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Bay P, Audureau E, Préau S, Favory R, Guigon A, Heming N, Gault E, Pham T, Chaghouri A, Turpin M, Morand-Joubert L, Jochmans S, Pitsch A, Meireles S, Contou D, Henry A, Joseph A, Chaix ML, Uhel F, Roux D, Descamps D, Emery M, Garcia-Sanchez C, Levy D, Burrel S, Mayaux J, Kimmoun A, Hartard C, Pène F, Rozenberg F, Gaudry S, Brichler S, Guillon A, Handala L, Tamion F, Moisan A, Daix T, Hantz S, Delamaire F, Thibault V, Souweine B, Henquell C, Picard L, Botterel F, Rodriguez C, Dessap AM, Pawlotsky JM, Fourati S, de Prost N. COVID-19 associated pulmonary aspergillosis in critically-ill patients: a prospective multicenter study in the era of Delta and Omicron variants. Ann Intensive Care 2024; 14:65. [PMID: 38658426 PMCID: PMC11043290 DOI: 10.1186/s13613-024-01296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND During the first COVID-19 pandemic wave, COVID-19-associated pulmonary aspergillosis (CAPA) has been reported in up to 11-28% of critically ill COVID-19 patients and associated with increased mortality. As new SARS-CoV-2 variants emerged, the characteristics of critically ill COVID-19 patients have evolved, particularly in the era of Omicron. The purpose of this study is to investigate the characteristics of CAPA in the era of new variants. METHODS This is a prospective multicenter observational cohort study conducted in France in 36 participating intensive care units (ICU), between December 7th, 2021 and April 26th 2023. Diagnosis criteria of CAPA relied on European Confederation of Medical Mycology (ECMM)/International Society for Human & Animal Mycology (ISHAM) consensus criteria. RESULTS 566 patients were included over the study period. The prevalence of CAPA was 5.1% [95% CI 3.4-7.3], and rose to 9.1% among patients who required invasive mechanical ventilation (IMV). Univariable analysis showed that CAPA patients were more frequently immunosuppressed and required more frequently IMV support, vasopressors and renal replacement therapy during ICU stay than non-CAPA patients. SAPS II score at ICU admission, immunosuppression, and a SARS-CoV-2 Delta variant were independently associated with CAPA in multivariable logistic regression analysis. Although CAPA was not significantly associated with day-28 mortality, patients with CAPA experienced a longer duration of mechanical ventilation and ICU stay. CONCLUSION This study contributes valuable insights into the prevalence, characteristics, and outcomes of CAPA in the era of Delta and Omicron variants. We report a lower prevalence of CAPA (5.1%) among critically-ill COVID-19 patients than previously reported, mainly affecting intubated-patients. Duration of mechanical ventilation and ICU stay were significantly longer in CAPA patients.
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Affiliation(s)
- Pierre Bay
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), CHU Henri Mondor, 51, Av. de Lattre de Tassigny, CEDEX, 94010, Créteil, France.
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), Créteil, France.
- Université Paris-Est-Créteil (UPEC), Créteil, France.
- IMRB INSERM U955, Team "Viruses, Hepatology, Cancer", Créteil, France.
| | - Etienne Audureau
- Université Paris-Est-Créteil (UPEC), Créteil, France
- IMRB INSERM U955, Team CEpiA, Créteil, France
- Unité de Recherche Clinique, Department of Public Health, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Sébastien Préau
- U1167-RID-AGE Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, 59000, Lille, France
| | - Raphaël Favory
- U1167-RID-AGE Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, 59000, Lille, France
| | - Aurélie Guigon
- Service de Virologie, CHU de Lille, 59000, Lille, France
| | - Nicholas Heming
- Médecine Intensive Réanimation, Hôpital Raymond Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Elyanne Gault
- Laboratoire de Virologie, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), Boulogne, France
| | - Tài Pham
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), Créteil, France
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, DMU 4 CORREVE Maladies du Cœur et des Vaisseaux, FHU Sepsis, Le Kremlin-Bicêtre, France
- Inserm U1018, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France
| | - Amal Chaghouri
- Laboratoire de Virologie, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | - Matthieu Turpin
- Centre de Recherche Saint-Antoine INSERM, Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Laurence Morand-Joubert
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Laboratoire de Virologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012, Paris, France
| | | | - Aurélia Pitsch
- Laboratoire de Microbiologie, Hôpital Marc Jacquet, Melun, France
| | - Sylvie Meireles
- Service de Réanimation Médico-Chirurgicale, Assistance Publique-Hôpitaux de Paris, Hôpital Ambroise Paré, Boulogne, France
| | - Damien Contou
- Service de Réanimation, Hôpital Victor Dupouy, Argenteuil, France
| | - Amandine Henry
- Service de Virologie, Hôpital Victor Dupouy, Argenteuil, France
| | - Adrien Joseph
- Médecine Intensive Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marie-Laure Chaix
- Inserm HIPI, Université Paris Cité, 75010, Paris, France
- Laboratoire de Virologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 75010, Paris, France
| | - Fabrice Uhel
- DMU ESPRIT, Service de Médecine Intensive Réanimation, Université Paris Cité, APHP, Hôpital Louis Mourier, Colombes, France
- INSERM U1151, CNRS UMR 8253, Department of Immunology, Infectiology and Hematology, Institut Necker-Enfants Malades (INEM), Paris, France
| | - Damien Roux
- DMU ESPRIT, Service de Médecine Intensive Réanimation, Université Paris Cité, APHP, Hôpital Louis Mourier, Colombes, France
- INSERM U1151, CNRS UMR 8253, Department of Immunology, Infectiology and Hematology, Institut Necker-Enfants Malades (INEM), Paris, France
| | - Diane Descamps
- IAME INSERM UMR 1137, Service de Virologie, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Malo Emery
- Service de Réanimation, Hôpital Saint-Camille, Bry-Sur-Marne, France
| | | | - David Levy
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Réanimation Médicale, Sorbonne Université, Paris, France
| | - Sonia Burrel
- Service de Virologie, CHU de Bordeaux et CNRS UMR 5234, Fundamental Microbiology and Pathogenicity, Université de Bordeaux, Bordeaux, France
- Département de Virologie, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Julien Mayaux
- Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Médecine Intensive Réanimation, Sorbonne Université, Paris, France
| | - Antoine Kimmoun
- CHRU de Nancy, Médecine Intensive et Réanimation Brabois, Université de Lorraine, Vandœuvre-Lès-Nancy, France
- INSERM U942 and U1116, F-CRIN-INIC RCT, Vandœuvre-Lès-Nancy, France
| | - Cédric Hartard
- Service de Virologie, CHRU de Nancy, Vandœuvre-Lès-Nancy, France
| | - Frédéric Pène
- Médecine Intensive Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Flore Rozenberg
- Laboratoire de Virologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Gaudry
- Service de Réanimation, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Ségolène Brichler
- Laboratoire de Virologie, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France
| | - Antoine Guillon
- Intensive Care Unit, Tours University Hospital, Research Center for Respiratory Diseases (CEPR), INSERM U1100, University of Tours, Tours, France
| | - Lynda Handala
- INSERM U1259, Université de Tours, Tours, France
- CHRU de Tours, National Reference Center for HIV-Associated Laboratory, Tours, France
| | - Fabienne Tamion
- Service de Médecine Intensive-Réanimation, CHU De Rouen, Rouen, France
| | - Alice Moisan
- INSERM, Normandie Univ, DYNAMICURE UMR 1311, CHU Rouen, Department of Virology, Univ Rouen Normandie, Université de Caen Normandie, 76000, Rouen, France
| | - Thomas Daix
- Réanimation Polyvalente, INSERM CIC 1435 and UMR 1092, CHU Limoges, Limoges, France
| | - Sébastien Hantz
- French National Reference Center for Herpesviruses, Bacteriology, Virology, Hygiene Department, CHU Limoges, 87000, Limoges, France
- INSERM, RESINFIT, U1092, 87000, Limoges, France
| | - Flora Delamaire
- CHU Rennes, Maladies Infectieuses et Réanimation Médicale, Rennes, France
| | - Vincent Thibault
- Laboratoire de Virologie, CHU Rennes, 35000, Rennes, France
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) UMR_S 1085, Univ Rennes, 35000, Rennes, France
| | - Bertrand Souweine
- Service de Médecine Intensive et Réanimation, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Cecile Henquell
- 3IHP, Service de Virologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Lucile Picard
- Département d'Anesthésie Réanimations Chirurgicales, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France
| | - Françoise Botterel
- Université Paris-Est-Créteil (UPEC), Créteil, France
- Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Christophe Rodriguez
- Université Paris-Est-Créteil (UPEC), Créteil, France
- IMRB INSERM U955, Team "Viruses, Hepatology, Cancer", Créteil, France
- Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Armand Mekontso Dessap
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), CHU Henri Mondor, 51, Av. de Lattre de Tassigny, CEDEX, 94010, Créteil, France
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), Créteil, France
- Université Paris-Est-Créteil (UPEC), Créteil, France
| | - Jean-Michel Pawlotsky
- Université Paris-Est-Créteil (UPEC), Créteil, France
- IMRB INSERM U955, Team "Viruses, Hepatology, Cancer", Créteil, France
- Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Slim Fourati
- Université Paris-Est-Créteil (UPEC), Créteil, France
- IMRB INSERM U955, Team "Viruses, Hepatology, Cancer", Créteil, France
- Department of Virology, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Nicolas de Prost
- Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), CHU Henri Mondor, 51, Av. de Lattre de Tassigny, CEDEX, 94010, Créteil, France
- Groupe de Recherche Clinique CARMAS, Université Paris-Est-Créteil (UPEC), Créteil, France
- Université Paris-Est-Créteil (UPEC), Créteil, France
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Chun JY, Jeong SJ, Kim S, Choi S, Lee JH, Chung HS, Park S, Lee H, Kim HY, Hwangbo B, Choi YJ. Performance of the galactomannan test for the diagnosis of invasive pulmonary aspergillosis using non-invasive proximal airway samples. J Infect 2024; 88:106159. [PMID: 38641139 DOI: 10.1016/j.jinf.2024.106159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/08/2024] [Accepted: 04/12/2024] [Indexed: 04/21/2024]
Abstract
OBJECTIVE To diagnose invasive pulmonary aspergillosis (IPA), galactomannan (GM) detection in serum or bronchoalveolar lavage fluid (BALF) is widely used. However, the utility of proximal airway GM test (from induced sputum or tracheal aspirate) has not been well elucidated. METHODS In this retrospective cohort study, we evaluated the diagnostic performance of proximal airway GM in diagnosis of IPA including COVID-19 associated pulmonary aspergillosis (CAPA). Between January 2022 and January 2023, patients who had been tested for GM with clinical suspicion or for surveillance from any specimen (serum, induced sputum, tracheal aspirate, and BALF) were screened. IPA was diagnosed using EORTC/MSGERC criteria, and CAPA was diagnosed following the 2020 ECMM/ISHAM consensus criteria. RESULTS Of 624 patients with GM results, 70 met the criteria for proven/probable IPA and 427 had no IPA. The others included possible IPA and chronic form of aspergillosis. The sensitivities and specificities of serum, proximal airway, and BALF GM for proven/probable IPA versus no IPA were 78.9% and 70.6%, 93.1% and 78.7%, and 78.6% and 91.0%, respectively. Areas under the receiver operating characteristic curve (AUCs) were 0.742 for serum GM, 0.935 for proximal airway GM, and 0.849 for BALF GM (serum GM vs proximal airway GM, p = 0.014; proximal airway GM vs BALF GM, p = 0.334; serum GM vs BALF GM, p = 0.286). CONCLUSION This study demonstrates that the performance of GM test from non-invasive proximal airway samples is comparable or even better than those from serum and distal airway sample (BALF).
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Affiliation(s)
- June Young Chun
- Division of Infectious Disease, Department of Internal Medicine, National Cancer Center, Goyang, South Korea.
| | - Sahng-Joon Jeong
- Department of Internal Medicine, National Cancer Center, Goyang, South Korea
| | - Sinae Kim
- Biostatics Collaboration Team, Research Core Center, National Cancer Center, Goyang, South Korea
| | - Soyoung Choi
- Department of Agricultural Biotechnology, Seoul National University, Seoul, South Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea; College of Medicine, Seoul National University, Seoul, South Korea
| | - Hyun Sung Chung
- Division of Pulmonology, Department of Internal Medicine, National Cancer Center, Goyang, South Korea
| | - Seungman Park
- Department of Laboratory Medicine, National Cancer Center, Goyang, South Korea
| | - Hyewon Lee
- Division of Hemato-oncology, Department of Internal Medicine, National Cancer Center, Goyang, South Korea
| | - Hyae Young Kim
- Department of Radiology, National Cancer Center, Goyang, South Korea
| | - Bin Hwangbo
- Division of Pulmonology, Department of Internal Medicine, National Cancer Center, Goyang, South Korea
| | - Young Ju Choi
- Division of Infectious Disease, Department of Internal Medicine, National Cancer Center, Goyang, South Korea
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Yu W, Xiao Y, Luo Y, Hu Y, Ji R, Wang W, Wu Z, Qi Z, Guo T, Wang Y, Zhao C. Risk factors for short-term prognosis of end-stage liver disease complicated by invasive pulmonary aspergillosis. Eur J Clin Microbiol Infect Dis 2024; 43:713-721. [PMID: 38347245 DOI: 10.1007/s10096-024-04775-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/05/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND AND AIM Patients with end-stage liver disease (ESLD) are susceptible to invasive pulmonary aspergillosis (IPA). This study aimed to investigate the risk factors affecting the occurrence and short-term prognosis of ESLD complicated by IPA. METHODS This retrospective case-control study included 110 patients with ESLD. Of them, 27 ESLD-IPA received antifungal therapy with amphotericin B (AmB); 27 AmB-free-treated ESLD-IPA patients were enrolled through 1:1 propensity score matching. Fifty-six ESLD patients with other comorbid pulmonary infections were enrolled as controls. The basic features of groups were compared, while the possible risk factors affecting the occurrence and short-term outcomes of IPA were analyzed. RESULTS Data analysis revealed invasive procedures, glucocorticoid exposure, and broad-spectrum antibiotic use were independent risk factors for IPA. The 54 patients with ESLD-IPA exhibited an overall treatment effectiveness and 28-d mortality rate of 50.00% and 20.37%, respectively, in whom patients treated with AmB-containing showed higher treatment efficacy than patients treated with AmB-free antifungal regimens (66.7% vs. 33.3%, respectively, χ2 = 6.000, P = 0.014). Multivariate logistic regression analysis revealed that the treatment regimen was the only predictor affecting patient outcomes, with AmB-containing regimens were 4.893 times more effective than AmB-free regimens (95% CI, 1.367-17.515; P = 0.015). The only independent predictors affecting the 28-d mortality rate were neutrophil-to-lymphocyte ratio and IPA diagnosis (OR = 1.140 and 10.037, P = 0.046 and 0.025, respectively). CONCLUSIONS Glucocorticoid exposure, invasive procedures, and broad-spectrum antibiotic exposure increased the risk of IPA in ESLD patients. AmB alone or combined with other antifungals may serve as an economical, safe, and effective treatment option for ESLD-IPA.
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Affiliation(s)
- Weiyan Yu
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
- Hebei Clinical Medical Research Center of Infectious Diseases, Shijiazhuang, 050051, China
| | - Ying Xiao
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yue Luo
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
- Public Health Clinical Center of Chengdu, Chengdu, 610011, China
| | - Yangyang Hu
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Ru Ji
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
- Hebei Clinical Medical Research Center of Infectious Diseases, Shijiazhuang, 050051, China
| | - Wei Wang
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
- Hebei Clinical Medical Research Center of Infectious Diseases, Shijiazhuang, 050051, China
| | - Zhinian Wu
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Zeqiang Qi
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Tingyu Guo
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China
| | - Yadong Wang
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
- Hebei Clinical Medical Research Center of Infectious Diseases, Shijiazhuang, 050051, China.
| | - Caiyan Zhao
- Department of Infectious Disease, the Hebei Medical University Third Hospital, No. 139, Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
- Hebei Clinical Medical Research Center of Infectious Diseases, Shijiazhuang, 050051, China.
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Zhao J, Zhuo X, Pu D, Fan G, Lu B, Cao B. Comparison of influenza- and COVID-19-associated pulmonary aspergillosis in China. Eur J Clin Microbiol Infect Dis 2024; 43:683-692. [PMID: 38326545 DOI: 10.1007/s10096-024-04772-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/31/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE We conducted a monocentric retrospective study using the latest definitions to compare the demographic, clinical, and biological characteristics of influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA). METHODS The study retrospectively enrolled 180 patients, including 70 influenza/IPA patients (with positive influenza A/B and Aspergillus) and 110 COVID-19/IPA patients (with positive SARS-CoV-2 and Aspergillus). Among them, 42 (60%) and 30 (27.3%) patients fulfilled the definitions of IAPA and CAPA, respectively. RESULTS The CAPA patients had significantly higher in-hospital mortality (13/31, 41.9%) than IAPA patients (8/42, 19%) with a P-value of 0.033. Kaplan-Meier survival curve also showed significantly higher 30-day mortality for CAPA patients (P = 0.025). Additionally, the CAPA patients were older, though insignificantly, than IAPA patients (70 (60-80) vs. 62 (52-72), P = 0.075). A lower percentage of chronic pulmonary disease (12.9 vs. 40.5%, P = 0.01) but higher corticosteroids use 7 days before and after ICU admission (22.6% vs. 0%, P = 0.002) were found in CAPA patients. Notably, there were no significant differences in the percentage of ICU admission or ICU mortality between the two groups. In addition, the time from observation to Aspergillus diagnosis was significantly longer in CAPA patients than in IAPA patients (7 (2-13) vs. 0 (0-4.5), P = 0.048). CONCLUSION Patients infected with SARS-CoV-2 and Aspergillus during the concentrated outbreak of COVID-19 in China had generally higher in-hospital mortality but a lower percentage of chronic pulmonary disease than those infected with influenza and Aspergillus. For influenza-infected patients who require hospitalization, close attention should be paid to the risk of invasive aspergillosis upfront.
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Affiliation(s)
- Jiankang Zhao
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Xianxia Zhuo
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Danni Pu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Guohui Fan
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Binghuai Lu
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
| | - Bin Cao
- National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
- Department of Respiratory Medicine, Capital Medical University, Beijing, China.
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
- Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China.
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Lin C, Zhou J, Gao N, Liu R, Li G, Wang J, Lu G, Shen J. Establishing a pulmonary aspergillus fumigatus infection diagnostic platform based on RPA-CRISPR-Cas12a. World J Microbiol Biotechnol 2024; 40:116. [PMID: 38418617 DOI: 10.1007/s11274-024-03940-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
In this study, we devised a diagnostic platform harnessing a combination of recombinase polymerase amplification (RPA) and the clustered regularly interspaced short palindromic repeats (CRISPR)/Cas12a system. Notably, this platform obviates the need for intricate equipment and finds utility in diverse settings. Two result display methods were incorporated in this investigation: the RPA-Cas12a-fluorescence method and the RPA-Cas12a-LFS (lateral flow strip). Upon validation, both display platforms exhibited no instances of cross-reactivity, with seven additional types of fungal pathogens responsible for respiratory infections. The established detection limit was ascertained to be as low as 102 copies/µL. In comparison to fluorescence quantitative PCR, the platform demonstrated a sensitivity of 96.7%, a specificity of 100%, and a consistency rate of 98.0%.This platform provides expeditious, precise, and on-site detection capabilities, thereby rendering it a pivotal diagnostic instrument amenable for deployment in primary healthcare facilities and point-of-care settings.
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Affiliation(s)
- Chunhui Lin
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
- Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China
| | - Jing Zhou
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
- Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China
| | - Nana Gao
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
- Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China
| | - Runde Liu
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
- Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China
| | - Ge Li
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
- Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China
| | - Jinyu Wang
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
- Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China
| | - Guoping Lu
- Department of Laboratory Medicine, Fuyang Hospital of Anhui Medical University, Fuyang, People's Republic of China
| | - Jilu Shen
- Department of Clinical Laboratory, the First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China.
- Department of Clinical Laboratory, Anhui Public Health Clinical Center, Hefei, People's Republic of China.
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6
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Chen WC, Chen IC, Chen JP, Liao TL, Chen YM. Prognostic factors and outcomes of invasive pulmonary aspergillosis, a retrospective hospital-based study. PeerJ 2024; 12:e17066. [PMID: 38436032 PMCID: PMC10908254 DOI: 10.7717/peerj.17066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
Objective Invasive pulmonary aspergillosis (IPA) affects immunocompromised hosts and is associated with higher risks of respiratory failure and mortality. However, the clinical outcomes of different IPA types have not been identified. Methods Between September 2002 and May 2021, we retrospectively enrolled patients with IPA in Taichung Veterans General Hospital, Taiwan. Cases were classified as possible IPA, probable IPA, proven IPA, and putative IPA according to EORTC/MSGERC criteria and the AspICU algorithm. Risk factors of respiratory failure, kidney failure, and mortality were analyzed by logistic regression. A total of 3-year survival was assessed by the Kaplan-Meier method with log-rank test for post-hoc comparisons. Results We included 125 IPA patients (50: possible IPA, 47: probable IPA, 11: proven IPA, and 17: putative IPA). Comorbidities of liver cirrhosis and solid organ malignancy were risk factors for respiratory failure; diabetes mellitus and post-liver or kidney transplantation were related to kidney failure. Higher galactomannan (GM) test optical density index (ODI) in either serum or bronchoalveolar lavage fluid was associated with dismal outcomes. Probable IPA and putative IPA had lower 3-year respiratory failure-free survival compared to possible IPA. Probable IPA and putative IPA exhibited lower 3-year renal failure-free survival in comparison to possible IPA and proven IPA. Putative IPA had the lowest 3-year overall survival rates among the four IPA groups. Conclusion Patients with putative IPA had higher mortality rates than the possible, probable, or proven IPA groups. Therefore, a prompt diagnosis and timely treatment are warranted for patients with putative IPA.
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Affiliation(s)
- Wei-Che Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taiwan
| | - I-Chieh Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jun-Peng Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsai-Ling Liao
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taichung, Taiwan
| | - Yi-Ming Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, National Chung Hsing University, Taichung, Taichung, Taiwan
- Precision Medicine Research Center, National Chung Hsing University, Taichung, Taichung, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
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7
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Ghassan M, Wissam S. Severe pulmonary aspergillosis post viral illness in immunocompetent patients: A case series. Respir Med Case Rep 2024; 48:101991. [PMID: 38380072 PMCID: PMC10876679 DOI: 10.1016/j.rmcr.2024.101991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/12/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Abstract
Invasive pulmonary aspergillosis (IPA) is a life-threatening disease commonly affecting the lungs of immunosuppressed patients. Recently, Aspergillosis was diagnosed in immunocompetent patients with viral pneumonia due to influenza virus and coronavirus-19 infections. A series of four immunocompetent patients from different hospitals in Lebanon diagnosed with pulmonary aspergillosis post viral infection is reported. Aspergillosis is an important differential diagnosis in patients with viral infections and worsening infiltrates on chest x-ray, in addition to bacterial and mycobacterial infections with which they share common features. Fungal infections should be suspected early, and treatment should be considered knowing that these infections entail worse outcomes.
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Affiliation(s)
- Moujaes Ghassan
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Balamand, Lebanon
| | - Sleiman Wissam
- Department of Internal Medicine, Division of Pulmonary and Critical Care, University of Balamand, Mount Lebanon Hospital – University Medical Center, Hazmieh, Lebanon
- Department of Internal Medicine, Division of Pulmonary and Critical Care, Ain W Zain Medical Village University Hospital, Ain W Zain, Lebanon
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8
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Liu RT, Zhang D, Li S, Chen Y, Wan XX, Diao ST, Weng L, Peng JM, Du B. Comparison of different criteria of metagenomic next-generation sequencing for the diagnosis of invasive pulmonary aspergillosis in critically ill patients. Diagn Microbiol Infect Dis 2024; 108:116135. [PMID: 38065016 DOI: 10.1016/j.diagmicrobio.2023.116135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To compare different criteria of Metagenomic Next-Generation Sequencing (mNGS) in bronchoalveolar lavage fluid (BALF) for diagnosing invasive pulmonary aspergillosis (IPA). METHODS We compared the diagnostic agreement and performances of six BALF mNGS-derived criteria (SDSMRN>1, SDSMRN≥3, SMRN≥10, SMRN≥50, RPM ratio≥10, and relative abundance of genus>30 %) in pneumonia patients. RESULTS A total of 115 patients were analyzed, with 28 identified with IPA. Diagnostic agreement among the six mNGS-derived criteria was moderate, with a Cohen's kappa of 0.577(P < 0.001). mNGS-derived criteria had low sensitivity ranging from 21.4 % to 57.1 % and high specificity from 88 % to 92 %. The optimal threshold of SDSMRN, SMRN, RPM ratio, and relative abundance of genus for diagnosing IPA were 5, 0.25, 8, and 20 %, respectively. Although using the optimal threshold, the sensitivity of mNGS is lower than 50 %. CONCLUSIONS All mNGS-derived criteria had low sensitivity for diagnosing IPA. A combination of mNGS and conventional mycological tests may be the best diagnostic strategy.
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Affiliation(s)
- Rui-Ting Liu
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China; Department of Critical Care Medicine, The Second Affiliated Hospital of Air Force Medical University, Shaanxi, China
| | - Dong Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China
| | - Shan Li
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China
| | - Yan Chen
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China
| | - Xi-Xi Wan
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China
| | - Shi-Tong Diao
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China
| | - Li Weng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China
| | - Jin-Min Peng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China.
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking, China
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9
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Desmedt L, Raymond M, Le Thuaut A, Asfar P, Darreau C, Reizine F, Colin G, Auchabie J, Lorber J, La Combe B, Kergoat P, Hourmant B, Delbove A, Frérou A, Morin J, Ergreteau PY, Seguin P, Martin M, Reignier J, Lascarrou JB, Canet E. Covid-19-associated pulmonary aspergillosis in mechanically ventilated patients: incidence and outcome in a French multicenter observational cohort (APICOVID). Ann Intensive Care 2024; 14:17. [PMID: 38285382 PMCID: PMC10825096 DOI: 10.1186/s13613-023-01229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/11/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Recent studies identified coronavirus disease 2019 (COVID-19) as a risk factor for invasive pulmonary aspergillosis (IPA) but produced conflicting data on IPA incidence and impact on patient outcomes. We aimed to determine the incidence and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA) in mechanically ventilated patients. METHODS We performed a multicenter retrospective observational cohort study in consecutive adults admitted to 15 French intensive care units (ICUs) in 2020 for COVID-19 requiring mechanical ventilation. CAPA was diagnosed and graded according to 2020 ECMM/ISHAM consensus criteria. The primary objective was to determine the incidence of proven/probable CAPA, and the secondary objectives were to identify risk factors for proven/probable CAPA and to assess associations between proven/probable CAPA and patient outcomes. RESULTS The 708 included patients (522 [73.7%] men) had a mean age of 65.2 ± 10.8 years, a median mechanical ventilation duration of 15.0 [8.0-27.0] days, and a day-90 mortality rate of 28.5%. Underlying immunosuppression was present in 113 (16.0%) patients. Corticosteroids were used in 348 (63.1%) patients. Criteria for probable CAPA were met by 18 (2.5%) patients; no patient had histologically proven CAPA. Older age was the only factor significantly associated with probable CAPA (hazard ratio [HR], 1.04; 95% CI 1.00-1.09; P = 0.04). Probable CAPA was associated with significantly higher day-90 mortality (HR, 2.07; 95% CI 1.32-3.25; P = 0.001) but not with longer mechanical ventilation or ICU length of stay. CONCLUSION Probable CAPA is a rare but serious complication of severe COVID-19 requiring mechanical ventilation and is associated with higher day-90 mortality.
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Affiliation(s)
- Luc Desmedt
- Service de Médecine Intensive Réanimation, CHU Nantes, Nantes Université, 30 Bd. Jean Monnet, 44000, Nantes, France.
| | - Matthieu Raymond
- Service de Médecine Intensive Réanimation, CHU Nantes, Nantes Université, 30 Bd. Jean Monnet, 44000, Nantes, France
| | - Aurélie Le Thuaut
- Direction de la recherche, Plateforme de Méthodologie et Biostatistique, CHU de Nantes, Nantes, France
| | - Pierre Asfar
- Service de Médecine Intensive Réanimation, CHU d'Angers, Angers, France
| | - Cédric Darreau
- Service de Réanimation polyvalente, CH du Mans, Le Mans, France
| | - Florian Reizine
- Service de Médecine Intensive Réanimation, CHU de Rennes, Rennes, France
| | - Gwenhaël Colin
- Service de Réanimation polyvalente, CHD de La Roche sur Yon, La Roche-sur-Yon, France
| | - Johann Auchabie
- Service de Réanimation polyvalente, CH de Cholet, Cholet, France
| | - Julien Lorber
- Service de Réanimation polyvalente, CH de Saint Nazaire, Saint-Nazaire, France
| | - Béatrice La Combe
- Service de Réanimation Polyvalente, Groupe Hospitalier Bretagne Sud, Lorient, France
| | - Pierre Kergoat
- Service de Réanimation polyvalente, Cornouille General Hospital, Quimper, France
| | - Baptiste Hourmant
- Service de Médecine Intensive Réanimation, CHU de Brest, Brest, France
| | - Agathe Delbove
- Service de Réanimation polyvalente, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Aurélien Frérou
- Service de Réanimation polyvalente, CH de Saint Malo, Saint-Malo, France
| | - Jean Morin
- Unité de soins intensifs de Pneumologie, CHU de Nantes, Nantes, France
| | | | - Philippe Seguin
- Service de Réanimation chirurgicale, CHU de Rennes, Rennes, France
| | - Maëlle Martin
- Service de Médecine Intensive Réanimation, CHU Nantes, Nantes Université, 30 Bd. Jean Monnet, 44000, Nantes, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, Movement-Interactions-Performance, MIP, UR 4334, CHU Nantes, Nantes Université, 44000, Nantes, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive Réanimation, Movement-Interactions-Performance, MIP, UR 4334, CHU Nantes, Nantes Université, 44000, Nantes, France
| | - Emmanuel Canet
- Service de Médecine Intensive Réanimation, CHU Nantes, Nantes Université, 30 Bd. Jean Monnet, 44000, Nantes, France.
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Yu X, Xu L, Zheng J, Lei Z, Pang Y, Li X, Zhu J, Liu J. Efficacy and safety of voriconazole in the treatment of invasive pulmonary aspergillosis in patients with liver failure: study protocol for a randomized controlled clinical trial. Trials 2023; 24:811. [PMID: 38105213 PMCID: PMC10726598 DOI: 10.1186/s13063-023-07755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/27/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Acute-on-chronic liver failure (ACLF) is a common clinical type of liver failure, and patients with acute-on-chronic liver failure are prone to fungal infections, especially the increasing incidence of invasive pulmonary aspergillosis (IPA). Voriconazole is recommended as the first-line antifungal agent in the treatment of invasive aspergillosis; however, no recommendation has been given for patients with severe liver cirrhosis (Child-Pugh C) and liver failure. This trial aims to examine the therapeutic effects and safety of voriconazole in the treatment of IPA in patients with liver failure. METHODS This study is a non-double-blind randomized controlled trial. The 96 eligible acute-on-chronic liver failure patients complicated with invasive pulmonary aspergillosis will be randomly assigned to receive either the optimized voriconazole regimen or the recommended voriconazole regimen for patients with mild to moderate liver cirrhosis (Child-Pugh A and B), at a 1:1 ratio, with an 8-week follow-up period. The antifungal efficacy of voriconazole will be the primary outcome measure. Plasma voriconazole trough concentration, the laboratory examination (CRP, PCT, ESR, etc.), chest CT, adverse events, and mortality at week 4 and 8 will be the secondary outcome measures. DISCUSSION This trial aims to demonstrate the efficacy and safety of voriconazole in the treatment of IPA in patients with liver failure, which is expected to provide a reference for scientific optimization of voriconazole regimens and a realistic basis for the standardized treatment of acute-on-chronic liver failure patients complicated with invasive pulmonary aspergillosis. TRIAL REGISTRATION The trial was registered with the Chinese Clinical Trial Registry, ChiCTR2100048259. Registered on 5 July 2021.
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Affiliation(s)
- Xue Yu
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, 600# Tianhe RoadGuangdong Province, Guangzhou City, 510630, China
| | - Lejia Xu
- Department of Pharmacy, Third Affiliated Hospital of Sun Yat-Sen University, 600# Tianhe RoadGuangdong Province, Guangzhou City, 510630, China
| | - Jiaxing Zheng
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, 600# Tianhe RoadGuangdong Province, Guangzhou City, 510630, China
| | - Ziying Lei
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, 600# Tianhe RoadGuangdong Province, Guangzhou City, 510630, China
| | - Yihua Pang
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, 600# Tianhe RoadGuangdong Province, Guangzhou City, 510630, China
| | - Xiaojie Li
- Department of Laboratory Medicine, Third Affiliated Hospital of Sun Yat-Sen University, 600# Tianhe RoadGuangdong Province, Guangzhou City, 510630, China
| | - Jianyun Zhu
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, 600# Tianhe RoadGuangdong Province, Guangzhou City, 510630, China.
| | - Jing Liu
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, 600# Tianhe RoadGuangdong Province, Guangzhou City, 510630, China.
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11
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Ozturk A, Bozok T, Erdogan M, Ibrahim BMS, Bozok TS. COVID-19-associated pulmonary aspergillosis (CAPA): identification of Aspergillus species and determination of antifungal susceptibility profiles. Folia Microbiol (Praha) 2023; 68:951-959. [PMID: 37294497 PMCID: PMC10250855 DOI: 10.1007/s12223-023-01069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
Among the co-infectious agents in COVID-19 patients, Aspergillus species cause invasive pulmonary aspergillosis (IPA). IPA is difficult to diagnose and is associated with high morbidity and mortality. This study is aimed at identifying Aspergillus spp. from sputum and tracheal aspirate (TA) samples of COVID-19 patients and at determining their antifungal susceptibility profiles. A total of 50 patients with COVID-19 hospitalized in their intensive care units (ICU) were included in the study. Identification of Aspergillus isolates was performed by phenotypic and molecular methods. ECMM/ISHAM consensus criteria were used for IPA case definitions. The antifungal susceptibility profiles of isolates were determined by the microdilution method. Aspergillus spp. was detected in 35 (70%) of the clinical samples. Among the Aspergillus spp., 20 (57.1%) A. fumigatus, six (17.1%) A. flavus, four (11.4%) A. niger, three (8.6%) A. terreus, and two (5.7%) A. welwitschiae were identified. In general, Aspergillus isolates were susceptible to the tested antifungal agents. In the study, nine patients were diagnosed with possible IPA, 11 patients were diagnosed with probable IPA, and 15 patients were diagnosed with Aspergillus colonization according to the used algorithms. Serum galactomannan antigen positivity was found in 11 of the patients diagnosed with IPA. Our results provide data on the incidence of IPA, identification of Aspergillus spp., and its susceptibility profiles in critically ill COVID-19 patients. Prospective studies are needed for a faster diagnosis or antifungal prophylaxis to manage the poor prognosis of IPA and reduce the risk of mortality.
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Affiliation(s)
- Ali Ozturk
- Department of Medical Microbiology, Faculty of Medicine, Nigde Omer Halisdemir University, Nigde, Turkey
| | - Taylan Bozok
- Department of Medical Microbiology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Merve Erdogan
- Department of Medical Microbiology, Faculty of Medicine, Sanko University, Gaziantep, Turkey
| | - Bashar MS. Ibrahim
- Department of Pharmaceutical Microbiology, Suleyman Demirel University, Isparta, Turkey
| | - Tugce Simsek Bozok
- Department of Infectious Diseases and Clinical Microbiology, Mersin University Hospital, Mersin, Turkey
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12
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Huang Q, Wu Y, Lu X, Xia L. Case report: nanopore targeted sequencing in the diagnosis of invasive pulmonary Aspergillus infection in a patient with acute promyelocytic leukemia. Hematology 2023; 28:2225345. [PMID: 37535054 DOI: 10.1080/16078454.2023.2225345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
Invasive pulmonary aspergillosis (IPA) is an infectious disease with a high mortality rate due to diagnostic difficulties associated with the lack of a typical clinical presentation and the inadequacy of the available laboratory testing methods. Nanopore targeted sequencing (NTS) is an alternative method of broad-based pathogen discovery, associated with rapid turnaround and high accuracy. This case report presents a patient with IPA and acute promyelocytic leukemia, diagnosed using the NTS method, which detected Aspergillus flavus in the patient's blood and pleural fluid. The patient was treated effectively with antifungal therapy. Early diagnosis of IPA improved long-term patient prognosis and quality of life.
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Affiliation(s)
- Qiuxia Huang
- Department of Hematology, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Yaohui Wu
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xuan Lu
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Linghui Xia
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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13
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Yeoh DK, McMullan BJ, Clark JE, Slavin MA, Haeusler GM, Blyth CC. The Challenge of Diagnosing Invasive Pulmonary Aspergillosis in Children: A Review of Existing and Emerging Tools. Mycopathologia 2023; 188:731-743. [PMID: 37040020 PMCID: PMC10564821 DOI: 10.1007/s11046-023-00714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/07/2023] [Indexed: 04/12/2023]
Abstract
Invasive pulmonary aspergillosis remains a major cause of morbidity and mortality for immunocompromised children, particularly for patients with acute leukaemia and those undergoing haematopoietic stem cell transplantation. Timely diagnosis, using a combination of computed tomography (CT) imaging and microbiological testing, is key to improve prognosis, yet there are inherent challenges in this process. For CT imaging, changes in children are generally less specific than those reported in adults and recent data are limited. Respiratory sampling by either bronchoalveolar lavage or lung biopsy is recommended but is not always feasible in children, and serum biomarkers, including galactomannan, have important limitations. In this review we summarise the current paediatric data on available diagnostic tests for IPA and highlight key emerging diagnostic modalities with potential for future use.
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Affiliation(s)
- Daniel K Yeoh
- Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Avenue, Perth, WA, 6009, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia.
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
| | - Brendan J McMullan
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, NSW, Australia
- School of Women's and Children's Health, UNSW, Sydney, NSW, Australia
| | - Julia E Clark
- Infection Management Service, Queensland Children's Hospital, Brisbane, QLD, Australia
- School of Clinical Medicine, Children's Health Queensland Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Monica A Slavin
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Gabrielle M Haeusler
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Infectious Diseases, Royal Children's Hospital, Parkville, VIC, Australia
- The Paediatric Integrated Cancer Service, Melbourne, VIC, Australia
| | - Christopher C Blyth
- Department of Infectious Diseases, Perth Children's Hospital, 15 Hospital Avenue, Perth, WA, 6009, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, WA, Australia
- School of Medicine, University of Western Australia, Perth, WA, Australia
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14
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Meng X, Liu Y, Li J, Wang L, Shi R, Chen Y, Zhu Y, Zhuang S. Metagenomic next-generation sequencing for diagnosis and efficacy evaluation of a critical case of SFTS complicated by invasive pulmonary aspergillosis. IDCases 2023; 33:e01884. [PMID: 37663136 PMCID: PMC10470360 DOI: 10.1016/j.idcr.2023.e01884] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by SFTS virus (SFTSV). SFTS patients were prone to invasive pulmonary aspergillosis (IPA), which was directly related to increased mortality. Here, we present a critical case of SFTS complicated by IPA in a previously healthy 58-year-old woman. On day 1, SFTSV and three different Aspergillus species were both detected in the patient's bronchoalveolar lavage fluid and blood through metagenomic next-generation sequencing (mNGS). After 17 days of treatment, the patient was still in poor condition and A. fumigatus was once again detected in her blood through mNGS. Then her family decided to give up treatment because of financial problems and grave prognosis. She was discharged home and died the next day. Medical personnel should be alter to the possibility of IPA in SFTS patients due to its high mortality. mNGS may be used as an auxiliary diagnostic tool and efficacy-monitoring method for suspected SFTS complicated by IPA.
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Affiliation(s)
- Xing Meng
- Department of Emergency Intensive Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yan Liu
- Genskey Medical Technology Co., Ltd, Beijing, China
| | - Jun Li
- Genskey Medical Technology Co., Ltd, Beijing, China
| | - Liang Wang
- Genskey Medical Technology Co., Ltd, Beijing, China
| | - Ruixue Shi
- Genskey Medical Technology Co., Ltd, Beijing, China
| | - Ying Chen
- Genskey Medical Technology Co., Ltd, Beijing, China
| | - Yun Zhu
- Genskey Medical Technology Co., Ltd, Beijing, China
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Costa-Pinto R, Klink S, Rotherham H, Perera P, Finlay L, Urbancic K, Vaz K, Trubiano J, Bellomo R. Assessing the safety profile of voriconazole use in suspected COVID-19-Associated pulmonary aspergillosis - A two-centre observational study. Med Mycol 2023:7191845. [PMID: 37286877 DOI: 10.1093/mmy/myad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
The decision to use voriconazole for suspected COVID-19 associated pulmonary aspergillosis (CAPA) is based on clinical judgement weighed against concerns about its potential toxicity. We assessed the safety profile of voriconazole for patients with suspected CAPA by conducting a retrospective study of patients across two intensive care units. We compared changes in any liver enzymes or bilirubin and any new or increasing QTc prolongation following voriconazole use to patient baseline to indicate possible drug effect. In total, 48 patients with presumed CAPA treated with voriconazole were identified. Voriconazole therapy was administered for a median of 8 days (IQR 5-22) and the median level was 1.86 mg/L (IQR 1.22-2.94). At baseline, 2% of patients had a hepatocellular injury profile, 54% cholestatic injury profile and 21% mixed injury profile. There were no statistically significant changes in liver function tests over the first seven days after voriconazole initiation. At day 28, there was a significant increase in ALP only (81U/L to 122U/L, p = 0.006), driven by changes in patients with baseline cholestatic injury. In contrast, patients with baseline hepatocellular or mixed injury had a significant decrease in ALT and AST. Baseline QTc was 437 msecs and remained unchanged after seven days of voriconazole therapy even after sensitivity analysis for concomitantly administered QT prolonging agents. Therefore, at the doses used in this study, we did not detect evidence of significant liver or cardiac toxicity related to voriconazole use. Such information can be used to assist clinicians in the decision to initiate such treatment.
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Affiliation(s)
- Rahul Costa-Pinto
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia
- Department of Critical Care, Department of Medicine, the University of Melbourne, Parkville, Victoria, Australia
| | - Sarah Klink
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia
| | - Hannah Rotherham
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Padeepa Perera
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Liam Finlay
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Karen Urbancic
- Department of Infectious Diseases, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia
| | - Karl Vaz
- Department of Gastroenterology, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia
| | - Jason Trubiano
- Department of Infectious Diseases, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia
- Department of Critical Care, Department of Medicine, the University of Melbourne, Parkville, Victoria, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Australia
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16
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Liu RT, Chen Y, Li S, Wan XX, Weng L, Peng JM, Du B. A Comparison of Diagnostic Criteria for Invasive Pulmonary Aspergillosis in Critically Ill Patients. Infect Dis Ther 2023:10.1007/s40121-023-00818-w. [PMID: 37199881 DOI: 10.1007/s40121-023-00818-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Invasive pulmonary aspergillosis (IPA) is a common infection in intensive care units (ICUs). There are no consensus criteria for defining IPA in the ICU. We aimed to compare the diagnosis and prognosis performances of three criteria (the 2020 EORTC/MSG criteria, the 2021 EORTC/MSG ICU criteria, the modified AspICU criteria (M-AspICU)) for IPA in the ICU. METHODS In this retrospective study from our single center, we applied the three different criteria for IPA in patients with suspected pneumonia and undergoing at least one mycological test between November 10, 2016 and November 10, 2021. We compared the diagnosis agreement and prognosis performances of these three criteria in the ICU. RESULTS Overall, 2403 patients were included. The rates of IPA according to the 2020 EORTC/MSG, 2021 EORTC/MSG ICU, and M-AspICU were 3.37%, 6.53%, and 23.10%, respectively. Diagnostic agreement among these criteria was poor (Cohen's kappa 0.208-0.666). IPA diagnosed by either the 2020 EORTC/MSG (odds ratio = 2.709, P < 0.001) or the 2021 EORTC/MSG ICU (odds ratio = 2.086, P = 0.001) criteria was independently associated with 28-day mortality. IPA diagnosed by M-AspICU is an independent risk factor of 28-day mortality (odds ratio = 1.431, P = 0.031) when excluding patients who fulfilled neither host criteria nor radiological factors of 2021 EORTC/MSG ICU. CONCLUSIONS Although M-AspICU criteria have the highest "sensitivity", IPA diagnosed by M-AspICU was not an independent risk factor of 28-day mortality. Caution is required when using the M-AspICU criteria in ICU, especially in patients with non-specific infiltration and non-classical host factors.
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Affiliation(s)
- Rui-Ting Liu
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Yan Chen
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Shan Li
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Xi-Xi Wan
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Li Weng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China
| | - Jin-Min Peng
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
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17
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Huang S, Zhang S, Yuan L, Zhuo Z, Wu X. Severe pediatric adenoviral pneumonia combined with invasive pulmonary aspergillosis. BMC Pulm Med 2023; 23:152. [PMID: 37127631 PMCID: PMC10150341 DOI: 10.1186/s12890-023-02447-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 04/19/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND This study aimed to analyze the clinical characteristics of severe pediatric adenoviral pneumonia combined with invasive pulmonary aspergillosis. METHODS We retrospectively analyzed the clinical data of five children clinically diagnosed with severe adenoviral pneumonia combined with invasive pulmonary aspergillosis at Xiamen Children's Hospital. RESULTS These five children included one boy and four girls, with ages of onset ranging from 8 months and 15 days to 2 years and 2 months. All of them had fever with a mean duration of 11-35 days and cough. Pulmonary imaging was performed, which revealed solid pulmonary opacification in all five children, pleural effusion in two children, and emphysema and multiple small cavity formations in one child. Multiple microbiological tests were performed on the 5 children, and adenovirus was positive in the alveolar lavage fluid for the first time, and aspergillus culture was positive in the second test. On tracheoscopy, the bronchial mucosa was seen to be congested and edematous or pale and eroded; white moss-like material was seen adhering to the tracheal wall or even blocking the airway. The five children were treated with a combination of two or more broad-spectrum antimicrobials, glucocorticoids, and gamma globulins and underwent bronchoscopy. Voriconazole was added in the treatment regimen after the diagnosis of aspergillosis (28-34 days of treatment). Four of the children were discharged in good condition with a mean total length of hospital stay of 17-47 days. The other child leave against medical advice. Follow-up 3-5 months after discharge showed that one child had been cured; two children had developed obliterative bronchiolitis; one child had developed bronchiectasis; and the remaining child who had been discharged spontaneously was not contactable via telephone. CONCLUSIONS Immune disorders and antibiotic and steroid treatments for adenovirus infection are high-risk factors for secondary invasive pulmonary aspergillosis in children. Prolonged fever and cough are the main manifestations, but which lack specificity, and bronchoscopic mucosal-specific injury evaluation and alveolar lavage fluid culture are helpful in the diagnosis of aspergillosis. The long-term prognosis of severe pediatric adenoviral pneumonia combined with invasive pulmonary aspergillosis maybe poor.
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Affiliation(s)
- Shuihua Huang
- Department of Infection, Xiamen Children's Hospital, Xiamen Branch of Fudan University Pediatric Hospital, Xiamen, Fujian, China
| | - Shengxin Zhang
- Pediatric intensive care unit, Xiamen Children's Hospital, Xiamen Branch of Fudan University Pediatric Hospital, Xiamen, Fujian, China
| | - Lin Yuan
- Department of Infection, Xiamen Children's Hospital, Xiamen Branch of Fudan University Pediatric Hospital, Xiamen, Fujian, China.
| | - Zhiqiang Zhuo
- Department of Infection, Xiamen Children's Hospital, Xiamen Branch of Fudan University Pediatric Hospital, Xiamen, Fujian, China
| | - Xingdong Wu
- Department of Infection, Xiamen Children's Hospital, Xiamen Branch of Fudan University Pediatric Hospital, Xiamen, Fujian, China.
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18
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Işık MC, Karcıoğlu O, Hazırolan G, Gülmez D, Onur MR, Kunt MM, Arikan-Akdagli S, Metan G. Necrotizing pneumonia due to Aspergillus and Salmonella after immune checkpoint inhibitor treatment: An unusual case and review of the literature. Rev Iberoam Micol 2023; 40:26-30. [PMID: 37714729 DOI: 10.1016/j.riam.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are a promising new treatment for different types of cancer. The infectious complications in patients taking ICIs are rare. CASE REPORT A 58-year-old male who received chemotherapy consisting of pembrolizumab (PD-1 inhibitor) for esophagus squamous cell carcinoma one month before was admitted to the emergency room with shortness of breath soon after fiberoptic bronchoscopy, which was done for the inspection of the lower airway. A computed tomography of the chest revealed a progressive consolidation on the right upper lobe. Salmonella group D was isolated from the bronchoalveolar lavage (BAL) fluid culture. The fungal culture of the same clinical sample yielded Aspergillus niger; furthermore, a high titer (above the cut-off values) of Aspergillus antigen was found both in the BAL fluid and serum of the patient. Despite the effective spectrum and appropriate dose of antimicrobial treatment, the patient died due to disseminated intravascular coagulopathy. CONCLUSIONS Awareness of unusual pathogens in the etiology of pneumonia after ICI treatment may help to avoid underdiagnosis.
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Affiliation(s)
- Muhammed Cihan Işık
- Department of Clinical Microbiology and Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Oğuz Karcıoğlu
- Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dolunay Gülmez
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Ruhi Onur
- Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Mahir Kunt
- Department of Emergency, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gökhan Metan
- Department of Clinical Microbiology and Infectious Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey.
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19
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Zhong Y, Ji T, Qin D, Cheng D. Clinical characteristics and risk factors of in-hospital mortality in patients coinfected with Pneumocystis jirovecii and Aspergillus. J Mycol Med 2023; 33:101330. [PMID: 36265259 DOI: 10.1016/j.mycmed.2022.101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/20/2022] [Accepted: 09/04/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To analyze clinical characteristics and risk factors for in-hospital mortality in patients coinfected with P. jirovecii and Aspergillus. METHODS This study included 53 patients with coinfection of P. jirovecii pneumonia (PJP) and invasive pulmonary aspergillosis (IPA) in our center from January 2011 to December 2021. All cases were divided into survivor (n=27) and non-survivor groups (n=26). Medical records, laboratory and radiology data were collected. Risk factors for in-hospital mortality were identified by multivariable analyses. RESULTS HIV-positive patients accounted for 3.8%. Fever (77.4%), dyspnea (69.8%) and wet cough (24.5%) were common symptoms. Ground-glass opacity (83.0%), consolidation (71.7%), septal thickening (66.0%), and nodules (54.7%) were the most common radiological signs. CD4+ T cell count and serum albumin (ALB) level were significantly lower in non-survival group than in the survival group. Conversely, serum lactate dehydrogenase (LDH) and procalcitonin (PCT) levels were higher in non-survival group than in survival group. Lactic acidosis [odds ratio (OR): 33.999,95% confidential interval (CI): 3.112-371.409; p=0.004], low CD4+ T cell count (<114 cell/µL) [OR: 19.343, 95% CI: 1.533-259.380; p=0.022] and high level of LDH (> 519 U/L) [OR: 11.422, 95% CI: 1.271-102.669; p=0.030] were independent risk factors for mortality. CONCLUSION PJP coinfected with IPA incurs high mortality with nonspecific clinical characteristics and is more likely to involve HIV-negative patients. Lactic acidosis, low CD4+ T cell count and high LDH level are independent risk factors for mortality, close monitoring of these parameters is necessary to help distinguish high-risk patients and make appropriate clinical decisions.
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Affiliation(s)
- Yuxia Zhong
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, China
| | - Ting Ji
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, China
| | - Dan Qin
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, China
| | - Deyun Cheng
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Sichuan 610041, China.
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20
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Caillet A, Bellanger AP, Navellou JC, Daguindau E, Rocchi S, Scherer E, Berceanu A, Millon L. Refractory invasive pulmonary aspergillosis due to Aspergillus flavus detected with the combination of two in-house Aspergillus qPCR. J Mycol Med 2023; 33:101350. [PMID: 36375310 DOI: 10.1016/j.mycmed.2022.101350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/31/2022] [Accepted: 11/07/2022] [Indexed: 11/10/2022]
Abstract
We present a case of probable invasive pulmonary aspergillosis due to Aspergillus flavus, in a female patient treated for an acute myeloid leukemia. Two weeks after an allogenic stem cell transplantation a probable invasive pulmonary aspergillosis was diagnosed based on thoracic imaging combined with positive galactomannan antigen and positive in-house mitochondrial Aspergillus qPCR in serum. Although an antifungal treatment was initiated, Aspergillus qPCR and galactomannan antigen remained positive in serum and worsening of the thoracic lesions was observed. The discordance between the negativity of the in-house ribosomal Aspergillus qPCR (specific to A. fumigatus) and the positivity of the in-house mitochondrial Aspergillus qPCR (targeting A. fumigatus and some other Aspergillus) allowed the suspicion of a thermophilic Aspergillus species that was not A. fumigatus. No strain was obtained in culture but the involvement of A. flavus was confirmed using a specific A. flavus qPCR. This case illustrated the usefulness of our original strategy combining two different in-house Aspergillus qPCRs, in addition to galactomannan assay, to diagnose invasive aspergillosis in hematology patients.
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Affiliation(s)
- Adrien Caillet
- Hematology Department, Besançon University Hospital, Besançon 25000, France
| | - Anne-Pauline Bellanger
- Chrono-Environnement CNRS 6249 Research Team, Franche-Comté University, Besançon 25000, France; Parasitology-Mycology Department, Besançon University Hospital, Besançon 25000, France.
| | | | - Etienne Daguindau
- Hematology Department, Besançon University Hospital, Besançon 25000, France
| | - Steffi Rocchi
- Chrono-Environnement CNRS 6249 Research Team, Franche-Comté University, Besançon 25000, France; Parasitology-Mycology Department, Besançon University Hospital, Besançon 25000, France
| | - Emeline Scherer
- Chrono-Environnement CNRS 6249 Research Team, Franche-Comté University, Besançon 25000, France; Parasitology-Mycology Department, Besançon University Hospital, Besançon 25000, France
| | - Ana Berceanu
- Hematology Department, Besançon University Hospital, Besançon 25000, France
| | - Laurence Millon
- Chrono-Environnement CNRS 6249 Research Team, Franche-Comté University, Besançon 25000, France; Parasitology-Mycology Department, Besançon University Hospital, Besançon 25000, France
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21
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Kubota Y, Takasawa A, Ono Y, Aoyama T, Takasawa K, Tada A, Magara K, Murakami T, Daimon F, Yamamoto S, Sato S, Hiratsuka Y, Kyuno D, Osanai M. Invasive pulmonary aspergillosis with candidiasis: usefulness of molecular and ultrastructural morphological analysis on FFPE tissue for invasive fungal infections. Med Mol Morphol 2023; 56:144-151. [PMID: 36806624 PMCID: PMC9940076 DOI: 10.1007/s00795-023-00349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
Invasive pulmonary aspergillosis (IPA) is one of the most frequent forms of invasive fungal infections (IFI); however, it is often difficult to identify the pathogenic fungal species and to select appropriate treatments for patients with IFI including IPA. Here, we describe the detailed pathophysiology of an autopsy case of severe respiratory failure due to IPA with candidiasis. The patient developed severe respiratory failure after influenza infection and died, and the autopsy revealed a mixed disease of IPA with candidiasis. In this study, in addition to the routine pathological examination, we further examined formalin-fixed paraffin-embedded (FFPE) tissues by scanning electron microscopy (SEM) and partial genomic DNA sequencing. Although optical microscopy alone was insufficient to identify the pathogenic organisms, SEM clearly depicted the characteristic morphology of Aspergillus sp. and Candida sp. as closely overlapping in a nested fashion, providing evidence of mixed infection of both fungal species in a focal site. The technique using FFPE tissue in combination with ultrastructural observation by SEM, elemental analysis by SEM-EDX, and DNA sequencing is promising for analyzing the pathophysiology of IFI.
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Affiliation(s)
- Yusaku Kubota
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, 060-8556, Japan
| | - Akira Takasawa
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, 060-8556, Japan.
| | - Yusuke Ono
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, 060-8556, Japan
| | - Tomoyuki Aoyama
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, 060-8556, Japan
| | - Kumi Takasawa
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, 060-8556, Japan
| | - Akinori Tada
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, 060-8556, Japan
| | - Kazufumi Magara
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, 060-8556, Japan
| | - Taro Murakami
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, 060-8556, Japan
| | - Fuminori Daimon
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, 060-8556, Japan
| | - Soh Yamamoto
- Department of Microbiology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shota Sato
- Emergency and Critical Care Center, Hakodate Municipal Hospital, Hakodate, Japan
| | - Yutaro Hiratsuka
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, 060-8556, Japan
- Department of Internal Medicine, Kin-ikyo Chuo Hospital, Sapporo, Japan
| | - Daisuke Kyuno
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, 060-8556, Japan
| | - Makoto Osanai
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-ku, Sapporo, 060-8556, Japan
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22
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van Grootveld R, van der Beek MT, Janssen NAF, Ergün M, van Dijk K, Bethlehem C, Stads S, van Paassen J, Heunks LMA, Bouman CSC, Reijers MHE, Brüggeman RJ, van de Veerdonk FL, van Bree SHW, van den Berg CHSB, Kuindersma M, Wauters J, Beishuizen A, Verweij PE, Schouten JA. Incidence, risk factors and pre-emptive screening for COVID-19 associated pulmonary aspergillosis in an era of immunomodulant therapy. J Crit Care 2023; 76:154272. [PMID: 36801598 PMCID: PMC9934852 DOI: 10.1016/j.jcrc.2023.154272] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE COVID-19 associated pulmonary aspergillosis (CAPA) is associated with increased morbidity and mortality in ICU patients. We investigated the incidence of, risk factors for and potential benefit of a pre-emptive screening strategy for CAPA in ICUs in the Netherlands/Belgium during immunosuppressive COVID-19 treatment. MATERIALS AND METHODS A retrospective, observational, multicentre study was performed from September 2020-April 2021 including patients admitted to the ICU who had undergone diagnostics for CAPA. Patients were classified based on 2020 ECMM/ISHAM consensus criteria. RESULTS CAPA was diagnosed in 295/1977 (14.9%) patients. Corticosteroids were administered to 97.1% of patients and interleukin-6 inhibitors (anti-IL-6) to 23.5%. EORTC/MSGERC host factors or treatment with anti-IL-6 with or without corticosteroids were not risk factors for CAPA. Ninety-day mortality was 65.3% (145/222) in patients with CAPA compared to 53.7% (176/328) without CAPA (p = 0.008). Median time from ICU admission to CAPA diagnosis was 12 days. Pre-emptive screening for CAPA was not associated with earlier diagnosis or reduced mortality compared to a reactive diagnostic strategy. CONCLUSIONS CAPA is an indicator of a protracted course of a COVID-19 infection. No benefit of pre-emptive screening was observed, but prospective studies comparing pre-defined strategies would be required to confirm this observation.
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Affiliation(s)
- Rebecca van Grootveld
- Leiden University Medical Center, Leiden, the Netherlands; National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | | | - Nico A F Janssen
- Radboud University Medical Center, Nijmegen, the Netherlands; Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
| | - Mehmet Ergün
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Karin van Dijk
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | | | | | - Leo M A Heunks
- Amsterdam University Medical Center, Amsterdam, the Netherlands; Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | | | | | | | | | | | | | | | - Paul E Verweij
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Radboud University Medical Center, Nijmegen, the Netherlands
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- Leiden University Medical Center, Leiden, the Netherlands; Radboud University Medical Center, Nijmegen, the Netherlands; Amsterdam University Medical Center, Amsterdam, the Netherlands; Medical Center Leeuwarden, Leeuwarden, the Netherlands; Ikazia, Rotterdam, the Netherlands; Gelderse Vallei Hospital, Ede, the Netherlands; University Medical Center Groningen, Groningen, the Netherlands; Gelre Hospitals, Apeldoorn, the Netherlands; University Hospitals Leuven, Leuven, Belgium; Medical Spectrum Twente, Enschede, the Netherlands
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23
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Lu Y, Liu L, Li H, Chen B, Gu Y, Wang L, Feng C, Chen C, Chen Y, Sun W, Cui X, Cao M, Tao Y, Zhong J, Zhong H, Ni Y, Cai Y, Song M, Liu X, Shi Y, Su X. The clinical value of Aspergillus-specific IgG antibody test in the diagnosis of nonneutropenic invasive pulmonary aspergillosis. Clin Microbiol Infect 2023:S1198-743X(23)00055-1. [PMID: 36773771 DOI: 10.1016/j.cmi.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/29/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES Aspergillus-specific IgG antibody (Asp IgG) has been successfully applied in the diagnosis of chronic pulmonary aspergillosis. We explored its value in nonneutropenic invasive pulmonary aspergillosis (IPA) by a multicenter, prospective, and controlled study. METHODS We enrolled 372 clinically suspected nonneutropenic patients with IPA from February 2015 to August 2022. After excluding 4 cases with Aspergillus colonization, the remaining 368 cases were finally confirmed as patients with IPA (n = 99), or non-IPA patients (n = 269) consisting of community-acquired pneumonia (n = 206), tuberculosis (n = 22), nontuberculous mycobacteria (n = 5), lung abscess (n = 6), or noninfectious diseases (n = 30). Asp IgG in plasma samples was tested by enzyme-linked immunosorbent assay. RESULTS At cut-off value of ≥80 AU/mL, Asp IgG had much higher sensitivity (59.6% vs. 19.2%, p < 0.0001), but lower specificity (77.0% vs. 96.3%, p < 0.0001) than serum galactomannan (GM) (cut-off value of ≥1.0), and similar sensitivity (59.6% vs. 55.6%, p = 0.611) but lower specificity (77.0% vs. 91.2%, p = 0.001) than bronchoalveolar lavage fluid (BALF) GM (cut-off value of ≥1.0), respectively. Combination diagnosis of either positive for Asp IgG or BALF GM had higher sensitivity (81.0% vs. 55.6%, p = 0.002), but lower specificity (75.2% vs. 91.2%, p = 0.001) than BALF GM alone. The receiver operating characteristic curve showed that Asp IgG had an optimal diagnostic value when the cut-off value was 56.6 AU/ml, and the sensitivity and specificity were 77.8% and 63.9%, respectively. DISCUSSIONS The diagnostic value of Asp IgG for IPA is superior to serum GM, and a little inferior to BALF GM in nonneutropenic patients with IPA. Considering the convenience of taking blood samples, it is a good screening and diagnostic method for nonneutropenic patients with IPA, especially for those who cannot bear invasive procedures.
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Affiliation(s)
- Yajie Lu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lulu Liu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hongxing Li
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing No.2 Southern Medical University, Guangzhou, China
| | - Bilin Chen
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yu Gu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Li Wang
- Department of Respiratory and Critical Care Medicine, Nanjing First Hospital, Nanjing, China
| | - Chunlai Feng
- Department of Respiratory and Critical Care Medicine, Changzhou First People's Hospital, Changzhou, China
| | - Cheng Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yanbin Chen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wenkui Sun
- Department of Respiratory and Critical Care Medicine, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xuefan Cui
- Department of Respiratory and Critical Care Medicine, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Cao
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yujian Tao
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Jinjin Zhong
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Huanhuan Zhong
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yueyan Ni
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Yuchen Cai
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Mengyue Song
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Xiaoguang Liu
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing No.2 Southern Medical University, Guangzhou, China
| | - Yi Shi
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xin Su
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China; Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China; Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing No.2 Southern Medical University, Guangzhou, China; Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing Medical University, Nanjing, China.
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Han Y, Wu X, Jiang G, Guo A, Jin Z, Ying Y, Lai J, Li W, Yan F. Bronchoalveolar lavage fluid polymerase chain reaction for invasive pulmonary aspergillosis among high-risk patients: a diagnostic meta-analysis. BMC Pulm Med 2023; 23:58. [PMID: 36750828 PMCID: PMC9906844 DOI: 10.1186/s12890-023-02343-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Polymerase chain reaction (PCR) assays are perceived to facilitate the diagnosis of fungal infections. However, due to lack of standardization, the value of bronchoalveolar lavage (BAL) fluid PCR in diagnosis of invasive pulmonary aspergillosis (IPA) remains unclear. METHODS We conducted a systematic meta-analysis to evaluate the accuracy of BAL fluid PCR in IPA diagnosis among high-risk patients. All studies involving patients at risk for IPA were included. The sensitivity, specificity, positive and negative likelihood ratios of BAL fluid PCR were summarized for diagnosis of proven/probable IPA, or proven IPA only. Potential heterogeneity was assessed by subgroup analyses and meta-regression. RESULTS Forty-one studies involving 5668 patients were analyzed. The summary sensitivity, specificity, positive and negative likelihood ratios of BAL fluid PCR for proven/probable IPA were 0.75 (95% CI = 0.67-0.81), 0.94 (95% CI = 0.90-0.96), 11.8 (95% CI = 7.7-18.1) and 0.27 (95% CI = 0.20-0.36), respectively. Whereas for proven IPA only, sensitivity and specificity were 0.91 (95% CI = 0.68-0.98) and 0.80 (95% CI = 0.74-0.85) in fourteen studies involving 2061 patients. Significant heterogeneity was present due to the underlying disease, antifungal treatment and differences in DNA extraction techniques and choice of PCR assay. Compared to patients with hematological malignancies (HM) and hematopoietic stem cell/solid organ transplantation (HSCT/SOT), sensitivity was higher in the population with disease such as chronic obstructive pulmonary disease, solid tumor, autoimmune disease with prolonged use of corticosteroids, etc. (0.88 vs. 0.68, P < 0.001), which was related to the concurrent use of antifungal prophylaxis among patients with HM and HSCT/SOT. CONCLUSION BAL fluid PCR is a useful diagnostic tool for IPA in immunocompromised patients and is also effective for diagnosing IPA in patients without HM and HSCT/SOT. Furthermore, standard protocols for DNA extraction and PCR assays should be focused on to improve the diagnostic accuracy. Trial registration PROSPERO, registration number CRD42021239028.
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Affiliation(s)
- Yinling Han
- grid.412465.0Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China
| | - Xiang Wu
- grid.412465.0Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China ,Department of Pulmonary and Critical Care Medicine, Huangshan Hua Ze Hospital of Integrated Traditional Chinese and Western Medicine, Huangshan, 245000 Anhui China
| | - Guangwei Jiang
- grid.412465.0Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China ,Department of Intensive Care Unit, War Trauma Rescue Center, The 903Rd Hospital of PLA Joint Logistics Support Force, Hangzhou, 310007 Zhejiang China
| | - Anyi Guo
- grid.412465.0Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China
| | - Zhangchu Jin
- grid.412465.0Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China
| | - Yinghua Ying
- grid.412465.0Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China
| | - Jianxing Lai
- grid.412465.0Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009 Zhejiang China
| | - Wen Li
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China.
| | - Fugui Yan
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China.
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25
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van Grootveld R, Masarotto V, von dem Borne PA, Blijlevens NMA, Chitu DA, van der Beek MT, Fiocco M, de Boer MGJ. Effect of invasive aspergillosis on risk for different causes of death in older patients with acute myeloid leukaemia or high-risk myelodysplastic syndrome. BMC Infect Dis 2023; 23:78. [PMID: 36747127 PMCID: PMC9903459 DOI: 10.1186/s12879-023-08013-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/18/2023] [Indexed: 02/08/2023] Open
Abstract
PURPOSE Study objectives were to estimate the cumulative incidence of death due to different causes of death (CODs) and investigate the effect of invasive aspergillosis (IA) on each separate COD in a cohort of older patients with acute myeloid leukaemia (AML) or high-risk myelodysplastic syndrome (MDS) included in the Haemato-Oncology Foundation for Adults in the Netherlands (HOVON) 43 randomized controlled trial. METHODS Pre-collected data from the trial was obtained from the HOVON data center and relevant clinical information was extracted. The cumulative incidence of death due to different CODs was estimated with a competing risk model and the association between each COD and prognostic factors, including IA, were investigated with a cause-specific hazard Cox regression model. RESULTS In total 806 patients were included, mean age of 70 years and 55% were male. The cumulative incidences of death due to leukaemia or infection at 3, 6, 12 and 36 months were 0.06, 0.11, 0.23, 0.42 and 0.17, 0.19, 0.22, 0.25 respectively. Incidence of IA was 21% and diagnosis of IA up until the final chemotherapy cycle was associated with an increased risk of dying from leukaemia (cause-specific hazard ratio (CSHR): 1.75, 95% CI 1.34-2.28) and a trend was seen for infection (CSHR: 1.36, 95% CI 0.96-1.91). CONCLUSION Leukaemia was the most likely cause of death over time, however in the first year after diagnosis of AML or high-risk MDS infection was the most likely cause of death. Patients with IA had a relatively increased risk of dying from leukaemia or infection.
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Affiliation(s)
- Rebecca van Grootveld
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Valentina Masarotto
- grid.5132.50000 0001 2312 1970Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Peter A. von dem Borne
- grid.10419.3d0000000089452978Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nicole M. A. Blijlevens
- grid.10417.330000 0004 0444 9382Department of Haematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dana A. Chitu
- grid.5645.2000000040459992XDepartment of Haematology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martha T. van der Beek
- grid.10419.3d0000000089452978Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marta Fiocco
- grid.5132.50000 0001 2312 1970Mathematical Institute, Leiden University, Leiden, The Netherlands ,grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark G. J. de Boer
- grid.10419.3d0000000089452978Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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Li ZM, Kuang YK, Zheng YF, Xu PH, Wang JY, Gan RJ, Li HX, Bai LH, Xie CM, Tang KJ. Gut-derived fungemia due to Kodamaea ohmeri combined with invasive pulmonary aspergillosis: a case report. BMC Infect Dis 2022; 22:903. [PMID: 36460998 PMCID: PMC9719164 DOI: 10.1186/s12879-022-07866-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 11/10/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Kodamaea ohmeri is a rare pathogen with high mortality and is found among blood samples in a considerable proportion; however, gastrointestinal infection of K. ohmeri is extremely rare. Invasive pulmonary aspergillosis is also an uncommon fungal; these two fungal infections reported concomitantly are unprecedented. CASE PRESENTATION We described a case of a 37-year-old male who got infected with K. ohmeri and invasive pulmonary aspergillosis. We used the mass spectrometry and histopathology to identify these two fungal infections separately. For the treatment of K. ohmeri, we chose caspofungin. As for invasive pulmonary aspergillosis, we used voriconazole, amphotericin B, and then surgery. The patient was treated successfully through the collaboration of multiple disciplines. CONCLUSIONS We speculate that the destruction of the intestinal mucosa barrier can make the intestine one of the ways for certain fungi to infect the human body.
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Affiliation(s)
- Zi-Mu Li
- grid.12981.330000 0001 2360 039XDivision of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan Er Lu, Guangzhou, 510080 China ,grid.12981.330000 0001 2360 039XInstitute of Pulmonary Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Yu-Kun Kuang
- grid.12981.330000 0001 2360 039XDivision of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan Er Lu, Guangzhou, 510080 China ,grid.12981.330000 0001 2360 039XInstitute of Pulmonary Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Yi-Fan Zheng
- grid.12981.330000 0001 2360 039XDepartment of Pharmacy, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Pei-Hang Xu
- grid.12981.330000 0001 2360 039XDivision of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan Er Lu, Guangzhou, 510080 China ,grid.12981.330000 0001 2360 039XInstitute of Pulmonary Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Ji-Yu Wang
- grid.12981.330000 0001 2360 039XDivision of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan Er Lu, Guangzhou, 510080 China ,grid.12981.330000 0001 2360 039XInstitute of Pulmonary Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Run-Jing Gan
- grid.12981.330000 0001 2360 039XDivision of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan Er Lu, Guangzhou, 510080 China ,grid.12981.330000 0001 2360 039XInstitute of Pulmonary Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Hui-Xia Li
- grid.12981.330000 0001 2360 039XDivision of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan Er Lu, Guangzhou, 510080 China ,grid.12981.330000 0001 2360 039XInstitute of Pulmonary Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Li-Hong Bai
- grid.12981.330000 0001 2360 039XDivision of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan Er Lu, Guangzhou, 510080 China ,grid.12981.330000 0001 2360 039XInstitute of Pulmonary Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Can-Mao Xie
- grid.12981.330000 0001 2360 039XDivision of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan Er Lu, Guangzhou, 510080 China ,grid.12981.330000 0001 2360 039XInstitute of Pulmonary Diseases, Sun Yat-Sen University, Guangzhou, China
| | - Ke-Jing Tang
- grid.12981.330000 0001 2360 039XDivision of Pulmonary and Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, No. 58, Zhongshan Er Lu, Guangzhou, 510080 China ,grid.12981.330000 0001 2360 039XDepartment of Pharmacy, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Acet-Öztürk NA, Ömer-Topçu D, Vurat-Acar K, Aydın-Güçlü Ö, Pınar İE, Demirdöğen E, Görek-Dilektaşlı A, Kazak E, Özkocaman V, Ursavas A, Akalın H, Özkalemkaş F, Ener B, Ali R. Impact of revised EORTC/MSGERC 2020 criteria on diagnosis and prognosis of invasive pulmonary aspergillosis in patients with hematological malignancies undergoing bronchoscopy. J Mycol Med 2022; 32:101304. [PMID: 35738036 DOI: 10.1016/j.mycmed.2022.101304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 04/29/2022] [Accepted: 06/14/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The first consensus definitions for invasive fungal diseases (IFD) were published in 2002. Advances in diagnostic tests and a clear need for improvement in certain areas led to a revision of these definitions in 2008. However, growing data on Aspergillus galactomannan (GM) thresholds and the introduction of new polymerase chain reaction-based diagnostic tests resulted in a further update by EORTC and Mycoses Study Group Education and Research Consortium (MSGERC) in 2020. Compared to the 2008 version, the 2020 EORTC/MSGERC criteria have stricter definitions, especially regarding GM levels, which should lead to improved specificity. Thus, our study aimed to evaluate diagnostic changes, based on GM levels, resulting from these new definitions and ascertain the impact of the new classification on mortality rates. METHOD Patients hospitalized in a single tertiary care center with hematologic malignancies and undergoing bronchoscopy for suspected IPA between April 2004 and December 2019 were included in this retrospective study. RESULTS The study population consisted of 327 patients with 31 patients (nine patients with proven IPA and 22 patients with no IPA) excluded from the study. 194 patients were classified as probable IPA cases according to 2008 EORTC/MSG criteria. However, 53 (27.3%) of these patients were re-classified as possible IPA according to 2020 EORTC/MSGERC criteria, due to novel galactomannan cut-off levels. Compared to re-classified possible IPA patients, those remaining in the probable IPA category experienced a higher incidence of septic shock (34.0% vs 16.9%, p=0.02), and required more non-invasive (12.0% vs 0.0%, p=0.004) and invasive (44.6 vs 24.5%, p=0.01) mechanical ventilation. There was a higher in-hospital mortality rate in probable IPA patients than in the re-classified possible IPA group (42.5% vs 22.6%, p=0.01). Patients reassigned to possible IPA had similar underlying diseases, radiological features and prognosis to patients already classified as possible IPA. Independent risk factors for mortality were classification as probable IPA according to 2020 EORTC/MSGERC criteria, lack of remission from hematologic malignancy, and number of nodules in Thorax CT. CONCLUSION The use of 2020 EORTC/MSGERC criteria resulted in a 27.3% significant reduction in probable IPA diagnoses and created a more homogeneous category of patients with respect to treatment response, prognosis and mortality. Therefore, 2020 EORTC/MSGERC criteria afford more reliable mortality prediction than 2008 EORTC/MSG criteria.
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28
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Yun KS, Kwon HW, Kwak JG, Park JD, Koh J. Left atrial thrombosis with invasive pulmonary aspergillosis in children with immunodeficiency. Cardiol Young 2022;:1-4. [PMID: 36169004 DOI: 10.1017/S104795112200302X] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Invasive aspergillosis is a major cause of infectious disease in immunocompromised patients; however, cardiac involvement in pulmonary aspergillosis is not well-known. Two paediatric patients undergoing chemotherapy were diagnosed with cardiac aspergilloma, accompanied by pulmonary aspergillosis. In both patients, antibiotic and antifungal treatments were initiated immediately after the pneumonia was diagnosed; however, both died of multiple cerebral thromboembolisms.
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Bongomin F, Kwizera R, Mande E, Aloyo SM, Achan B, Namusobya M, Sereke SG, Batte C, Kiguli S, Baluku JB, Joloba ML, Kirenga BJ. Aspergillus-specific IgM/IgG antibody serostatus of patients hospitalized with moderate-critical COVID-19 in Uganda. Afr Health Sci 2022; 22:506-511. [PMID: 36910368 PMCID: PMC9993298 DOI: 10.4314/ahs.v22i3.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Invasive pulmonary aspergillosis is known to complicate the coronavirus diseases-2019 (COVID-19), especially those with critical illness. We investigated the baseline anti-Aspergillus antibody serostatus of patients with moderate-critical COVID-19 hospitalized at 3 COVID-19 Treatment Units in Uganda. All 46 tested patients, mean age 30, and 11% with underlying respiratory disease had a negative serum anti-Aspergillus IgM/IgG antibody immunochromatographic test on day 3 (mean) of symptom onset (range 1-26), but follow up specimens to assess seroconversion were not available.
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Affiliation(s)
- Felix Bongomin
- Department of Medical Microbiology and Immunology, Gulu University Medical School, Gulu Uganda
| | - Richard Kwizera
- Translational research laboratory, Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O Box 22418, Kampala, Uganda
| | - Emmanuel Mande
- Translational research laboratory, Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O Box 22418, Kampala, Uganda
| | - Sharley Melissa Aloyo
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Beatrice Achan
- Department of Medical Microbiology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Martha Namusobya
- Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda
| | - Senai Goitom Sereke
- Department of Radiology and Radiotherapy, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Charles Batte
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sarah Kiguli
- Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Baruch Baluku
- Department of Internal Medicine, Mulago National Referral Hospital, Kampala, Uganda.,Directorate of Programs, Mildmay Uganda, Wakiso, Uganda
| | - Moses L Joloba
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Bruce J Kirenga
- Makerere University Lung Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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Lamberink H, Wagemakers A, Sigaloff KCE, van Houdt R, de Jonge NA, van Dijk K. The impact of the updated EORTC/MSG criteria on the classification of hematological patients with suspected invasive pulmonary aspergillosis. Clin Microbiol Infect 2022; 28:1120-1125. [PMID: 35248746 DOI: 10.1016/j.cmi.2022.02.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 02/13/2022] [Accepted: 02/19/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Our aim was to evaluate the effect of the updated European Organization for Research and Treatment of Cancer (EORTC) and Mycoses Study Group 2019 definitions for invasive pulmonary aspergillosis (IPA) on patient classification and the related all-cause 12-week mortality. METHODS In this retrospective cohort study from our tertiary care centre, we reclassified patients with haematological malignancy who underwent bronchoalveolar lavage between 2014 and 2019 for suspected IPA using the novel EORTC 2019 criteria. We performed receiver operating characteristic curve analysis to define the optimal cut-off for positive PCR and galactomannan and present survival analyses and their possible association with these diagnostic criteria through post hoc comparisons with log rank and Cox regression. RESULTS From 323 episodes of suspected IPA in 282 patients, 73 were reclassified: 31 (42.5%) from possible to probable IPA, 5 (6.8%) from EORTC criteria not met to probable IPA, and 37 (50.7%) from EORTC criteria not met to possible IPA. Probable IPA increased therefore 11.1% (64/323, 19.8% to 100/323, 30.9%), mostly due to positive PCR (31/36, 86.1%). There was no difference in mortality between newly defined possible and probable IPA (log rank p = 0.950). Mortality was higher in probable cases with lower cycle thresholds (Ct values) versus higher Ct values (p = 0.004). Receiver operating characteristic curve analysis showed an optimal Ct value cut-off of 36.8 with a sensitivity of 75% (95% CI 64.9%-85.1%) and a specificity of 61.7% (95% CI 53.5-69.9) for 12-week mortality. DISCUSSION The new EORTC criteria led to 11.1% more probable IPA diagnoses, mostly due to Aspergillus PCR. Restricting positive PCR to below a certain threshold might improve the discrimination of the new EORTC IPA categories for mortality.
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Affiliation(s)
- Hanne Lamberink
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Alex Wagemakers
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Kim C E Sigaloff
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Robin van Houdt
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nick A de Jonge
- Department of Hematology, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Karin van Dijk
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Bounhiol A, Pasquier G, Novara A, Bougnoux ME, Dannaoui E. Aspergillus detection in airways of ICU COVID-19 patients: To treat or not to treat? J Mycol Med 2022; 32:101290. [PMID: 35569323 PMCID: PMC9045860 DOI: 10.1016/j.mycmed.2022.101290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 12/14/2022]
Abstract
It is now well known that patients with severe COVID-19 are at risk for developing invasive pulmonary aspergillosis (IPA). Nevertheless, the symptomatology of IPA is often atypical in mechanically ventilated patients and the radiological aspects of SARS CoV-2 pneumonia and IPA are difficult to differentiate. In this context, the significance of the presence of Aspergillus in respiratory tract samples (detected by culture, galactomannan antigen, or specific PCR) is not yet fully understood. Here we report two cases of intubated and mechanically ventilated ICU patients with SARS-CoV-2 pneumonia, in whom Aspergillus was detected in respiratory samples, who had a favorable outcome in the absence of antifungal treatment. These two cases highlight the difficulty of using the new definitions of COVID-19 associated pulmonary aspergillosis for routine management of patients.
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Affiliation(s)
- Agathe Bounhiol
- Microbiology Department, Parasitology-Mycology Unit, Faculty of Medicine, Paris University, AP–HP, European Georges-Pompidou Hospital, 75015 Paris, France
| | - Grégoire Pasquier
- Microbiology Department, Parasitology-Mycology Unit, Faculty of Medicine, Paris University, Necker-Enfants Maladies Hospital, 75015 Paris, France
| | - Ana Novara
- Medical Intensive Care Unit, Faculty of Medicine, Paris-Descartes University, AP–HP, European Georges-Pompidou Hospital, 75015 Paris, France
| | - Marie-Elisabeth Bougnoux
- Microbiology Department, Parasitology-Mycology Unit, Faculty of Medicine, Paris University, Necker-Enfants Maladies Hospital, 75015 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, 75015 Paris, France,Dynamyc EA 7380, Paris-Créteil University, Créteil, France,Corresponding author: Unité de Parasitologie - Mycologie. Laboratoire de Microbiologie, Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75908 Paris Cedex 15, AP-HP. Centre – Université de Paris, France
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Mizushima R, Haruhara K, Fukasawa N, Satake M, Fukui A, Koike K, Tsuboi N, Takahashi H, Yokoo T. Two entities in pulmonary nodules of a diabetic patient receiving corticosteroid therapy for bullous pemphigoid: an autopsy case report. BMC Infect Dis 2022; 22:597. [PMID: 35799119 PMCID: PMC9264713 DOI: 10.1186/s12879-022-07566-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Invasive pulmonary aspergillosis (IPA) is a serious complication occurring in immunocompromised patients, who often show multiple nodular lesions with or without cavitation. Due to high mortality and poor prognosis, the earlier detection and initiation of treatment are needed, while the definitive diagnosis is often difficult to make in clinical settings. Septic pulmonary embolism (SPE) is a complication that occurs in patients with bloodstream infections (e.g., infectious endocarditis). Patients with SPE also present with multiple nodules, nodules with or without cavitation, which are quite similar to the findings of IPA. We herein report an autopsy case that showed multiple nodules due to IPA and infectious endocarditis-related SPE. Case A 69-year-old man receiving maintenance hemodialysis due to diabetic nephropathy was admitted with worsening skin rash due to bullous pemphigoid and toxic epidermal necrolysis. He was treated with intravenous methylprednisolone followed by an increased dose of oral prednisolone. On the 6th week of admission, he was diagnosed with infectious endocarditis after the isolation of Corynebacterium in blood samples, with a nodule lesion with cavitation in the right lung. Intravenous vancomycin was initiated. After antibacterial treatment, the nodules in the right lung gradually diminished, whereas a nodule with cavitation in the left lung emerged. The nodule in the left lung showed rapid growth along with elevation of serum β-d-glucan and galactomannan antigen. Despite starting treatment with antifungal agents, he died from respiratory failure. An autopsy revealed Groccott staining-positive aspergillus in the left lung, but not in the right lung. We found fibrosis with mitral valve vegetation, indicating a recovery from infectious endocarditis. Conclusion Although similar features of nodules with cavitation on CT imaging were shared with SPE and IPA, this case demonstrated that these heterogeneous diseases can occur within the lungs and the distinctly different transitions of CT imaging are helpful for suspecting the presence of multiple pathogeneses.
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Affiliation(s)
- Reimi Mizushima
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.,Department of Respiratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kotaro Haruhara
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| | - Nei Fukasawa
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mari Satake
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Fukui
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Koike
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Lee R, Cho SY, Lee DG, Ahn H, Choi H, Choi SM, Choi JK, Choi JH, Kim SY, Kim YJ, Lee HJ. Risk factors and clinical impact of COVID-19-associated pulmonary aspergillosis: Multicenter retrospective cohort study. Korean J Intern Med 2022; 37:851-863. [PMID: 35611611 PMCID: PMC9271713 DOI: 10.3904/kjim.2022.069] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIMS The risk factors and clinical impacts of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) remain controversial, and no data have been reported in Korea. This study aimed to investigate the epidemiology and importance of CAPA diagnostic efforts and to identify the predictors of CAPA and the impacts on clinical outcomes. METHODS Between January 2020 and May 2021, data of severely to critically ill COVID-19 patients were extracted from seven hospitals of the Catholic Medical Center through a clinical data warehouse. Corticosteroid use was subcategorized into total cumulative dose, early 7-day dose, mean daily dose, and duration of use. RESULTS A total of 2,427 patients were screened, and 218 patients were included. CAPA was diagnosed in 4.6% (10/218) of all hospitalized and 11.2% (10/89) of intensive care unit patients. Total cumulative dose (over 1,000 mg as methylprednisolone) and daily high-dose corticosteroid use (over 60 mg/day) were independent predictors but not early 7-day high-dose corticosteroid use (over 420 mg/week) (odds ratio [OR], 1.731; 95% confidence interval [CI], 0.350 to 8.571) nor prolonged use (OR, 2.794; 95% CI, 0.635 to 13.928). In-hospital overall mortality was 11.9% (26 of 218). CAPA itself did not affect the outcome; rather, daily high-dose steroid use significantly increased the 30-day mortality (hazard ratio, 5.645; 95% CI, 1.225 to 26.091). CONCLUSION CAPA was not uncommon, especially in critically ill patients. Daily high-dose corticosteroid use was the predictor of CAPA and associated with high mortality rates. High-dose corticosteroids use after early inflammatory phase should be avoided, and active surveillance methods for CAPA are essential for those high-risk patients.
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Affiliation(s)
- Raeseok Lee
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hyojin Ahn
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hyeah Choi
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Su-Mi Choi
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Division of Infectious Diseases, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Jae-Ki Choi
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Division of Infectious Diseases, Department of Internal Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon,
Korea
| | - Jung-Hyun Choi
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Division of Infectious Diseases, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Shin Young Kim
- Division of Pulmonology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon,
Korea
| | - Youn Jeong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon,
Korea
| | - Hyo-Jin Lee
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Division of Infectious Diseases, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu,
Korea
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Inoue K, Muramatsu K, Nishimura T, Fujino Y, Matsuda S, Fushimi K, Kamochi M. Association between early diagnosis of and inpatient mortality from invasive pulmonary aspergillosis among patients without immunocompromised host factors: a nationwide observational study. Int J Infect Dis 2022; 122:279-284. [PMID: 35643307 DOI: 10.1016/j.ijid.2022.05.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/19/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES The incidence of invasive pulmonary aspergillosis (IPA) among patients without immunocompromised host factors (ICHF) has been described extensively. However, its diagnosis remains challenging. To date, no study has statistically confirmed the efficacy of early IPA diagnosis in patients without ICHF. METHODS We conducted a cross-sectional study on mortality from IPA among patients without ICHF, using the Japanese Diagnosis Procedure Combination National Inpatient Database (April 2014-March 2018). The early diagnosis group was defined according to antifungal therapy initiation within 7 days of hospital admission. The delayed diagnosis group was defined according to antifungal therapy initiation between 8 and 28 days of the hospitalization. Associations were estimated using multivariate logistic regression. RESULTS A total of 423 patients were registered (early diagnosis group, n = 262, 62%). The early diagnosis group had a lower mortality rate (30%) than the delayed diagnosis group (42%). The early diagnosis group that was treated with voriconazole was associated with lower odds of mortality (odds ratio 0.55, 95% confidence interval 0.31-0.99, P = 0.047). An age of ≥65 years and mechanical ventilation were associated with a higher mortality rate. CONCLUSION Early diagnosis along with optimal antifungal treatment are crucial for achieving favorable outcomes among patients with IPA without ICHF.
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Affiliation(s)
- Katsuhiro Inoue
- Intensive Care Unit, Hospital of University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 8078555, Japan.
| | - Keiji Muramatsu
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi,, 8078555, Japan
| | - Takehiro Nishimura
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi,, 8078555, Japan
| | - Yoshihisa Fujino
- Department of Environmental Epidemiology, Institute of industrial Ecological Sciences, University of Occupational and Environmental Health, 11 Iseigaoka, Yahatanishi, Kitakyushu, 8078555, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi,, 8078555, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, 1 5-45 Yushima, Bunkyo-ku, Tokyo, 1138510, Japan
| | - Masayuki Kamochi
- Intensive Care Unit, Hospital of University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 8078555, Japan
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Bernardi RM, Holler SR, Almeida EGCD, Anton C, Machado FD, Silva DR. Evaluation of the diagnostic accuracy of galactomannan from the bronchoalveolar lavage fluid of patients with suspected invasive pulmonary aspergillosis. Rev Iberoam Micol 2022; 39:31-35. [PMID: 35461766 DOI: 10.1016/j.riam.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/16/2021] [Accepted: 07/21/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Several studies to evaluate the accuracy of galactomannan (GM) in bronchoalveolar lavage fluid (BALF) as a diagnostic tool have been carried out; however, there are still controversies about the optimal cut-off point of BALF GM. AIMS The objective of this study was to determine the diagnostic accuracy and the optimal cut-off point on BALF GM from patients with suspected invasive pulmonary aspergillosis (IPA) in a tertiary care hospital. METHODS A cross-sectional study with 188 patients (≥18 years) that had undergone a bronchoscopy with BAL due to suspected IPA was carried out. IPA was diagnosed according to the EORTC/MSG guidelines. RESULTS The optimal optical density cut-off point for BALF GM was 0.67, with sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 70%, 32.3%, and 100%, respectively. CONCLUSIONS BALF GM detection proved to be a useful supplementary technique in the early diagnosis of IPA in both neutropenic and non-neutropenic patients.
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Affiliation(s)
- Rafaela Manzoni Bernardi
- Programa de Pós-Graduação em Ciências Pneumológicas da Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
| | | | | | - Camila Anton
- Programa de Pós-Graduação em Ciências Pneumológicas da Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Hospital de Clínicas de Porto Alegre, Brazil
| | - Felipe Dominguez Machado
- Programa de Pós-Graduação em Ciências Pneumológicas da Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Hospital de Clínicas de Porto Alegre, Brazil
| | - Denise Rossato Silva
- Programa de Pós-Graduação em Ciências Pneumológicas da Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Hospital de Clínicas de Porto Alegre, Brazil.
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Morita K, Yamamoto S, Ueda M, Taniguchi K, Nakai H, Minamiguchi S, Muso E, Yanagita M. A rare case of atypical ANCA-associated vasculitis without crescents overlapping with invasive pulmonary aspergillosis, successfully treated to remission with intravenous immunoglobulin therapy. CEN Case Rep 2022; 11:428-435. [PMID: 35267179 DOI: 10.1007/s13730-022-00696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/23/2022] [Indexed: 11/27/2022] Open
Abstract
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is life-threatening without treatment, but aggressive immunosuppression increases the risk of exacerbating a coexisting infection. Finding the balance between efficacy and safety of immunosuppression is challenging. We describe a 74-year-old man who was diagnosed with AAV following the aggravation of chronic pulmonary aspergillosis that required an aggressive antifungal agent. The laboratory data on admission demonstrated severe kidney failure requiring hemodialysis. Due to the active infection, we chose intravenous immunoglobulin (IVIg) as a low-risk initial treatment, which remarkably improved renal dysfunction (serum creatinine; 16.7 mg/dL-3.7 mg/dL) and systemic inflammation. Renal biopsy that was performed after renal recovery revealed atypical ANCA-associated nephritis without cellular crescents but with massive arteritis with multiple vascular sizes and diffuse interstitial inflammation. Despite these active AAV findings, adding plasma exchange therapy (PE) and low-dose steroids were sufficient to induce remission. The main pathogenesis of severe renal impairment was probably the reduction of blood flow, resulting from occlusions of small arteries by inflammatory cell infiltration and vascular endothelial injury due to AAV. Combination treatment with antifungal agents, IVIg, PE, and low-dose steroid treatment led to complete resolution of vasculitis. The specific histological findings and the good response to treatments suggest that pulmonary aspergillosis might trigger vasculitis through induction of ANCA antigen expression. IVIg could be an important option especially for cases of AAV associated with pulmonary aspergillosis.
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Affiliation(s)
- Keisuke Morita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shinya Yamamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Marina Ueda
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Keisuke Taniguchi
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hirotsugu Nakai
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eri Muso
- Division of Nephrology and Dialysis, Kitano Hospital, Osaka, Japan
- Department of Food and Nutrition, Faculty of Contemporary Home Economics, Kyoto Kacho University, Kyoto, Japan
| | - Motoko Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Shogoin-Kawahara-cho 54, Sakyo-ku, Kyoto, 606-8507, Japan
- Institute for the Advanced Study of Human Biology (ASHBi), Kyoto University, Kyoto, Japan
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Rouzé A, Lemaitre E, Martin-Loeches I, Povoa P, Diaz E, Nyga R, Torres A, Metzelard M, Du Cheyron D, Lambiotte F, Tamion F, Labruyere M, Boulle Geronimi C, Luyt CE, Nyunga M, Pouly O, Thille AW, Megarbane B, Saade A, Magira E, Llitjos JF, Ioannidou I, Pierre A, Reignier J, Garot D, Kreitmann L, Baudel JL, Voiriot G, Plantefeve G, Morawiec E, Asfar P, Boyer A, Mekontso-Dessap A, Makris D, Vinsonneau C, Floch PE, Marois C, Ceccato A, Artigas A, Gaudet A, Nora D, Cornu M, Duhamel A, Labreuche J, Nseir S. Invasive pulmonary aspergillosis among intubated patients with SARS-CoV-2 or influenza pneumonia: a European multicenter comparative cohort study. Crit Care 2022; 26:11. [PMID: 34983611 PMCID: PMC8724752 DOI: 10.1186/s13054-021-03874-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/17/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Recent multicenter studies identified COVID-19 as a risk factor for invasive pulmonary aspergillosis (IPA). However, no large multicenter study has compared the incidence of IPA between COVID-19 and influenza patients. OBJECTIVES To determine the incidence of putative IPA in critically ill SARS-CoV-2 patients, compared with influenza patients. METHODS This study was a planned ancillary analysis of the coVAPid multicenter retrospective European cohort. Consecutive adult patients requiring invasive mechanical ventilation for > 48 h for SARS-CoV-2 pneumonia or influenza pneumonia were included. The 28-day cumulative incidence of putative IPA, based on Blot definition, was the primary outcome. IPA incidence was estimated using the Kalbfleisch and Prentice method, considering extubation (dead or alive) within 28 days as competing event. RESULTS A total of 1047 patients were included (566 in the SARS-CoV-2 group and 481 in the influenza group). The incidence of putative IPA was lower in SARS-CoV-2 pneumonia group (14, 2.5%) than in influenza pneumonia group (29, 6%), adjusted cause-specific hazard ratio (cHR) 3.29 (95% CI 1.53-7.02, p = 0.0006). When putative IPA and Aspergillus respiratory tract colonization were combined, the incidence was also significantly lower in the SARS-CoV-2 group, as compared to influenza group (4.1% vs. 10.2%), adjusted cHR 3.21 (95% CI 1.88-5.46, p < 0.0001). In the whole study population, putative IPA was associated with significant increase in 28-day mortality rate, and length of ICU stay, compared with colonized patients, or those with no IPA or Aspergillus colonization. CONCLUSIONS Overall, the incidence of putative IPA was low. Its incidence was significantly lower in patients with SARS-CoV-2 pneumonia than in those with influenza pneumonia. Clinical trial registration The study was registered at ClinicalTrials.gov, number NCT04359693 .
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Affiliation(s)
- Anahita Rouzé
- CHU de Lille, Médecine Intensive-Réanimation, 59000, Lille, France
- INSERM U1285, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Université de Lille, 59000, Lille, France
| | - Elise Lemaitre
- CHU de Lille, Médecine Intensive-Réanimation, 59000, Lille, France
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, Ireland
- Department of Clinical medicine, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Hospital Clinic, IDIBAPS, Universidad de Barcelona, Ciberes, Barcelona, Spain
| | - Pedro Povoa
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
- NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
| | - Emili Diaz
- Critical Care Department, Hospital Universitari Parc Tauli, Sabadell, Departament de Medicina, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Rémy Nyga
- Service de médecine intensive réanimation, CHU Amiens Picardie, 80000, Amiens, France
| | - Antoni Torres
- Department of Pulmonology, Hospital Clinic of Barcelona, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - Matthieu Metzelard
- Service de médecine intensive réanimation, CHU Amiens Picardie, 80000, Amiens, France
| | - Damien Du Cheyron
- Department of Medical Intensive Care, Caen University Hospital, 14000, Caen, France
| | - Fabien Lambiotte
- Service de réanimation polyvalente, Centre hospitalier de Valenciennes, Valenciennes, France
| | - Fabienne Tamion
- Medical Intensive Care Unit, UNIROUEN, Inserm U1096, FHU- REMOD-VHF, Rouen University Hospital, 76000, Rouen, France
| | - Marie Labruyere
- Department of Intensive Care, François Mitterrand University Hospital, Dijon, France
| | - Claire Boulle Geronimi
- Service de réanimation et de soins intensifs, Centre hospitalier de Douai, Douai, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris Cedex 13, France
| | - Martine Nyunga
- Service de réanimation, Centre hospitalier de Roubaix, Roubaix, France
| | - Olivier Pouly
- Service de médecine intensive réanimation, Hôpital Saint Philibert GHICL, Université catholique, Lille, France
| | - Arnaud W Thille
- CHU de Poitiers, Médecine Intensive Réanimation, CIC 1402 ALIVE, Université de Poitiers, Poitiers, France
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, INSERM UMRS-1144, Paris University, Paris, France
| | - Anastasia Saade
- Service de médecine intensive réanimation, Hôpital Saint-Louis, 75010, Paris, France
| | - Eleni Magira
- First Department of Critical Care Medicine, Medical School, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Jean-François Llitjos
- Medical Intensive Care Unit, Cochin Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Iliana Ioannidou
- First Department of Pulmonary Medicine and Intensive Care Unit, Sotiria Chest Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandre Pierre
- Service de réanimation polyvalente, Centre Hospitalier de Lens, Lens, France
| | - Jean Reignier
- Service de Médecine Intensive Réanimation, CHU de Nantes, Nantes, France
| | - Denis Garot
- Service de Médecine Intensive Réanimation, CHU de Tours, Hôpital Bretonneau, 37044, Tours Cedex 9, France
| | - Louis Kreitmann
- Service de Médecine Intensive - Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69437, Lyon Cedex 03, France
| | - Jean-Luc Baudel
- Service de Médecine Intensive Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012, Paris, France
| | - Guillaume Voiriot
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Gaëtan Plantefeve
- Service de réanimation polyvalente, CH Victor Dupouy, Argenteuil, France
| | - Elise Morawiec
- Service de Médecine Intensive-Réanimation et Pneumologie, Hôpital Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
- Inserm UMRS Neurophysiologie respiratoire expérimentale et clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Pierre Asfar
- Département de Médecine Intensive Réanimation, CHU d'Angers, 49933, Angers Cedex 9, France
| | - Alexandre Boyer
- Service de médecine intensive réanimation, CHU de Bordeaux, 33000Bordeaux, France
| | - Armand Mekontso-Dessap
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, CARMAS ; INSERM U955, Institut Mondor de recherche Biomédicale, Université Paris Est Créteil, 94010, Créteil, France
| | - Demosthenes Makris
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly, 41110, Biopolis Larissa, Greece
| | | | | | - Clémence Marois
- Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Département de Neurologie, Unité de Médecine Intensive Réanimation Neurologique, Sorbonne Université, Paris, France
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Maladies métaboliques, biliaires et fibro-inflammatoire du foie, Institute of Cardiometabolism and Nutrition (ICAN), Sorbonne Université, Paris, France
| | - Adrian Ceccato
- Intensive Care Unit, IDIBAPS, CIBERES, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | - Antonio Artigas
- Critical Care Center, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Sabadell, Spain
| | - Alexandre Gaudet
- CHU de Lille, Médecine Intensive-Réanimation, 59000, Lille, France
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR9017-CIIL-Centre d'Infection et d'Immunité de Lille, Univ. Lille, Lille, France
| | - David Nora
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Marjorie Cornu
- INSERM U1285, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Université de Lille, 59000, Lille, France
- Institut de Microbiologie, Service de Parasitologie Mycologie, CHU Lille, Pôle de Biologie-Pathologie-Génétique, 59000, Lille, France
| | - Alain Duhamel
- ULR 2694-METRICS : Evaluation des technologies de santé et des pratiques médicales, Univ. Lille, 59000, Lille, France
- Biostatistics Department, CHU de Lille, 59000, Lille, France
| | - Julien Labreuche
- ULR 2694-METRICS : Evaluation des technologies de santé et des pratiques médicales, Univ. Lille, 59000, Lille, France
- Biostatistics Department, CHU de Lille, 59000, Lille, France
| | - Saad Nseir
- CHU de Lille, Médecine Intensive-Réanimation, 59000, Lille, France.
- INSERM U1285, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Université de Lille, 59000, Lille, France.
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Sánchez Martín C, Madrid Martínez E, González Pellicer R, Armero Ibáñez R, Martínez González E, Llau Pitarch JV. Invasive pulmonary aspergillosis in patients with acute respiratory syndrome by COVID-19. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:48-53. [PMID: 35033481 PMCID: PMC8739016 DOI: 10.1016/j.redare.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022]
Abstract
Patients with COVID-19 who are admitted to intensive care unit (ICU) are at high risk of developing secondary infections, including invasive fungal infections such as invasive pulmonary aspergillosis (IPA). The main purpose was to analyse the putative COVID-19 Associated Pulmonary Aspergillosis (CAPA) patients in our setting. In these patients, we performed mycological culture in bronchoalveolar lavage (BAL) for isolation of Aspergillus sp. We followed the AspICU algorithm to diagnose putative IPA. Moreover, we considered relevant the positivity of Galactomannan in BAL. We diagnosed putative IPA in 3 patients. The common features of these 3 patients were: more than 21 days of stay in ICU, severe acute respiratory distress syndrome (ARDS) and treatment with steroids (1 mg/kg per day). Therefore, CAPA has to be systematically considered although a new algorithm to diagnose it is needed to treat patients in early stages in order to avoid catastrophic outcomes.
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Affiliation(s)
- C Sánchez Martín
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain.
| | - E Madrid Martínez
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain
| | - R González Pellicer
- Servicio de Microbiología, Hospital Universitario Doctor Peset, Valencia, Spain
| | - R Armero Ibáñez
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain
| | - E Martínez González
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain
| | - J V Llau Pitarch
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, Spain; Anestesiología, Universitat de València, Valencia, Spain
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He Q, Zhang M, Feng C. The role of pentraxin3 in plasma and bronchoalveolar lavage fluid in COPD patients with invasive pulmonary aspergillosis. BMC Pulm Med 2021; 21:414. [PMID: 34915889 PMCID: PMC8680116 DOI: 10.1186/s12890-021-01793-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background The use of galactomannan (GM) testing in plasma and bronchoalveolar lavage fluid (BALF) has improved the diagnosis of invasive pulmonary aspergillosis (IPA) in patients with chronic obstructive pulmonary disease (COPD); however, the high false-positive rate leads to overdiagnosis. Pentraxin 3 (PTX3) as an indicator of inflammation plays an important role in resistance to Aspergillus infections. This study aimed to investigate the diagnostic value of PTX3 for diagnosing IPA with COPD.
Methods We retrospectively collected data on patients with suspected COPD and IPA who had been hospitalized in the Third Affiliated Hospital of Soochow University between September 2017 and November 2020. PTX3 and GM were measured using enzyme-linked immunosorbent assays. Results A total of 165 patients were included in the study, of whom 35 had confirmed or probable IPA. The remaining 130 patients served as controls. The median plasma and BALF PTX3 levels were significantly higher in patients with IPA than in control patients (3.74 ng/mL vs. 1.29 ng/mL, P < 0.001; and 3.88 ng/mL vs. 1.58 ng/mL, P < 0.001 in plasma and BALF, respectively). The plasma GM, plasma PTX3, BALF GM, and BALF PTX3 assays had sensitivities of 60.0%, 77.1%, 78.6%, and 89.3%, respectively, and specificities of 73.8%, 69.2%, 80.7%, and 77.1%, respectively. The sensitivity of PTX3 in plasma and BALF was higher than that of GM. However, the specificity of PTX3 and GM did not differ significantly between the IPA group and the control group. The specificity of the assays for the diagnosis of IPA was > 90% in patients who were PTX3-positive and GM-positive in plasma and BALF. Conclusions BALF and plasma PTX3 levels were significantly higher in COPD patients with IPA. The sensitivity of PTX3 was superior to that of GM for diagnosing IPA in patients with COPD. The combination of GM and PTX3 is useful for the diagnosis of IPA in patients with COPD.
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Affiliation(s)
- Qian He
- Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Soochow University, Changzhou, 23000, China
| | - Ming Zhang
- Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Soochow University, Changzhou, 23000, China
| | - Chunlai Feng
- Department of Respiratory and Critical Care Medicine, Third Affiliated Hospital of Soochow University, Changzhou, 23000, China.
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Chong WH, Saha BK, Neu KP. Comparing the clinical characteristics and outcomes of COVID-19-associate pulmonary aspergillosis (CAPA): a systematic review and meta-analysis. Infection 2021; 50:43-56. [PMID: 34570355 PMCID: PMC8475405 DOI: 10.1007/s15010-021-01701-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/14/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Invasive pulmonary aspergillosis has been increasingly recognized in COVID-19 patients, termed COVID-19-associate pulmonary aspergillosis (CAPA). Our meta-analysis aims to assess the clinical characteristics and outcomes of patients diagnosed with CAPA compared to those without CAPA. METHODS We searched the Pubmed, Cochrane Library, SCOPUS, and Web of Science databases for studies published between January 1, 2020 and August 1, 2021, containing comparative data of patients diagnosed with CAPA and those without CAPA. RESULTS Eight cohort studies involving 729 critically ill COVID-19 patients with comparative data were included. CAPA patients were older (mean age 66.58 vs. 59.25 years; P = 0.007) and had underlying chronic obstructive pulmonary disease (COPD) (13.7 vs. 6.1%; OR 2.75; P = 0.05). No differences in gender, body mass index (BMI), and comorbidities of diabetes and cancer were observed. CAPA patients were more likely to receive long-term corticosteroid treatment (15.0 vs. 5.3%; OR 3.53; P = 0.03). CAPA patients had greater severity of illness based on sequential organ failure assessment (SOFA) score with a higher all-cause in-hospital mortality rate (42.6 vs. 26.5%; OR 3.39; P < 0.001) and earlier ICU admission from illness onset (mean 11.00 vs. 12.00 days; P = 0.003). ICU length of stay (LOS), invasive mechanical ventilation (IMV) duration, the requirement of inotropic support and renal replacement therapy were comparable between the two groups. CONCLUSIONS CAPA patients are typically older with underlying COPD and received long-term corticosteroid treatment. Furthermore, CAPA is associated with higher SOFA scores, mortality, and earlier onset of ICU admission from illness onset.
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Affiliation(s)
- Woon Hean Chong
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, 12208, USA.
| | - Biplab K Saha
- Department of Pulmonary and Critical Care, Ozarks Medical Center, West Plains, MO, 65775, USA
| | - Kristoffer P Neu
- Department of Pulmonary and Critical Care, Albany Stratton VA Medical Center, Albany, NY, 12208, USA
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Montrucchio G, Lupia T, Lombardo D, Stroffolini G, Corcione S, De Rosa FG, Brazzi L. Risk factors for invasive aspergillosis in ICU patients with COVID-19: current insights and new key elements. Ann Intensive Care 2021; 11:136. [PMID: 34524562 DOI: 10.1186/s13613-021-00923-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/29/2021] [Indexed: 12/15/2022] Open
Abstract
Invasive pulmonary aspergillosis (IPA) has always been a challenging diagnosis and risk factors an important guide to investigate specific population, especially in Intensive Care Unit. Traditionally recognized risk factors for IPA have been haematological diseases or condition associated with severe immunosuppression, lately completed by chronic conditions (such as obstructive pulmonary disease, liver cirrhosis, chronic kidney disease and diabetes), influenza infection and Intensive Care Unit (ICU) admission. Recently, a new association with SARS-CoV2 infection, named COVID-19-associated pulmonary aspergillosis (CAPA), has been reported worldwide, even if its basic epidemiological characteristics have not been completely established yet. In this narrative review, we aimed to explore the potential risk factors for the development of CAPA and to evaluate whether previous host factors or therapeutic approaches used in the treatment of COVID-19 critically ill patients (such as mechanical ventilation, intensive care management, corticosteroids, broad-spectrum antibiotics, immunomodulatory agents) may impact this new diagnostic category. Reviewing all English-language articles published from December 2019 to December 2020, we identified 21 papers describing risk factors, concerning host comorbidities, ICU management, and COVID-19 therapies. Although limited by the quality of the available literature, data seem to confirm the role of previous host risk factors, especially respiratory diseases. However, the attention is shifting from patients' related risk factors to factors characterizing the hospital and intensive care course, deeply influenced by specific features of COVID treatment itself. Prolonged invasive or non-invasive respiratory support, as well as the impact of corticosteroids and/or immunobiological therapies seem to play a pivotal role. ICU setting related factors, such as environmental factors, isolation conditions, ventilation systems, building renovation works, and temporal spread with respect to pandemic waves, need to be considered. Large, prospective studies based on new risk factors specific for CAPA are warranted to guide surveillance and decision of when and how to treat this particular population.
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Schils R, Altdorfer A, Moerman F, Weber T, De Waele M, Maertens J, Pirotte BF. A rare case of invasive pulmonary aspergillosis presenting as organizing pneumonia due to Aspergillus niger in an immunocompetent host. Respir Med Case Rep 2021; 34:101503. [PMID: 34485051 PMCID: PMC8406023 DOI: 10.1016/j.rmcr.2021.101503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/11/2021] [Accepted: 08/24/2021] [Indexed: 11/27/2022] Open
Abstract
Invasive pulmonary aspergillosis associated with organizing pneumonia is increasingly described and mainly affects the immunocompromised individual. Most of Aspergillus invasive infections in both immunocompetent and immunocompromised patients are attributed to Aspergillus fumigatus. Herein we describe a clinical case of pulmonary Aspergillus niger infection presenting as an organizing pneumonia in an immunocompetent patient. A wedge resection and two successive cures of azoles (voriconazole 6 weeks then itraconazole 6 weeks) were necessary for the patient to be totally recovered. The association of OP and IPA is rare. The involvement of A. niger makes it even rarer, this is the reason why we decided to report on this case.
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Affiliation(s)
- Raphaël Schils
- Department of Internal Medicine and Infectious Diseases, Liège University Hospital, 4000, Liège, Belgium
| | - Antoine Altdorfer
- Department of Internal Medicine and Infectious Diseases, CHR de la Citadelle, 4000, Liège, Belgium
| | - Filip Moerman
- Department of Internal Medicine and Infectious Diseases, CHR de la Citadelle, 4000, Liège, Belgium
| | - Thierry Weber
- Department of Pneumology, CHR de la Citadelle, 4000, Liège, Belgium
| | - Michèle De Waele
- Department of Cardiothoracic Surgery, CHR de la Citadelle, 4000, Liège, Belgium
| | - Johan Maertens
- Department of Hematology, University Hospital Leuven, 3000, Leuven, Belgium
| | - Benoit F Pirotte
- Department of Internal Medicine and Infectious Diseases, CHR de la Citadelle, 4000, Liège, Belgium
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Chen D, Qian Z, Su H, Meng Z, Lv J, Huang Y, Gao Y, Liu J, Zhao C, Gao H, Chen Y, Xia J, Peng L, Han T, Li H, Zheng X, Wang X, Lu X, Shi Y, Hu J, Chen J. Invasive Pulmonary Aspergillosis in Acute-on-Chronic Liver Failure Patients: Short-Term Outcomes and Antifungal Options. Infect Dis Ther 2021; 10:2525-2538. [PMID: 34468963 PMCID: PMC8572893 DOI: 10.1007/s40121-021-00524-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Acute-on-chronic liver failure (ACLF) patients are susceptible to invasive fungal infections. We evaluated the prognosis and antifungal options in ACLF patients with invasive pulmonary aspergillosis (IPA). Methods ACLF patients with IPA from 15 hospitals were retrospectively screened from 2011 to 2018, and 383 ACLF patients without lung infections were included from a prospective cohort (NCT02457637). Demographic, laboratory, clinical data, and 28-day outcomes were documented in the two cohorts. Results ACLF patients with probable IPA (n = 145) had greater 28-day mortality (33.6% vs. 15.7%, p < 0.001) than those without (n = 383). The respiratory failure-associated 28-day mortality was greater in ACLF patients with IPA than in those without before (17.1% vs. 0.3%, p < 0.001) and after (16.0% vs. 0.0%, p < 0.001) propensity score matching in 116 pairs. IPA patients with lung injury had greater 28-day all-cause mortality (66.5% vs. 24.2%, p < 0.001) and IPA-associated mortality (45.8% vs. 8.1%, p < 0.001) than patients without lung injury (PaO2/FiO2 ≥ 400 mmHg). Antifungal therapy was prescribed to 139 of 145 patients, and 102 patients were treated with voriconazole alone (n = 59) or sequential/combined therapy (n = 43) with varying loading doses (100–800 mg) and daily maintenance doses (0–800 mg). A proposed optimal voriconazole regimen (loading dose, 200 mg twice daily; daily maintenance dose, 100 mg) achieved comparable short-term survival and optimal trough drug concentrations (1–5 μg/mL) on therapeutic drug monitoring in 26 patients. Conclusion Presence of IPA increases the short-term mortality of ACLF patients mainly due to respiratory failure. An optimal voriconazole regimen is needed for such critical patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00524-5.
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Affiliation(s)
- Danli Chen
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No 1838, Guangzhou Dadao Bei, Guangzhou, 510515, People's Republic of China
| | - Zhiping Qian
- Department of Infectious Disease, Shanghai Public Health Clinical Center Affiliated to Fudan University, Shanghai, People's Republic of China
| | - Haibin Su
- Liver Failure Treatment and Research Center, The Fifth Medical Center of PLA General Hospital, No 100, Xisihuanzhonglu Road, Beijing, 100039, People's Republic of China
| | - Zhongji Meng
- Department of Infectious Diseases, Taihe Hospital, Hubei University of Medicine, Shiyan, People's Republic of China
| | - Jun Lv
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yan Huang
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Yanhang Gao
- Hepatology Department, First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Jingyuan Liu
- Department of Intensive Care Unit, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Caiyan Zhao
- Department of Infectious Disease, The Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Hongbo Gao
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangdong, People's Republic of China
| | - Yu Chen
- Difficult and Complicated Liver Diseases and Artificial Liver Center, Beijing YouAn Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jie Xia
- Department of Infectious Diseases, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Liang Peng
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun-Yat-Sen University, Guangzhou, People's Republic of China
| | - Tao Han
- Department of Hepatology and Gastroenterology, Tianjin Third Central Hospital, Tianjin, China
| | - Hai Li
- Chinese (acute on) Chronic Liver Failure Consortium (Ch-CLIF.C), Shanghai, People's Republic of China.,Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xin Zheng
- Department of Infectious Diseases, Institute of Infection and Immunology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, People's Republic of China
| | - Xianbo Wang
- Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaobo Lu
- The First Affiliated Hospital of Xinjiang Medical University (XMU), Xinjiang, People's Republic of China
| | - Yu Shi
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
| | - Jinhua Hu
- Liver Failure Treatment and Research Center, The Fifth Medical Center of PLA General Hospital, No 100, Xisihuanzhonglu Road, Beijing, 100039, People's Republic of China.
| | - Jinjun Chen
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, No 1838, Guangzhou Dadao Bei, Guangzhou, 510515, People's Republic of China. .,Chinese (acute on) Chronic Liver Failure Consortium (Ch-CLIF.C), Shanghai, People's Republic of China.
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Zaragoza R, Maseda E, Pemán J. [Individualized antifungal therapy in critically ill patients with invasive fungal infection]. Rev Iberoam Micol 2021; 38:68-74. [PMID: 34301466 DOI: 10.1016/j.riam.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/16/2021] [Accepted: 04/28/2021] [Indexed: 12/12/2022] Open
Abstract
Invasive candidiasis (IC) is the most common invasive fungal infection (IFI) affecting critically ill patients, followed by invasive pulmonary aspergillosis (IPA). International guidelines provide different recommendations for a first-line antifungal therapy and, in most of them, echinocandins are considered the first-line treatment for IC, and triazoles are so for the treatment of IPA. However, liposomal amphotericinB (L-AmB) is still considered a second-line therapy for both clinical entities. Although in the last decade the management of IFI has improved, several controversies persist. The antifungal drugs currently available may have a suboptimal activity, or be wrongly used in certain IFI involving critically ill patients. The aim of this review is to analyze when to provide individualized antifungal therapy to critically ill patients suffering from IFI, emphasizing the role of L-AmB. Drug-drug interactions, the clinical status, infectious foci (peritoneal candidiasis is discussed), the fungal species involved, and the need of monitoring the concentration of the antifungal drug in the patient are considered.
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Affiliation(s)
- Rafael Zaragoza
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, España.
| | - Emilio Maseda
- Unidad de Críticos Quirúrgicos, Servicio de Anestesia y Reanimación, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Javier Pemán
- Servicio de Microbiología, Hospital Universitario y Politécnico la Fe, Valencia, España
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Stanzani M, Sassi C, Lewis R, Sartor C, Rasetto G, Cavo M, Battista G. Early low-dose computed tomography with pulmonary angiography to improve the early diagnosis of invasive mould disease in patients with haematological malignancies: A pilot study. J Infect 2021; 83:371-380. [PMID: 34171366 DOI: 10.1016/j.jinf.2021.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/19/2021] [Accepted: 06/19/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE High-resolution computed tomography (CT) is an essential diagnostic tool for invasive mould disease (IMD) in patients with haematological malignancies but is infrequently performed in the first 72 h of neutropenic fever until after chest X-ray (CXR). We hypothesised that early (< 48 h) low-dose CT (LD-CT; 90% reduction in radiation dose) combined with CT pulmonary angiography (CTPA) to detect the venous occlusion sign (VOS) inside suspected infiltrates could improve IMD diagnosis. METHODS We prospectively studied 68 consecutive adult patients undergoing treatment for haematological malignancies who developed fever following chemotherapy or haematopoietic stem cell transplantation. Within 48 h of fever, patients underwent a standard CXR followed by LD-CT imaging and CTPA if eligible based on baseline imaging findings; the same protocol was performed in 42/68 (61.7%) of patients at day 7 follow-up. The diagnostic performance of CT signs for EORTC/MSG-defined proven, probable, and possible IMD was analysed at both imaging periods. RESULTS The baseline LD-CT was positive for abnormalities in 43/68 (63%) of patients within 48 h of fever and 35/42 (83%) of patients at the follow-up exam. Amongst these 43 patients, CTPA was performed in 17/43 (39%) and in 18/35 (51%) at D + 7 follow-up. A positive VOS was associated with the highest estimated positive likelihood ratio for EORTC/MSG-defined proven, probable, or possible IMD at baseline (20.6; 95% CI 1.4-311.2) and at day 7 follow-up (19.0; 95% CI 0.93-300.8) followed by the baseline non-contrast enhanced hypodense sign (18.3; 0.93-361.7), reverse halo (11.0; 0.47-256.5), halo sign (8.68;3.13-24.01) and air-crescent sign at day 7 (16.7; 0.93-301.0). However, a negative VOS was the only CT sign at baseline or day 7 associated with sufficiently low negative likelihood ratio (0.05;0.001-0.8) to possibly support ruling-out IMD in patients with positive CT findings. CONCLUSIONS Early LD-CT combined with CTPA shows promise for improving the early radiographic diagnosis of IMD.
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Affiliation(s)
- Marta Stanzani
- Department of Hematology and Oncology, Institute of Hematology Seràgnoli, IRCCS University Hospital S. Orsola-Malpighi, Bologna, Italy.
| | - Claudia Sassi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Unit of Radiology, IRCCS University Hospital S. Orsola-Malpighi, Bologna, Italy.
| | - Russell Lewis
- Department of Medical and Surgical Sciences, University of Bologna, Unit of Infectious Diseases, IRCCS University Hospital S. Orsola-Malpighi, Bologna, Italy.
| | - Chiara Sartor
- Department of Hematology and Oncology, Institute of Hematology Seràgnoli, IRCCS University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Gianluca Rasetto
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Unit of Radiology, IRCCS University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Michele Cavo
- Department of Hematology and Oncology, Institute of Hematology Seràgnoli, IRCCS University Hospital S. Orsola-Malpighi, Bologna, Italy
| | - Giuseppe Battista
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Unit of Radiology, IRCCS University Hospital S. Orsola-Malpighi, Bologna, Italy
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Versyck M, Zarrougui W, Lambiotte F, Elbeki N, Saint-Leger P. Invasive pulmonary aspergillosis in COVID-19 critically ill patients: Results of a French monocentric cohort. J Mycol Med 2021; 31:101122. [PMID: 33621792 PMCID: PMC7884920 DOI: 10.1016/j.mycmed.2021.101122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/30/2020] [Accepted: 02/12/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 or COVID-19 is a new infectious disease responsible for potentially severe respiratory impairment associated with initial immunosuppression. Similarly to influenza, several authors have described a higher risk of fungal infection after COVID-19, in particular for invasive pulmonary aspergillosis. The main objective here is to define the prevalence of invasive pulmonary aspergillosis (IPA) in a cohort of COVID-19 patients with moderate to severe acute respiratory disease syndrome (ARDS). MATERIAL AND METHODS We conducted a large monocentric retrospective study investigating all the ventilated COVID-19 patients with ARDS hospitalized at Valenciennes' general hospital, France, between March 15, 2020 and April 30, 2020. In the center a systematic IPA screening strategy was carried out for all ARDS patients, with weekly tests of serum galactomannan and beta-D-glucan. Bronchoalveolar lavage with culture and chest CT scan were performed when the serum assays were positives. RESULTS A total of 54 patients were studied. Their median age was 65 years, and 37 of the patients (71%) were male. Two patients had chronic immunosuppression and among all the patients, only 2 non-immunocompromised presented a putative IPA during their stay. CONCLUSION The prevalence of IPA in this cohort of COVID-19 patients (3.7%) is not higher than what is described in the other ARDS populations in the literature. These results are however different from the previous publications on COVID-19 patients and must therefore be confirmed by larger and multicentric studies.
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Affiliation(s)
- Maaike Versyck
- Department of Anesthesiology and Intensive Care Medicine, General Hospital of Valenciennes, France
| | - Wafa Zarrougui
- Department of Anesthesiology and Intensive Care Medicine, General Hospital of Valenciennes, France
| | - Fabien Lambiotte
- Department of Anesthesiology and Intensive Care Medicine, General Hospital of Valenciennes, France
| | - Nabil Elbeki
- Department of Anesthesiology and Intensive Care Medicine, General Hospital of Valenciennes, France
| | - Piehr Saint-Leger
- Department of Anesthesiology and Intensive Care Medicine, General Hospital of Valenciennes, France.
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Abstract
The spectrum of disease produced by Aspergillus species ranges from allergic syndromes to chronic pulmonary conditions and invasive infections. Invasive aspergillosis is a major cause of morbidity and mortality in immunocompromised patients. Risk factors continue to evolve and include newer biological agents that target the immune system and postinfluenza infection; and it has been observed following COVID-19 infection. Diagnosis remains a challenge but non-culture-based methods are available. Antifungal resistance has emerged. Voriconazole remains the treatment of choice but isavuconazole and posaconazole have similar efficacy with less toxicity. Combination therapy is used with extensive infection and in severe immunosuppression.
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Affiliation(s)
- Jose Cadena
- Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive - MSC 7881, San Antonio, TX 78229-3900, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California - Davis Health; Department of Medical Microbiology and Immunology, University of California - Davis Health.
| | - Thomas F Patterson
- Department of Medicine, Division of Infectious Diseases, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive - MSC 7881, San Antonio, TX 78229-3900, USA
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Oliva A, Ceccarelli G, Borrazzo C, Ridolfi M, D 'Ettorre G, Alessandri F, Ruberto F, Pugliese F, Raponi GM, Russo A, Falletta A, Mastroianni CM, Venditti M. Comparison of clinical features and outcomes in COVID-19 and influenza pneumonia patients requiring intensive care unit admission. Infection 2021. [PMID: 34036458 DOI: 10.1007/s15010-021-01624-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Little is known in distinguishing clinical features and outcomes between coronavirus disease-19 (COVID-19) and influenza (FLU). MATERIALS/METHODS Retrospective, single-centre study including patients with COVID-19 or FLU pneumonia admitted to the Intensive care Unit (ICU) of Policlinico Umberto I (Rome). Aims were: (1) to assess clinical features and differences of patients with COVID-19 and FLU, (2) to identify clinical and/or laboratory factors associated with FLU or COVID-19 and (3) to evaluate 30-day mortality, bacterial superinfections, thrombotic events and invasive pulmonary aspergillosis (IPA) in patients with FLU versus COVID-19. RESULTS Overall, 74 patients were included (19, 25.7%, FLU and 55, 74.3%, COVID-19), median age 67 years (58-76). COVID-19 patients were more male (p = 0.013), with a lower percentage of COPD (Chronic Obstructive Pulmonary Disease) and chronic kidney disease (CKD) (p = 0.001 and p = 0.037, respectively) than FLU. SOFA score was higher (p = 0.020) and lymphocytes were significantly lower in FLU than in COVID-19 [395.5 vs 770.0 cells/mmc, p = 0.005]. At multivariable analysis, male sex (OR 6.1, p < 0.002), age > 65 years (OR 2.4, p = 0.024) and lymphocyte count > 725 cells/mmc at ICU admission (OR 5.1, p = 0.024) were significantly associated with COVID-19, whereas CKD and COPD were associated with FLU (OR 0.1 and OR 0.16, p = 0.020 and p < 0.001, respectively). No differences in mortality, bacterial superinfections and thrombotic events were observed, whereas IPA was mostly associated with FLU (31.5% vs 3.6%, p = 0.0029). CONCLUSIONS In critically ill patients, male sex, age > 65 years and lymphocytes > 725 cells/mmc are related to COVID-19. FLU is associated with a significantly higher risk of IPA than COVID-19.
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Chong WH, Neu KP. Incidence, diagnosis and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA): a systematic review. J Hosp Infect 2021; 113:115-129. [PMID: 33891985 PMCID: PMC8057923 DOI: 10.1016/j.jhin.2021.04.012] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/28/2021] [Accepted: 04/13/2021] [Indexed: 01/08/2023]
Abstract
COVID-19-associated pulmonary aspergillosis (CAPA) is defined as invasive pulmonary aspergillosis occurring in COVID-19 patients. The purpose of this review was to discuss the incidence, characteristics, diagnostic criteria, biomarkers, and outcomes of hospitalized patients diagnosed with CAPA. A literature search was performed through Pubmed and Web of Science databases for articles published up to 20th March 2021. In 1421 COVID-19 patients, the overall CAPA incidence was 13.5% (range 2.5-35.0%). The majority required invasive mechanical ventilation (IMV). The time to CAPA diagnosis from illness onset varied between 8.0 and 16.0 days. However, the time to CAPA diagnosis from intensive care unit (ICU) admission and IMV initiation ranged between 4.0-15.0 days and 3.0-8.0 days. The most common diagnostic criteria were the modified AspICU-Dutch/Belgian Mycosis Study Group and IAPA-Verweij et al. A total of 77.6% of patients had positive lower respiratory tract cultures, other fungal biomarkers of bronchoalveolar lavage and serum galactomannan were positive in 45.3% and 18.2% of patients. The CAPA mortality rate was high at 48.4%, despite the widespread use of antifungals. Lengthy hospital and ICU stays ranging between 16.0-37.5 days and 10.5-37.0 days were observed. CAPA patients had prolonged IMV duration of 13.0-20.0 days. The true incidence of CAPA likely remains unknown as the diagnosis is limited by the lack of standardized diagnostic criteria that rely solely on microbiological data with direct or indirect detection of Aspergillus in respiratory specimens, particularly in clinical conditions with a low pretest probability. A well-designed, multi-centre study to determine the optimal diagnostic approach for CAPA is required.
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Affiliation(s)
- W H Chong
- Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY, USA.
| | - K P Neu
- Department of Pulmonary and Critical Care, Albany Stratton VA Medical Center, Albany, NY, USA
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50
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Sánchez Martín C, Madrid Martínez E, González Pellicer R, Armero Ibáñez R, Martínez González E, Llau Pitarch JV. Invasive pulmonary aspergillosis in patients with acute respiratory syndrome by COVID-19. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00131-6. [PMID: 34565575 PMCID: PMC8057739 DOI: 10.1016/j.redar.2021.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Abstract
Patients with COVID-19 who are admitted to intensive care unit (ICU) are at high risk of developing secondary infections, including invasive fungal infections such as invasive pulmonary aspergillosis (IPA). The main purpose was to analyse the putative COVID-19 Associated Pulmonary Aspergillosis (CAPA) patients in our setting. In these patients, we performed mycological culture in bronchoalveolar lavage (BAL) for isolation of Aspergillus sp. We followed the AspICU algorithm to diagnose putative IPA. Moreover, we considered relevant the positivity of galactomannan in BAL. We diagnosed putative IPA in 3 patients. The common features of these 3 patients were: more than 21 days of stay in ICU, severe acute respiratory distress syndrome (ARDS) and treatment with steroids (1mg/kg per day). Therefore, CAPA has to be systematically considered although a new algorithm to diagnose it is needed to treat patients in early stages in order to avoid catastrophic outcomes.
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Affiliation(s)
- C Sánchez Martín
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España.
| | - E Madrid Martínez
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España
| | - R González Pellicer
- Servicio de Microbiología, Hospital Universitario Doctor Peset, Valencia, España
| | - R Armero Ibáñez
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España
| | - E Martínez González
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España
| | - J V Llau Pitarch
- Servicio de Anestesiología-Reanimación y Terapéutica del Dolor, Hospital Universitario Doctor Peset, Valencia, España; Anestesiología, Universitat de València, Valencia, España
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