Invasive Pulmonary Aspergillosis Goes Viral Again?

The Changing Landscape of Invasive Fungal Infections in ICUs: A Need for Risk Stratification to Better Target Antifungal Drugs and the Threat of Resistance

The landscape of invasive candidiasis and invasive aspergillosis has changed dramatically in intensive care units over the past two decades. Today, we are faced with new risk factors such as the emergence of resistance, but are also equipped with new therapeutic strategies and diagnostic tools which are changing epidemiological data and diagnostic algorithms. Some common points need to be addressed: (i) the best way to use microbiological tools and to integrate their results in decisional algorithms; (ii) the need to find the optimum balance between under-diagnosis and overtreatment; (iii) and the need to decipher pathophysiology. In this short review, we will try to illustrate these points.

Novel Clinical and Laboratorial Challenges in Aspergillosis

In recent years, research in the areas of Aspergillus and aspergillosis has continued to advance rapidly, including advancements in genomics, immunological studies, clinical areas, and diagnostic areas. Recently, new risk groups for the development of aspergillosis have emerged—patients with influenza- or COVID-19-ssociated pulmonary aspergillosis. The rise and spread of antifungal resistances have also become a clinical concern in some geographic areas and have drawn the attention of clinicians due to difficulties in treating these infections. In this paper, a snapshot of these issues is presented, emphasizing these novel clinical and laboratorial challenges in the aspergillosis field and focusing on their actual relevance.

Bronchoscopy in COVID-19 inpatients: experience of a university hospital in the first outbreak of the disease in Brazil

OBJECTIVE

To describe the indications and endoscopic findings of bronchoscopy performed at a reference university hospital for inpatients diagnosed with COVID-19 during the first outbreak of the disease in Brazil.

METHODS

A retrospective analysis of medical records of adult patients diagnosed with COVID-19 who underwent bronchoscopy at the intensive care units of Instituto do Coração and Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, from March to August 2020.

RESULTS

A total of 132 bronchoscopies were performed in 103 patients diagnosed with COVID-19. Mean age was 56.1±14.5 years, and distribution was similar in both sexes. More than one test was performed in 16 patients. The most frequent indications were diagnostic endoscopic evaluation and therapeutic procedures in 78.6% of cases (n=81) and material collection in 21.4% of cases (n=22). The most frequent endoscopic findings were presence of secretion or clots in 34% of cases, the presence of acute inflammatory changes in 22.3%, and tracheal wall laceration in 20.4%. In 27.2% of patients, no relevant bronchoscopic findings were observed. In three patients, bronchoscopy was indicated to assess hemoptysis, but there was only one case of active bleeding. Procedure-related complications were not observed in this group of patients.

CONCLUSION

Bronchoscopy proved to be a safe and effective procedure to assist in treatment of COVID-19 patients, and the most frequent indications were related to investigation of airway involvement or to evaluate infectious and inflammatory pulmonary processes.