Corticosteroids as risk factor for COVID-19-associated pulmonary aspergillosis in intensive care patients

Review Infectious Diseases

Comparing the clinical characteristics and outcomes of COVID-19-associate pulmonary aspergillosis (CAPA): a systematic review and meta-analysis

Woon Hean Chong et al.

Summary: Patients with CAPA 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.

INFECTION (2022)

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Article Immunology

Coronavirus Disease 2019-Associated Pulmonary Aspergillosis in Mechanically Ventilated Patients

Nitipong Permpalung et al.

Summary: COVID-19-associated pulmonary aspergillosis (CAPA) is a serious condition in critically ill patients. A retrospective cohort study was conducted on mechanically ventilated adult patients with COVID-19, and it was found that CAPA is associated with underlying pulmonary vascular and liver diseases. Patients with CAPA have worse outcomes, requiring longer time for improvement and longer hospital stays.

CLINICAL INFECTIOUS DISEASES (2022)

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Article Critical Care Medicine

Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: the French multicentre MYCOVID study

Jean-Pierre Gangneux et al.

Summary: This study demonstrates a high prevalence of invasive pulmonary aspergillosis and candidemia in mechanically ventilated patients with severe COVID-19, and a high mortality associated with pr/pb CAPA. These findings highlight the importance of active surveillance for fungal pathogens in patients with severe COVID-19.

LANCET RESPIRATORY MEDICINE (2022)

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Article Immunology

Epidemiology of Invasive Pulmonary Aspergillosis Among Intubated Patients With COVID-19: A Prospective Study

Michele Bartoletti et al.

Summary: The study showed a high incidence of CAPA among critically ill COVID-19 patients, and its occurrence seems to alter the natural course of the disease.

CLINICAL INFECTIOUS DISEASES (2021)

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Editorial Material Immunology

Invasive Fungal Disease Complicating Coronavirus Disease 2019: When It Rains, It Spores

Martin Hoenigl

CLINICAL INFECTIOUS DISEASES (2021)

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Article Immunology

A National Strategy to Diagnose Coronavirus Disease 2019-Associated Invasive Fungal Disease in the Intensive Care Unit

P. Lewis White et al.

Summary: Invasive fungal disease is common in critically ill COVID-19 patients, with 26.7% incidence rate including 14.1% aspergillosis and 12.6% yeast infections. Mortality rates are reduced with antifungal therapy, while corticosteroid use and history of chronic respiratory disease increase the likelihood of aspergillosis. Strategic diagnostic screening and antifungal prophylaxis may enhance the management of COVID-19 patients.

CLINICAL INFECTIOUS DISEASES (2021)

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Article Critical Care Medicine

Occurrence of Invasive Pulmonary Fungal Infections in Patients with Severe COVID-19 Admitted to the ICU

Arnaud Fekkar et al.

Summary: This study examined the occurrence of invasive fungal respiratory superinfections in severe COVID-19 patients admitted to five ICUs in France, finding that patients with no underlying immunosuppression seem at low risk of invasive fungal secondary infection.

AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE (2021)

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Article Infectious Diseases

Risk factors associated with COVID-19-associated pulmonary aspergillosis in ICU patients: a French multicentric retrospective cohort

Sarah Delliere et al.

Summary: Invasive pulmonary aspergillosis (IPA) is a relatively common complication in severe COVID-19 patients, leading to increased mortality. Treatment with azithromycin for >= 3 days is associated with higher risk of developing probable IPA, while high-dose dexamethasone may also play a role in IPA occurrence.

CLINICAL MICROBIOLOGY AND INFECTION (2021)

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Review Public, Environmental & Occupational Health

COVID-19 fatality rates in hospitalized patients: systematic review and meta-analysis

Ana Macedo et al.

Summary: This study evaluated the mortality rates of COVID-19 patients, finding rates of 11.5% in general admitted patients and 40.5% in critical care cases. These findings should guide resource allocation and economic burden calculations during pandemics.

ANNALS OF EPIDEMIOLOGY (2021)

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Article Medicine, General & Internal

Timing of corticosteroids impacts mortality in hospitalized COVID-19 patients

Amit Bahl et al.

Summary: The study analyzed 1461 hospitalized COVID-19 patients and found that those receiving corticosteroid therapy had a lower risk of death. Patients who received their first dose of corticosteroids after 72 hours and those who started corticosteroids more than 7 days after symptom onset had a lower risk of death.

INTERNAL AND EMERGENCY MEDICINE (2021)

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Review Medicine, General & Internal

Aspergillus Infections

George R. Thompson et al.

Summary: Aspergillosis is an opportunistic fungal infection that poses a particular risk for patients with neutrophil defects and causes diverse clinical syndromes. This review discusses current understanding and advances in diagnosis and treatment of aspergillosis.

NEW ENGLAND JOURNAL OF MEDICINE (2021)

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Review Immunology

Navigating the Uncertainties of COVID-19-Associated Aspergillosis: A Comparison With Influenza-Associated Aspergillosis

Frederic Lamoth et al.

Summary: Invasive pulmonary aspergillosis is increasingly recognized as a life-threatening complication of severe respiratory viral infections, such as influenza, and concerns have been raised about its potential complicating COVID-19 in ICU patients. Differences in diagnostic strategies, definitions, and local factors may contribute to the variable incidence of this complication. The distinction between COVID-19-associated pulmonary aspergillosis (CAPA) and influenza-associated pulmonary aspergillosis (IAPA) lies in the majority of CAPA cases being classified as putative rather than proven/probable IPA, and the discrepancies can possibly be explained by the distinct physiopathology of influenza and COVID-19.

JOURNAL OF INFECTIOUS DISEASES (2021)

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Article Microbiology

COVID-19-Associated Pulmonary Aspergillosis, Fungemia, and Pneumocystosis in the Intensive Care Unit: a Retrospective Multicenter Observational Cohort during the First French Pandemic Wave

Stephane Bretagne et al.

Summary: To diagnose fungal coinfections in patients with COVID-19 in the ICU, it is important to implement correct treatment and prevention. Respiratory specimens remain the best approach for diagnosing CAPA, while fungemias are associated with a mortality rate of 45.7% in ICU patients. Pneumocystosis mainly occurs in immunocompromised patients and is diagnosed at ICU admission.

MICROBIOLOGY SPECTRUM (2021)

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Letter Infectious Diseases

COVID-19-associated pulmonary aspergillosis (CAPA): how big a problem is it?

Arnaud Fekkar et al.

CLINICAL MICROBIOLOGY AND INFECTION (2021)

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Review Microbiology

Invasive pulmonary aspergillosis associated with viral pneumonitis

Intan M. W. Dewi et al.

Summary: Invasive pulmonary aspergillosis (IPA) occurring in critically ill patients with viral pneumonitis has been increasingly reported in recent years, with influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) being the two most common forms. These diseases cause high mortality and the pathogenesis involves viral, fungal, and host factors.

CURRENT OPINION IN MICROBIOLOGY (2021)

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Article Critical Care Medicine

Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis

Paul E. Verweij et al.

Summary: Invasive pulmonary aspergillosis (IPA) is increasingly reported in severe COVID-19 patients admitted to the ICU. The diagnosis and management of COVID-19 associated pulmonary aspergillosis (CAPA) are challenging, with bronchoscopy and bronchoalveolar lavage as key diagnostic tools. Treatment includes antifungal therapy tailored to the individual patient's clinical condition.

INTENSIVE CARE MEDICINE (2021)

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Review Critical Care Medicine

Risk factors for invasive aspergillosis in ICU patients with COVID-19: current insights and new key elements

G. Montrucchio et al.

Summary: The review identified 21 English-language articles published before 2020, focusing on risk factors for COVID-19-associated pulmonary aspergillosis (CAPA), including host comorbidities, ICU management, and COVID-19 therapies. The results suggest that previous host risk factors, especially respiratory diseases, still play a crucial role; however, the attention is shifting from individual patient-related risk factors to factors characterizing hospital and ICU processes influenced by COVID treatment.

ANNALS OF INTENSIVE CARE (2021)

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Article Immunology

Multinational Observational Cohort Study of COVID-19-Associated Pulmonary Aspergillosis1

Nico A. F. Janssen et al.

Summary: An observational study found an incidence of 10%-15% of coronavirus-disease associated pulmonary aspergillosis in intensive care units, with several factors independently associated with the disease in one cohort and mortality rates ranging from 43%-52%.

EMERGING INFECTIOUS DISEASES (2021)

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Article Respiratory System

S2k Guideline - Recommendations for Inpatient Therapy of Patients with COVID-19

S. Kluge et al.

Summary: The novel coronavirus has rapidly spread globally since December 2019, challenging healthcare systems. Most patients exhibit mild symptoms, but a portion require hospitalization. Early clarification of treatment plans is crucial for pandemic control.

PNEUMOLOGIE (2021)

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Article Critical Care Medicine

Ventilator-associated pneumonia in critically ill patients with COVID-19

Mailis Maes et al.

Summary: This study found that COVID-19 patients were more likely to develop VAP, with 3 cases of invasive aspergillosis identified among them and herpesvirade activation being more frequent. The causative organisms of secondary pneumonia observed were similar between COVID-19 and non-COVID-19 patients, suggesting a link to pulmonary dysbiosis caused by COVID-19.

CRITICAL CARE (2021)

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Article Immunology