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COVID‐19–associated pulmonary aspergillosis: a prospective single‐center dual case series

BACKGROUND: COVID‐19–associated pulmonary aspergillosis (CAPA) has emerged as an invasive fungal disease, often affecting previously immunocompetent, mechanically ventilated, intensive care unit (ICU) patients. Incidence rates of 3.8%–33.3% have been reported depending on the geographic area, with h...

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Autores principales: Meijer, Eelco F. J., Dofferhoff, Anton S. M., Hoiting, Oscar, Meis, Jacques F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986084/
https://www.ncbi.nlm.nih.gov/pubmed/33569857
http://dx.doi.org/10.1111/myc.13254
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author Meijer, Eelco F. J.
Dofferhoff, Anton S. M.
Hoiting, Oscar
Meis, Jacques F.
author_facet Meijer, Eelco F. J.
Dofferhoff, Anton S. M.
Hoiting, Oscar
Meis, Jacques F.
author_sort Meijer, Eelco F. J.
collection PubMed
description BACKGROUND: COVID‐19–associated pulmonary aspergillosis (CAPA) has emerged as an invasive fungal disease, often affecting previously immunocompetent, mechanically ventilated, intensive care unit (ICU) patients. Incidence rates of 3.8%–33.3% have been reported depending on the geographic area, with high (47%) mortality. OBJECTIVES: Here, we describe a single‐centre prospective case series with CAPA cases from both the first (March‐May, n = 5/33) and second (mid‐September through mid‐December, n = 8/33) COVID‐19 wave at a 500‐bed teaching hospital in the Netherlands. PATIENTS/METHODS: In the first COVID‐19 wave, a total of 265 SARS‐CoV‐2 PCR‐positive patients were admitted to our hospital of whom 33 needed intubation and mechanical ventilation. In the second wave, 508 SARS‐CoV‐2 PCR‐positive patients were admitted of whom 33 needed mechanical ventilation. Data were prospectively collected. RESULTS: We found a significant decrease in COVID‐19 patients needing mechanical ventilation in the ICU in the second wave (p < .01). From these patients, however, a higher percentage were diagnosed with CAPA (24.2% vs 15.2%), although not significant (p = .36). All CAPA patients encountered in the second wave received dexamethasone. Mortality between both groups was similarly high (40%–50%). Moreover, we found environmental TR(34)/L98H azole‐resistant Aspergillus fumigatus isolates in two separate patients. CONCLUSIONS: In this series, 19.7% (n = 13/66) of mechanically ventilated SARS‐CoV‐2 patients were diagnosed with CAPA. In addition, we found a significant reduction in COVID‐19 patients needing mechanical ventilation on the ICU in the second wave. Numbers are too small to determine whether there is a true difference in CAPA incidence in mechanically ventilated patients between the two waves, and whether it could be attributed to dexamethasone SARS‐CoV‐2 therapy.
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spelling pubmed-79860842021-03-25 COVID‐19–associated pulmonary aspergillosis: a prospective single‐center dual case series Meijer, Eelco F. J. Dofferhoff, Anton S. M. Hoiting, Oscar Meis, Jacques F. Mycoses Original Articles BACKGROUND: COVID‐19–associated pulmonary aspergillosis (CAPA) has emerged as an invasive fungal disease, often affecting previously immunocompetent, mechanically ventilated, intensive care unit (ICU) patients. Incidence rates of 3.8%–33.3% have been reported depending on the geographic area, with high (47%) mortality. OBJECTIVES: Here, we describe a single‐centre prospective case series with CAPA cases from both the first (March‐May, n = 5/33) and second (mid‐September through mid‐December, n = 8/33) COVID‐19 wave at a 500‐bed teaching hospital in the Netherlands. PATIENTS/METHODS: In the first COVID‐19 wave, a total of 265 SARS‐CoV‐2 PCR‐positive patients were admitted to our hospital of whom 33 needed intubation and mechanical ventilation. In the second wave, 508 SARS‐CoV‐2 PCR‐positive patients were admitted of whom 33 needed mechanical ventilation. Data were prospectively collected. RESULTS: We found a significant decrease in COVID‐19 patients needing mechanical ventilation in the ICU in the second wave (p < .01). From these patients, however, a higher percentage were diagnosed with CAPA (24.2% vs 15.2%), although not significant (p = .36). All CAPA patients encountered in the second wave received dexamethasone. Mortality between both groups was similarly high (40%–50%). Moreover, we found environmental TR(34)/L98H azole‐resistant Aspergillus fumigatus isolates in two separate patients. CONCLUSIONS: In this series, 19.7% (n = 13/66) of mechanically ventilated SARS‐CoV‐2 patients were diagnosed with CAPA. In addition, we found a significant reduction in COVID‐19 patients needing mechanical ventilation on the ICU in the second wave. Numbers are too small to determine whether there is a true difference in CAPA incidence in mechanically ventilated patients between the two waves, and whether it could be attributed to dexamethasone SARS‐CoV‐2 therapy. John Wiley and Sons Inc. 2021-02-16 2021-04 /pmc/articles/PMC7986084/ /pubmed/33569857 http://dx.doi.org/10.1111/myc.13254 Text en © 2021 The Authors. Mycoses published by Wiley‐VCH GmbH. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Meijer, Eelco F. J.
Dofferhoff, Anton S. M.
Hoiting, Oscar
Meis, Jacques F.
COVID‐19–associated pulmonary aspergillosis: a prospective single‐center dual case series
title COVID‐19–associated pulmonary aspergillosis: a prospective single‐center dual case series
title_full COVID‐19–associated pulmonary aspergillosis: a prospective single‐center dual case series
title_fullStr COVID‐19–associated pulmonary aspergillosis: a prospective single‐center dual case series
title_full_unstemmed COVID‐19–associated pulmonary aspergillosis: a prospective single‐center dual case series
title_short COVID‐19–associated pulmonary aspergillosis: a prospective single‐center dual case series
title_sort covid‐19–associated pulmonary aspergillosis: a prospective single‐center dual case series
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986084/
https://www.ncbi.nlm.nih.gov/pubmed/33569857
http://dx.doi.org/10.1111/myc.13254
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