Author: Machado, Marina; Valerio, Maricela; Ãlvarezâ€UrÃa, Ana; Olmedo, MarÃa; Veintimilla, Cristina; Padilla, Belén; De la Villa, SofÃa; Guinea, Jesús; Escribano, Pilar; Ruizâ€Serrano, MarÃa Jesús; Reigadas, Elena; Alonso, Roberto; Guerrero, José Eugenio; Hortal, Javier; Bouza, Emilio; Muñoz, Patricia
Title: Invasive pulmonary aspergillosis in the COVIDâ€19 era: An expected new entity Cord-id: vr03orz6 Document date: 2020_11_29
ID: vr03orz6
Snippet: OBJECTIVES: Information on the recently COVIDâ€19â€associated pulmonary aspergillosis (CAPA) entity is scarce. We describe eight CAPA patients, compare them to colonised ICU patients with coronavirus disease 2019 (COVIDâ€19), and review the published literature from Western countries. METHODS: Prospective study (March to May, 2020) that included all COVIDâ€19 patients admitted to a tertiary hospital. Modified AspICU and European Organization for Research and Treatment of Cancer/Mycoses Study
Document: OBJECTIVES: Information on the recently COVIDâ€19â€associated pulmonary aspergillosis (CAPA) entity is scarce. We describe eight CAPA patients, compare them to colonised ICU patients with coronavirus disease 2019 (COVIDâ€19), and review the published literature from Western countries. METHODS: Prospective study (March to May, 2020) that included all COVIDâ€19 patients admitted to a tertiary hospital. Modified AspICU and European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria were used. RESULTS: COVIDâ€19â€associated pulmonary aspergillosis was diagnosed in eight patients (3.3% of 239 ICU patients), mostly affected nonâ€immunocompromised patients (75%) with severe acute respiratory distress syndrome (ARDS) receiving corticosteroids. Diagnosis was established after a median of 15 days under mechanical ventilation. Bronchoalveolar lavage was performed in two patients with positive Aspergillus fumigatus cultures and galactomannan (GM) index. Serum GM was positive in 4/8 (50%). Thoracic CT scan findings fulfilled EORTC/MSG criteria in one case. Isavuconazole was used in 4/8 cases. CAPAâ€related mortality was 100% (8/8). Compared with colonised patients, CAPA subjects were administered tocilizumab more often (100% vs. 40%, p = .04), underwent longer courses of antibacterial therapy (13 vs. 5 days, p = .008), and had a higher allâ€cause mortality (100% vs. 40%, p = .04). We reviewed 96 similar cases from recent publications: 59 probable CAPA (also putative according modified AspICU), 56 putative cases and 13 colonisations according AspICU algorithm; according EORTC/MSG six proven and two probable. Overall, mortality in the reviewed series was 56.3%. CONCLUSIONS: COVIDâ€19â€associated pulmonary aspergillosis must be considered a serious and potentially lifeâ€threatening complication in patients with severe COVIDâ€19 receiving immunosuppressive treatment.
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