, Italy
| | - Cristiana Leanza
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Palange
- Department of Public Health and Infectious Diseases, Sapienza University of Rome Italy Pulmonology Respiratory and Critical Care Unit, Policlinico Umberto I Hospital Rome, Rome, Italy
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Shekhova E, Salazar F, Da Silva Dantas A, Chakraborty T, Wooding EL, White PL, Warris A. Age difference of patients with and without invasive aspergillosis: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:220. [PMID: 38373908 PMCID: PMC10875810 DOI: 10.1186/s12879-024-09109-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Invasive Aspergillosis (IA) is a life-threatening fungal disease with significant mortality rates. Timely diagnosis and treatment greatly enhance patient outcomes. This study aimed to explore the association between patient age and the development of IA, as well as the potential implications for risk stratification strategies. METHODS We searched National Center for Biotechnology Information (NCBI) databases for publications until October 2023 containing age characteristics of patients with and without IA. A random-effects model with the application of inverse-variance weighting was used to pool reported estimates from each study, and meta-regression and subgroup analyses were utilized to assess sources of heterogeneity. RESULTS A systematic review was conducted, resulting in the inclusion of 55 retrospective observational studies with a total of 13,983 patients. Meta-analysis revealed that, on average, patients with IA were approximately two and a half years older (95% Confidence Interval [CI] 1.84-3.31 years; I2 = 26.1%) than those without the disease (p < 0.0001). No significant moderators could explain the observed heterogeneity in age difference. However, subgroup analysis revealed that age differences were more pronounced within particular patient groups compared to others. For example, patients with and without IA who had primary severe lung infections exhibited a greater difference in mean age than other patient cohorts. CONCLUSIONS Further research, such as individual patient data meta-analysis, is necessary to better understand the potential relationship between increasing age and the likelihood of IA. Improved risk stratification strategies based on patient age could potentially enhance the early detection and treatment of IA, ultimately improving patient outcomes.
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Affiliation(s)
- Elena Shekhova
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK.
| | - Fabián Salazar
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
| | | | - Tanmoy Chakraborty
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
| | - Eva L Wooding
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
- Royal Devon and Exeter Hospital, Exeter, EX2 5DW, UK
| | - P Lewis White
- Public Health Wales Microbiology Cardiff, Cardiff University, UHW, Cardiff, UK
- Centre for Trials Research, Division of Infection and Immunity, Cardiff University, UHW, Cardiff, UK
| | - Adilia Warris
- Medical Research Council Centre for Medical Mycology, Geoffrey Pope Building, University of Exeter, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
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Ramírez-Sánchez IC, Diaz-Sanabria RA, Alza-Arcila J. Invasive pulmonary aspergillosis following human metapneumovirus infection in solid-organ transplant recipients: Another virus to add to the list. Transpl Infect Dis 2024; 26:e14188. [PMID: 37938791 DOI: 10.1111/tid.14188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/22/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023]
Abstract
There is increasing recognition that respiratory viral infections such as influenza, respiratory syncytial virus, parainfluenza virus, adenovirus, and SARS-CoV-2 can promote the development of invasive fungal pulmonary coinfections, particularly invasive aspergillosis, both in immunocompetent and immunocompromised patients. To date, there are no case reports exploring the role of human metapneumovirus as a risk factor for fungal coinfection. Below, we describe the case of a 63-year-old woman who received a kidney transplant and developed invasive pulmonary aspergillosis after a human metapneumovirus infection and discuss the possible phenomena that could favor this association.
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Affiliation(s)
- Isabel Cristina Ramírez-Sánchez
- Infectious Diseases Section, Internal Medicine Department, Hospital Pablo Tobón Uribe, Medical School, Medellín, Colombia
- Infectious Diseases Section, Internal Medicine Department, Universidad de Antioquia, Medical School, Medellín, Colombia
| | - Ricardo Augusto Diaz-Sanabria
- Infectious Diseases Section, Internal Medicine Department, Universidad de Antioquia, Medical School, Medellín, Colombia
| | - Jhongert Alza-Arcila
- Infectious Diseases Section, Internal Medicine Department, Universidad de Antioquia, Medical School, Medellín, Colombia
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8
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Maillard A, Le Goff J, Barry M, Lemiale V, Mercier-Delarue S, Demoule A, Feghoul L, Jaber S, Klouche K, Kouatchet A, Argaud L, Barbier F, Bigé N, Moreau AS, Canet E, Pène F, Salmona M, Mokart D, Azoulay E. Multiplex Polymerase Chain Reaction Assay to Detect Nasopharyngeal Viruses in Immunocompromised Patients With Acute Respiratory Failure. Chest 2023; 164:1364-1377. [PMID: 37567412 DOI: 10.1016/j.chest.2023.07.4222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND In immunocompromised patients with acute respiratory failure (ARF), the clinical significance of respiratory virus detection in the nasopharynx remains uncertain. RESEARCH QUESTION Is viral detection in nasopharyngeal swabs associated with causes and outcomes of ARF in immunocompromised patients? STUDY DESIGN AND METHODS This preplanned post hoc analysis of a randomized controlled trial enrolled immunocompromised patients admitted to 32 ICUs for ARF between May 2016 and December 2017. Nasopharyngeal swabs sampled at inclusion were assessed for 23 respiratory pathogens using multiplex polymerase chain reaction (PCR) assay. Causes of ARF were established by managing physicians and were reviewed by three expert investigators masked to the multiplex PCR assay results. Associations between virus detection in nasopharyngeal swabs, causes of ARF, and composite outcome of day 28 mortality, invasive mechanical ventilation (IMV), or both were assessed. RESULTS Among the 510 sampled patients, the multiplex PCR assay results were positive in 103 patients (20.2%), and a virus was detected in 102 samples: rhinoviruses or enteroviruses in 35.5%, coronaviruses in 10.9%, and flu-like viruses (influenza virus, parainfluenza virus, respiratory syncytial virus, human metapneumovirus) in 52.7%. The cause of ARF varied significantly according to the results of the multiplex PCR assay, especially the proportion of viral pneumonia: 50.0% with flu-like viruses, 14.0% with other viruses, and 3.6% when no virus was detected (P < .001). No difference was found in the composite outcome of day 28 mortality, IMV, or both according to positive assay findings (54.9% vs 54.7%; P = .965). In a pre-established subgroup analysis, flu-like virus detection was associated with a higher rate of day 28 mortality, IMV, or both among recipients of allogeneic hematopoietic stem cell transplantation compared with those without detected virus. INTERPRETATION In immunocompromised patients with ARF, the results of nasopharyngeal multiplex PCR assays are not associated with IMV or mortality. A final diagnosis of viral pneumonia is retained in one-third of patients with positive assay results and in one-half of the patients with a flu-like virus.
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Affiliation(s)
- Alexis Maillard
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris
| | - Jérôme Le Goff
- Service de Virologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris
| | - Mariame Barry
- Service de Virologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris
| | - Virginie Lemiale
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris
| | | | - Alexandre Demoule
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris
| | - Linda Feghoul
- Service de Virologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris
| | - Samir Jaber
- Département Anesthésie et Réanimation B, Centre Hospitalier Universitaire de Montpellier, Hôpital Saint-Eloi
| | - Kada Klouche
- Département de Médecine Intensive et Réanimation, Hôpital Lapeyronie, Montpellier
| | | | - Laurent Argaud
- Médecine Intensive-Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon
| | - Francois Barbier
- Unité de Soins Intensifs Médicaux, La Source Hospital, Centre Hospitalier Régional d'Orléans, Orléans
| | - Naike Bigé
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris
| | - Anne-Sophie Moreau
- Pôle de Médecine Intensive Réanimation, Hôpital Roger Salengro, CHU Lille, Lille
| | - Emmanuel Canet
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes
| | - Frédéric Pène
- Service de Médecine Intensive-Réanimation, Hôpital Cochin, Assistance Publique des Hôpitaux de Paris, Paris
| | - Maud Salmona
- Laboratoire de Virologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris
| | - Djamel Mokart
- Département d'Anesthésie-Réanimation, Institut Paoli Calmette, Marseille, France
| | - Elie Azoulay
- Service de Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris.
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9
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Permpalung N, Liang T, Gopinath S, Bazemore K, Mathew J, Ostrander D, Durand CM, Shoham S, Zhang SX, Marr KA, Avery RK, Shah PD. Invasive fungal infections after respiratory viral infections in lung transplant recipients are associated with lung allograft failure and chronic lung allograft dysfunction within 1 year. J Heart Lung Transplant 2023; 42:953-963. [PMID: 36925381 DOI: 10.1016/j.healun.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/18/2023] [Accepted: 02/10/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Respiratory viral infections (RVI) are associated with chronic lung allograft dysfunction (CLAD) and mortality in lung transplant recipients (LTRs). However, the prevalence and impact of secondary invasive fungal infections (IFIs) post RVIs in LTRs have not been investigated. METHODS We performed a single center retrospective study including LTRs diagnosed with 5 different respiratory viral pathogens between January 2010 to May 2021 and evaluated their clinical outcomes in 1 year. The risk factors of IFIs were evaluated by logistic regression. The impact of IFIs on CLAD stage progression/death was examined by Cox regression. RESULTS A total of 202 RVI episodes (50 influenza, 31 severe acute respiratory syndrome coronavirus-2, 30 metapneumovirus, 44 parainfluenza, and 47 respiratory syncytial virus) in 132 patients was included for analysis. Thirty-one episodes (15%) were associated with secondary IFIs, and 27 occurred in LTRs with lower respiratory tract infection (LRTI; 28% from 96 LRTI episodes). Aspergillosis was the most common IFI (80%). LTRs with IFIs had higher disease severity during RVI episodes. In multivariable analysis, RVI with LTRI was associated with IFI (adjusted odds ratio [95% confidence interval (CI)] of 7.85 (2.48-24.9). Secondary IFIs were associated with CLAD stage progression/death after accounting for LRTI, pre-existing CLAD, intensive care unit admission, secondary bacterial pneumonia and underlying lung diseases pre-transplant with adjusted hazard ratio (95%CI) of 2.45 (1.29-4.64). CONCLUSIONS This cohort demonstrated 15% secondary IFI prevalence in LTRs with RVIs. Importantly, secondary IFIs were associated with CLAD stage progression/death, underscoring the importance of screening for fungal infections in this setting.
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Affiliation(s)
- Nitipong Permpalung
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Mycology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Tao Liang
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shilpa Gopinath
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katrina Bazemore
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joby Mathew
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Darin Ostrander
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christine M Durand
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shmuel Shoham
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sean X Zhang
- Division of Medical Microbiology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kieren A Marr
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Pearl Diagnostics Inc, Baltimore, Maryland
| | - Robin K Avery
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pali D Shah
- Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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10
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Li L, Wang C, Ren Y, Liu J, Liu F, Zhang X. Clinical features and risk factors for viral pneumonia complicated with invasive pulmonary aspergillosis in adult patients. Chin Med J (Engl) 2023; 136:1361-1363. [PMID: 37106526 PMCID: PMC10309498 DOI: 10.1097/cm9.0000000000002354] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Indexed: 04/29/2023] Open
Affiliation(s)
- Lijuan Li
- Department of Pulmonary and Critical Care Medicine, National Centre for Clinical Research on Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chuan Wang
- Department of Pulmonary and Critical Care Medicine, First Hospital of Shijiazhuang, Shijiazhuang, Hebei 050011, China
| | - Yali Ren
- Department of Pulmonary and Critical Care Medicine, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Jiangbo Liu
- Department of Pulmonary and Critical Care Medicine, Tianjin First Central Hospital, Tianjin 300192, China
| | - Feifei Liu
- Department of Respiratory and Critical Care Medicine, First Hospital of Qin Huang Dao, Qinhuangdao, Hebei 066000, China
| | - Xiaoqi Zhang
- Department of Pulmonary and Critical Care Medicine, Second People's Hospital of Weifang, Weifang, Shandong 261041, China
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11
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A Regional Observational Study on COVID-19-Associated Pulmonary Aspergillosis (CAPA) within Intensive Care Unit: Trying to Break the Mold. J Fungi (Basel) 2022; 8:jof8121264. [PMID: 36547597 PMCID: PMC9785727 DOI: 10.3390/jof8121264] [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: 11/03/2022] [Revised: 11/24/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
The reported incidence of COVID-19-associated pulmonary aspergillosis (CAPA) ranges between 2.4% and 35% in intensive care unit (ICU) patients, and awareness in the medical community is rising. We performed a regional retrospective observational study including patients diagnosed with CAPA defined according to the Modified AspICU Dutch/Belgian Mycosis Study Group and CAPA-EECMM, from five different ICUs, admitted between March, 2020 and September, 2021. Forty-five patients were included. The median age was 64 (IQR 60-72), mostly (73%) males. At ICU admission, the median Charlson comorbidity index was 3 (2-5), and the simplified acute physiology score (SAPS)-II score was 42 (31-56). The main underlying diseases were hypertension (46%), diabetes (36%) and pulmonary diseases (15%). CAPA was diagnosed within a median of 17 days (IQR 10-21.75) after symptoms onset and 9 days (IQR 3-11) after ICU admission. The overall 28-day mortality rate was 58%, and at univariate analysis, it was significantly associated with older age (p = 0.009) and SAPS-II score at admission (p = 0.032). The use of immunomodulatory agents, p = 0.061; broad-spectrum antibiotics, p = 0.091; positive culture for Aspergillus on BAL, p = 0.065; and hypertension, p = 0.083, were near reaching statistical significance. None of them were confirmed in multivariate analysis. In critically ill COVID-19 patients, CAPA acquired clinical relevance in terms of incidence and reported mortality. However, the risk between underdiagnosis-in the absence of specific invasive investigations, and with a consequent possible increase in mortality-and over-diagnosis (case identification with galactomannan on broncho-alveolar fluid alone) might be considered. Realistic incidence rates, based on local, real-life epidemiological data, might be helpful in guiding clinicians.
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12
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Mechanistic Basis of Super-Infection: Influenza-Associated Invasive Pulmonary Aspergillosis. J Fungi (Basel) 2022; 8:jof8050428. [PMID: 35628684 PMCID: PMC9147222 DOI: 10.3390/jof8050428] [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: 03/17/2022] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 12/02/2022] Open
Abstract
Influenza infection is a risk factor for invasive pulmonary aspergillosis in both immunocompetent and immunocompromised hosts. The purpose of this review is to highlight the epidemiology of influenza-associated invasive pulmonary aspergillosis and the mechanistic studies that have been performed to delineate how influenza increases susceptibility to this invasive fungal infection.
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13
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Clancy CJ, Nguyen MH. Coronavirus disease 2019 (COVID-19) associated pulmonary aspergillosis (CAPA): Re-framing the debate. Open Forum Infect Dis 2022; 9:ofac081. [PMID: 35386295 PMCID: PMC8903513 DOI: 10.1093/ofid/ofac081] [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: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 11/27/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) has been reported in ~5%–10% of critically ill COVID-19 patients. However, incidence varies widely (0%–33%) across hospitals, most cases are unproven, and CAPA definitions and clinical relevance are debated. Methods We reframed the debate by asking, what is the likelihood that patients with CAPA have invasive aspergillosis? We use diagnostic test performance in other clinical settings to estimate positive predictive values (PPVs) and negative predictive values (NPVs) of CAPA criteria for invasive aspergillosis in populations with varying CAPA incidence. Results In a population with CAPA incidence of 10%, anticipated PPV/NPV of diagnostic criteria are ~30%–60%/≥97%; ~3%–5% of tested cohort would be anticipated to have true invasive aspergillosis. If CAPA incidence is 2%–3%, anticipated PPV and NPV are ~8%–30%/>99%. Conclusions Depending on local epidemiology and clinical details of a given case, PPVs and NPVs may be useful in guiding antifungal therapy. We incorporate this model into a stepwise strategy for diagnosing and managing CAPA.
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Affiliation(s)
- Cornelius J Clancy
- University of Pittsburgh, Division of Infectious Diseases, Pittsburgh, PA, USA
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - M Hong Nguyen
- University of Pittsburgh, Division of Infectious Diseases, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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