<i>Aspergillus</i> in Critically Ill COVID-19 Patients: A Scoping Review
Several reports have been published on <i>Aspergillus</i> findings in COVID-19 patients leading to a proposition of new disease entity COVID-19-associated pulmonary aspergillosis. This scoping review is designed at clarifying the concepts on how the findings of <i>Aspergillus</i...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-06-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/10/11/2469 |
| _version_ | 1797531572408156160 |
|---|---|
| author | Erlangga Yusuf Leonard Seghers Rogier A. S. Hoek Johannes P. C. van den Akker Lonneke G. M. Bode Bart J. A. Rijnders |
| author_facet | Erlangga Yusuf Leonard Seghers Rogier A. S. Hoek Johannes P. C. van den Akker Lonneke G. M. Bode Bart J. A. Rijnders |
| author_sort | Erlangga Yusuf |
| collection | DOAJ |
| description | Several reports have been published on <i>Aspergillus</i> findings in COVID-19 patients leading to a proposition of new disease entity COVID-19-associated pulmonary aspergillosis. This scoping review is designed at clarifying the concepts on how the findings of <i>Aspergillus</i> spp. in COVID-19 patients were interpreted. We searched Medline to identify the studies on <i>Aspergillus</i> spp. findings in COVID-19 patients. Included were observational studies containing the following information: explicit mention of the total number of the study population, study period, reason for obtaining respiratory samples, case definition, and clinical outcomes. Excluded were case series, case reports and reviews. Identified were 123 publications, and 8 observational studies were included. From the included studies the following issues were identified. The proportion of immunocompromised patients considered as host factors varied from 0 to 17%. Most of the studies did not mention radiographic findings explicitly. Respiratory samples were mostly obtained to investigate clinical deterioration. <i>Aspergillus</i> culture, antigen or PCR testing on bronchoalveolar lavage (BAL) fluid were performed in between 23.3% and 66.3% of the study population. Two studies performed periodic samples of BAL. Galactomannan index (GI) positivity in BAL was between 10% and 28%. GI in blood was found in 0.9% to 6.7% of the available samples. The prevalence of COVID-19-associated pulmonary aspergillosis ranged from 2.7% to 27.7%. Studies compared the mortality between defined cases and non-cases, and all showed increased mortality in cases. No studies showed that antifungal treatment reduced mortality. Concluding, this review showed how studies defined the clinical entity COVID-19-associated pulmonary aspergillosis where positive <i>Aspergillus</i> test in the respiratory sample was the main driver for the diagnosis. There were many differences between studies in terms of test algorithm and <i>Aspergillus</i> test used that largely determined the prevalence. Whether antifungal therapy, either as prophylaxis, pre-emptive or targeted therapy will lead to better outcomes of COVID-19-associated pulmonary aspergillosis patients is still need to be answered. |
| first_indexed | 2024-03-10T10:46:39Z |
| format | Article |
| id | doaj.art-3366a63877dc4c02a8f556b8e66af5d8 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T10:46:39Z |
| publishDate | 2021-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-3366a63877dc4c02a8f556b8e66af5d82023-11-21T22:33:13ZengMDPI AGJournal of Clinical Medicine2077-03832021-06-011011246910.3390/jcm10112469<i>Aspergillus</i> in Critically Ill COVID-19 Patients: A Scoping ReviewErlangga Yusuf0Leonard Seghers1Rogier A. S. Hoek2Johannes P. C. van den Akker3Lonneke G. M. Bode4Bart J. A. Rijnders5Department of Medical Microbiology and Infectious Disease, Erasmus University Medical Center, 3015 GD Rotterdam, The NetherlandsDepartment of Pulmonary Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The NetherlandsDepartment of Pulmonary Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The NetherlandsDepartment of Intensive Care Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The NetherlandsDepartment of Medical Microbiology and Infectious Disease, Erasmus University Medical Center, 3015 GD Rotterdam, The NetherlandsDepartment of Medical Microbiology and Infectious Disease, Erasmus University Medical Center, 3015 GD Rotterdam, The NetherlandsSeveral reports have been published on <i>Aspergillus</i> findings in COVID-19 patients leading to a proposition of new disease entity COVID-19-associated pulmonary aspergillosis. This scoping review is designed at clarifying the concepts on how the findings of <i>Aspergillus</i> spp. in COVID-19 patients were interpreted. We searched Medline to identify the studies on <i>Aspergillus</i> spp. findings in COVID-19 patients. Included were observational studies containing the following information: explicit mention of the total number of the study population, study period, reason for obtaining respiratory samples, case definition, and clinical outcomes. Excluded were case series, case reports and reviews. Identified were 123 publications, and 8 observational studies were included. From the included studies the following issues were identified. The proportion of immunocompromised patients considered as host factors varied from 0 to 17%. Most of the studies did not mention radiographic findings explicitly. Respiratory samples were mostly obtained to investigate clinical deterioration. <i>Aspergillus</i> culture, antigen or PCR testing on bronchoalveolar lavage (BAL) fluid were performed in between 23.3% and 66.3% of the study population. Two studies performed periodic samples of BAL. Galactomannan index (GI) positivity in BAL was between 10% and 28%. GI in blood was found in 0.9% to 6.7% of the available samples. The prevalence of COVID-19-associated pulmonary aspergillosis ranged from 2.7% to 27.7%. Studies compared the mortality between defined cases and non-cases, and all showed increased mortality in cases. No studies showed that antifungal treatment reduced mortality. Concluding, this review showed how studies defined the clinical entity COVID-19-associated pulmonary aspergillosis where positive <i>Aspergillus</i> test in the respiratory sample was the main driver for the diagnosis. There were many differences between studies in terms of test algorithm and <i>Aspergillus</i> test used that largely determined the prevalence. Whether antifungal therapy, either as prophylaxis, pre-emptive or targeted therapy will lead to better outcomes of COVID-19-associated pulmonary aspergillosis patients is still need to be answered.https://www.mdpi.com/2077-0383/10/11/2469COVID-19<i>Aspergillus</i>scoping reviewmortality |
| spellingShingle | Erlangga Yusuf Leonard Seghers Rogier A. S. Hoek Johannes P. C. van den Akker Lonneke G. M. Bode Bart J. A. Rijnders <i>Aspergillus</i> in Critically Ill COVID-19 Patients: A Scoping Review Journal of Clinical Medicine COVID-19 <i>Aspergillus</i> scoping review mortality |
| title | <i>Aspergillus</i> in Critically Ill COVID-19 Patients: A Scoping Review |
| title_full | <i>Aspergillus</i> in Critically Ill COVID-19 Patients: A Scoping Review |
| title_fullStr | <i>Aspergillus</i> in Critically Ill COVID-19 Patients: A Scoping Review |
| title_full_unstemmed | <i>Aspergillus</i> in Critically Ill COVID-19 Patients: A Scoping Review |
| title_short | <i>Aspergillus</i> in Critically Ill COVID-19 Patients: A Scoping Review |
| title_sort | i aspergillus i in critically ill covid 19 patients a scoping review |
| topic | COVID-19 <i>Aspergillus</i> scoping review mortality |
| url | https://www.mdpi.com/2077-0383/10/11/2469 |
| work_keys_str_mv | AT erlanggayusuf iaspergillusiincriticallyillcovid19patientsascopingreview AT leonardseghers iaspergillusiincriticallyillcovid19patientsascopingreview AT rogierashoek iaspergillusiincriticallyillcovid19patientsascopingreview AT johannespcvandenakker iaspergillusiincriticallyillcovid19patientsascopingreview AT lonnekegmbode iaspergillusiincriticallyillcovid19patientsascopingreview AT bartjarijnders iaspergillusiincriticallyillcovid19patientsascopingreview |