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COVID-19-Associated Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Series in a Portuguese Hospital

Invasive pulmonary aspergillosis (IPA) has become a recognizable complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs). Alveolar damage in the context of acute respiratory distress syndrome (ARDS) appears to be the culprit in facilitating fungal invasio...

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Autores principales: Ranhel, David, Ribeiro, Ana, Batista, Judite, Pessanha, Maria, Cristovam, Elisabete, Duarte, Ana, Dias, Ana, Coelho, Luís, Monteiro, Filipa, Freire, Pedro, Veríssimo, Cristina, Sabino, Raquel, Toscano, Cristina
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8538920/
https://www.ncbi.nlm.nih.gov/pubmed/34682302
http://dx.doi.org/10.3390/jof7100881
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author Ranhel, David
Ribeiro, Ana
Batista, Judite
Pessanha, Maria
Cristovam, Elisabete
Duarte, Ana
Dias, Ana
Coelho, Luís
Monteiro, Filipa
Freire, Pedro
Veríssimo, Cristina
Sabino, Raquel
Toscano, Cristina
author_facet Ranhel, David
Ribeiro, Ana
Batista, Judite
Pessanha, Maria
Cristovam, Elisabete
Duarte, Ana
Dias, Ana
Coelho, Luís
Monteiro, Filipa
Freire, Pedro
Veríssimo, Cristina
Sabino, Raquel
Toscano, Cristina
author_sort Ranhel, David
collection PubMed
description Invasive pulmonary aspergillosis (IPA) has become a recognizable complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs). Alveolar damage in the context of acute respiratory distress syndrome (ARDS) appears to be the culprit in facilitating fungal invasion in COVID-19 patients, leading to a COVID-19-associated pulmonary aspergillosis (CAPA) phenomenon. From November 2020 to 15 February 2021, 248 COVID-19 patients were admitted to our ICUs, of whom ten patients (4% incidence) were classified as either probable (six) or possible (four) CAPA cases. Seven patients had positive cultural results: Aspergillus fumigatus sensu stricto (five), A. terreus sensu stricto (one), and A. welwitschiae (one). Five patients had positive bronchoalveolar lavage (BAL) and galactomannan (GM), and two patients had both positive cultural and GM criteria. All but two patients received voriconazole. Mortality rate was 30%. Strict interpretation of classic IPA definition would have resulted in eight overlooked CAPA cases. Broader diagnostic criteria are essential in this context, even though differentiation between Aspergillus colonization and invasive disease might be more challenging. Herein, we aim to raise awareness of CAPA in view of its potential detrimental outcome, emphasizing the relevance of a low threshold for screening and early antifungal treatment in ARDS patients.
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spelling pubmed-85389202021-10-24 COVID-19-Associated Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Series in a Portuguese Hospital Ranhel, David Ribeiro, Ana Batista, Judite Pessanha, Maria Cristovam, Elisabete Duarte, Ana Dias, Ana Coelho, Luís Monteiro, Filipa Freire, Pedro Veríssimo, Cristina Sabino, Raquel Toscano, Cristina J Fungi (Basel) Article Invasive pulmonary aspergillosis (IPA) has become a recognizable complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs). Alveolar damage in the context of acute respiratory distress syndrome (ARDS) appears to be the culprit in facilitating fungal invasion in COVID-19 patients, leading to a COVID-19-associated pulmonary aspergillosis (CAPA) phenomenon. From November 2020 to 15 February 2021, 248 COVID-19 patients were admitted to our ICUs, of whom ten patients (4% incidence) were classified as either probable (six) or possible (four) CAPA cases. Seven patients had positive cultural results: Aspergillus fumigatus sensu stricto (five), A. terreus sensu stricto (one), and A. welwitschiae (one). Five patients had positive bronchoalveolar lavage (BAL) and galactomannan (GM), and two patients had both positive cultural and GM criteria. All but two patients received voriconazole. Mortality rate was 30%. Strict interpretation of classic IPA definition would have resulted in eight overlooked CAPA cases. Broader diagnostic criteria are essential in this context, even though differentiation between Aspergillus colonization and invasive disease might be more challenging. Herein, we aim to raise awareness of CAPA in view of its potential detrimental outcome, emphasizing the relevance of a low threshold for screening and early antifungal treatment in ARDS patients. MDPI 2021-10-19 /pmc/articles/PMC8538920/ /pubmed/34682302 http://dx.doi.org/10.3390/jof7100881 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ranhel, David
Ribeiro, Ana
Batista, Judite
Pessanha, Maria
Cristovam, Elisabete
Duarte, Ana
Dias, Ana
Coelho, Luís
Monteiro, Filipa
Freire, Pedro
Veríssimo, Cristina
Sabino, Raquel
Toscano, Cristina
COVID-19-Associated Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Series in a Portuguese Hospital
title COVID-19-Associated Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Series in a Portuguese Hospital
title_full COVID-19-Associated Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Series in a Portuguese Hospital
title_fullStr COVID-19-Associated Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Series in a Portuguese Hospital
title_full_unstemmed COVID-19-Associated Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Series in a Portuguese Hospital
title_short COVID-19-Associated Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Series in a Portuguese Hospital
title_sort covid-19-associated invasive pulmonary aspergillosis in the intensive care unit: a case series in a portuguese hospital
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8538920/
https://www.ncbi.nlm.nih.gov/pubmed/34682302
http://dx.doi.org/10.3390/jof7100881
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