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Vanderbeke L, Jacobs C, Feys S, Reséndiz-Sharpe A, Debaveye Y, Hermans G, Humblet-Baron S, Lagrou K, Meersseman P, Peetermans M, Seldeslachts L, Vanstapel A, Vande Velde G, Van Wijngaerden E, Wilmer A, Verbeken E, De Hertogh G, Wauters J. A Pathology-based Case Series of Influenza- and COVID-19-associated Pulmonary Aspergillosis: The Proof Is in the Tissue. Am J Respir Crit Care Med 2023; 208:301-311. [PMID: 37311243 PMCID: PMC10395719 DOI: 10.1164/rccm.202208-1570oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 08/18/2022] [Accepted: 06/08/2023] [Indexed: 06/15/2023] Open
Abstract
Rationale: Invasive pulmonary aspergillosis has emerged as a frequent coinfection in severe coronavirus disease (COVID-19), similarly to influenza, yet the clinical invasiveness is more debated. Objectives: We investigated the invasive nature of pulmonary aspergillosis in histology specimens of influenza and COVID-19 ICU fatalities in a tertiary care center. Methods: In this monocentric, descriptive, retrospective case series, we included adult ICU patients with PCR-proven influenza/COVID-19 respiratory failure who underwent postmortem examination and/or tracheobronchial biopsy during ICU admission from September 2009 until June 2021. Diagnosis of probable/proven viral-associated pulmonary aspergillosis (VAPA) was made based on the Intensive Care Medicine influenza-associated pulmonary aspergillosis and the European Confederation of Medical Mycology (ECMM) and the International Society for Human and Animal Mycology (ISHAM) COVID-19-associated pulmonary aspergillosis consensus criteria. All respiratory tissues were independently reviewed by two experienced pathologists. Measurements and Main Results: In the 44 patients of the autopsy-verified cohort, 6 proven influenza-associated and 6 proven COVID-19-associated pulmonary aspergillosis diagnoses were identified. Fungal disease was identified as a missed diagnosis upon autopsy in 8% of proven cases (n = 1/12), yet it was most frequently found as confirmation of a probable antemortem diagnosis (n = 11/21, 52%) despite receiving antifungal treatment. Bronchoalveolar lavage galactomannan testing showed the highest sensitivity for VAPA diagnosis. Among both viral entities, an impeded fungal growth was the predominant histologic pattern of pulmonary aspergillosis. Fungal tracheobronchitis was histologically indistinguishable in influenza (n = 3) and COVID-19 (n = 3) cases, yet macroscopically more extensive at bronchoscopy in influenza setting. Conclusions: A proven invasive pulmonary aspergillosis diagnosis was found regularly and with a similar histological pattern in influenza and in COVID-19 ICU case fatalities. Our findings highlight an important need for VAPA awareness, with an emphasis on mycological bronchoscopic work-up.
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Affiliation(s)
- Lore Vanderbeke
- Department of Microbiology, Immunology, and Transplantation
- Medical Intensive Care Unit
| | | | - Simon Feys
- Department of Microbiology, Immunology, and Transplantation
- Medical Intensive Care Unit
| | | | - Yves Debaveye
- Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; and
- Department of Intensive Care Medicine
| | - Greet Hermans
- Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium; and
- Medical Intensive Care Unit
| | | | - Katrien Lagrou
- Department of Microbiology, Immunology, and Transplantation
- Department of Laboratory Medicine
- National Reference Center for Mycosis
| | - Philippe Meersseman
- Department of Microbiology, Immunology, and Transplantation
- Medical Intensive Care Unit
| | - Marijke Peetermans
- Department of Microbiology, Immunology, and Transplantation
- Medical Intensive Care Unit
| | | | | | | | - Eric Van Wijngaerden
- Department of Microbiology, Immunology, and Transplantation
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Alexander Wilmer
- Department of Microbiology, Immunology, and Transplantation
- Medical Intensive Care Unit
| | - Erik Verbeken
- Department of Imaging and Pathology, and
- Department of Pathology, and
| | - Gert De Hertogh
- Department of Imaging and Pathology, and
- Department of Pathology, and
| | - Joost Wauters
- Department of Microbiology, Immunology, and Transplantation
- Medical Intensive Care Unit
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Yulianti M, Johan C, Tenda ED, Singh G, Herikurniawan H, Wijaya IPEK. COVID-19 Associated Pulmonary Aspergillosis: A Case Series. Acta Med Indones 2022; 54:292-298. [PMID: 35818652] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has been a worldwide pandemic with several problems, one of which is the lack of definitive treatment. COVID-19-associated pulmonary aspergillosis (CAPA), the presence of invasive pulmonary aspergillosis (IPA) in COVID-19 patients, is one of the concerning secondary infections associated with higher mortality and worse clinical outcomes. Diagnosing CAPA may be challenging due to the possible absence of classic host factors and clinical symptoms or obscured radiological findings. We described two CAPA cases, which were suspected due to persistent respiratory failure despite standard treatment of COVID-19 with additional therapies and antimicrobial agents for secondary infections, eventually diagnosed with serum galactomannan testing. Clinical conditions of both patients improved significantly after the administration of voriconazole. This case series emphasizes the importance of being aware of clinical suspicions indicating CAPA followed by galactomannan testing as a relatively fast, noninvasive test for its diagnosis, which leads to appropriate antifungal treatment.
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Affiliation(s)
- Mira Yulianti
- Division of Respirology and Critical Illness, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
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Lahmer T, Kriescher S, Herner A, Rothe K, Spinner CD, Schneider J, Mayer U, Neuenhahn M, Hoffmann D, Geisler F, Heim M, Schneider G, Schmid RM, Huber W, Rasch S. Invasive pulmonary aspergillosis in critically ill patients with severe COVID-19 pneumonia: Results from the prospective AspCOVID-19 study. PLoS One 2021; 16:e0238825. [PMID: 33730058 PMCID: PMC7968651 DOI: 10.1371/journal.pone.0238825] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/17/2021] [Indexed: 01/08/2023] Open
Abstract
Background Superinfections, including invasive pulmonary aspergillosis (IPA), are well-known complications of critically ill patients with severe viral pneumonia. Aim of this study was to evaluate the incidence, risk factors and outcome of IPA in critically ill patients with severe COVID-19 pneumonia. Methods We prospectively screened 32 critically ill patients with severe COVID-19 pneumonia for a time period of 28 days using a standardized study protocol for oberservation of developement of COVID-19 associated invasive pulmonary aspergillosis (CAPA). We collected laboratory, microbiological, virological and clinical parameters at defined timepoints in combination with galactomannan-antigen-detection from nondirected bronchial lavage (NBL). We used logistic regression analyses to assess if COVID-19 was independently associated with IPA and compared it with matched controls. Findings CAPA was diagnosed at a median of 4 days after ICU admission in 11/32 (34%) of critically ill patients with severe COVID-19 pneumonia as compared to 8% in the control cohort. In the COVID-19 cohort, mean age, APACHE II score and ICU mortality were higher in patients with CAPA than in patients without CAPA (36% versus 9.5%; p<0.001). ICU stay (21 versus 17 days; p = 0.340) and days of mechanical ventilation (20 versus 15 days; p = 0.570) were not different between both groups. In regression analysis COVID-19 and APACHE II score were independently associated with IPA. Interpretation CAPA is highly prevalent and associated with a high mortality rate. COVID-19 is independently associated with invasive pulmonary aspergillosis. A standardized screening and diagnostic approach as presented in our study can help to identify affected patients at an early stage.
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Affiliation(s)
- Tobias Lahmer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
- * E-mail:
| | - Silja Kriescher
- Klinik und Poliklinik für Aneasthesiologie und Intensivmedizin, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Alexander Herner
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Kathrin Rothe
- Institut für Mikrobiologie, Immunologie und Hygiene, Technische Universität München, Munich, Germany
| | - Christoph D. Spinner
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Jochen Schneider
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Ulrich Mayer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Michael Neuenhahn
- Institut für Mikrobiologie, Immunologie und Hygiene, Technische Universität München, Munich, Germany
| | - Dieter Hoffmann
- Institut für Virologie, Technische Universität München, Munich, Germany
| | - Fabian Geisler
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Markus Heim
- Klinik und Poliklinik für Aneasthesiologie und Intensivmedizin, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Gerhard Schneider
- Klinik und Poliklinik für Aneasthesiologie und Intensivmedizin, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Roland M. Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Wolfgang Huber
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Sebastian Rasch
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Lamoth F, Glampedakis E, Boillat-Blanco N, Oddo M, Pagani JL. Incidence of invasive pulmonary aspergillosis among critically ill COVID-19 patients. Clin Microbiol Infect 2020; 26:1706-1708. [PMID: 32659385 PMCID: PMC7348600 DOI: 10.1016/j.cmi.2020.07.010] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Frederic Lamoth
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Emmanouil Glampedakis
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Noémie Boillat-Blanco
- Infectious Diseases Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mauro Oddo
- Service of Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Luc Pagani
- Service of Intensive Care Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Alanio A, Dellière S, Fodil S, Bretagne S, Mégarbane B. Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19. Lancet Respir Med 2020; 8:e48-e49. [PMID: 32445626 PMCID: PMC7239617 DOI: 10.1016/s2213-2600(20)30237-x] [Citation(s) in RCA: 301] [Impact Index Per Article: 75.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Alexandre Alanio
- Laboratoire de Parasitologie-Mycologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France; Université de Paris, Paris, France; Institut Pasteur, Centre National de la Recherche Scientifique, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, France.
| | - Sarah Dellière
- Laboratoire de Parasitologie-Mycologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France; Université de Paris, Paris, France; Institut Pasteur, Centre National de la Recherche Scientifique, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, France
| | - Sofiane Fodil
- Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France; Université de Paris, Paris, France
| | - Stéphane Bretagne
- Laboratoire de Parasitologie-Mycologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France; Université de Paris, Paris, France; Institut Pasteur, Centre National de la Recherche Scientifique, Unité de Mycologie Moléculaire, Centre National de Référence Mycoses Invasives et Antifongiques, France
| | - Bruno Mégarbane
- Réanimation Médicale et Toxicologique, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France; Université de Paris, Paris, France; Institut National de la Santé et de la Recherche Médicale, Paris, France
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