Challenges in Diagnosing COVID-19-Associated Pulmonary Aspergillosis in Critically Ill Patients: The Relationship between Case Definitions and Autoptic Data
Critically ill COVID-19 patients can develop invasive pulmonary aspergillosis (CAPA). Considering the weaknesses of diagnostic tests/case definitions, as well as the results from autoptic studies, there is a debate on the real burden of aspergillosis in COVID-19 patients. We performed a retrospectiv...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-08-01
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| Series: | Journal of Fungi |
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| Online Access: | https://www.mdpi.com/2309-608X/8/9/894 |
| _version_ | 1797486289621090304 |
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| author | Giacomo Casalini Andrea Giacomelli Laura Galimberti Riccardo Colombo Elisabetta Ballone Giacomo Pozza Martina Zacheo Miriam Galimberti Letizia Oreni Luca Carsana Margherita Longo Maria Rita Gismondo Cristina Tonello Manuela Nebuloni Spinello Antinori |
| author_facet | Giacomo Casalini Andrea Giacomelli Laura Galimberti Riccardo Colombo Elisabetta Ballone Giacomo Pozza Martina Zacheo Miriam Galimberti Letizia Oreni Luca Carsana Margherita Longo Maria Rita Gismondo Cristina Tonello Manuela Nebuloni Spinello Antinori |
| author_sort | Giacomo Casalini |
| collection | DOAJ |
| description | Critically ill COVID-19 patients can develop invasive pulmonary aspergillosis (CAPA). Considering the weaknesses of diagnostic tests/case definitions, as well as the results from autoptic studies, there is a debate on the real burden of aspergillosis in COVID-19 patients. We performed a retrospective observational study on mechanically ventilated critically ill COVID-19 patients in an intensive care unit (ICU). The primary objective was to determine the burden of CAPA by comparing clinical diagnosis (through case definitions/diagnostic algorithms) with autopsy results. Twenty patients out of 168 (11.9%) developed probable CAPA. Seven (35%) were females, and the median age was 66 [IQR 59–72] years. Thirteen CAPA patients (65%) died and, for six, an autopsy was performed providing a proven diagnosis in four cases. Histopathology findings suggest a focal pattern, rather than invasive and diffuse fungal disease, in the context of prominent viral pneumonia. In a cohort of mechanically ventilated patients with probable CAPA, by performing a high rate of complete autopsies, invasive aspergillosis was not always proven. It is still not clear whether aspergillosis is the major driver of mortality in patients with CAPA. |
| first_indexed | 2024-03-09T23:31:04Z |
| format | Article |
| id | doaj.art-44c1855ef46b49688a1935cabf7e0e97 |
| institution | Directory Open Access Journal |
| issn | 2309-608X |
| language | English |
| last_indexed | 2024-03-09T23:31:04Z |
| publishDate | 2022-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Fungi |
| spelling | doaj.art-44c1855ef46b49688a1935cabf7e0e972023-11-23T17:08:50ZengMDPI AGJournal of Fungi2309-608X2022-08-018989410.3390/jof8090894Challenges in Diagnosing COVID-19-Associated Pulmonary Aspergillosis in Critically Ill Patients: The Relationship between Case Definitions and Autoptic DataGiacomo Casalini0Andrea Giacomelli1Laura Galimberti2Riccardo Colombo3Elisabetta Ballone4Giacomo Pozza5Martina Zacheo6Miriam Galimberti7Letizia Oreni8Luca Carsana9Margherita Longo10Maria Rita Gismondo11Cristina Tonello12Manuela Nebuloni13Spinello Antinori14Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, ItalyIII Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, ItalyIII Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, ItalyDepartment of Anesthesiology and Intensive Care, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, ItalyDepartment of Anesthesiology and Intensive Care, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, ItalyDepartment of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, ItalyDepartment of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, ItalyDepartment of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, ItalyIII Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, ItalyPathology Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, ItalyClinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, ItalyClinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, ItalyPathology Unit, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, ItalyDepartment of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, ItalyDepartment of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, ItalyCritically ill COVID-19 patients can develop invasive pulmonary aspergillosis (CAPA). Considering the weaknesses of diagnostic tests/case definitions, as well as the results from autoptic studies, there is a debate on the real burden of aspergillosis in COVID-19 patients. We performed a retrospective observational study on mechanically ventilated critically ill COVID-19 patients in an intensive care unit (ICU). The primary objective was to determine the burden of CAPA by comparing clinical diagnosis (through case definitions/diagnostic algorithms) with autopsy results. Twenty patients out of 168 (11.9%) developed probable CAPA. Seven (35%) were females, and the median age was 66 [IQR 59–72] years. Thirteen CAPA patients (65%) died and, for six, an autopsy was performed providing a proven diagnosis in four cases. Histopathology findings suggest a focal pattern, rather than invasive and diffuse fungal disease, in the context of prominent viral pneumonia. In a cohort of mechanically ventilated patients with probable CAPA, by performing a high rate of complete autopsies, invasive aspergillosis was not always proven. It is still not clear whether aspergillosis is the major driver of mortality in patients with CAPA.https://www.mdpi.com/2309-608X/8/9/894COVID-19invasive fungal infectionsCAPAaspergillosisautopsyhistopathology |
| spellingShingle | Giacomo Casalini Andrea Giacomelli Laura Galimberti Riccardo Colombo Elisabetta Ballone Giacomo Pozza Martina Zacheo Miriam Galimberti Letizia Oreni Luca Carsana Margherita Longo Maria Rita Gismondo Cristina Tonello Manuela Nebuloni Spinello Antinori Challenges in Diagnosing COVID-19-Associated Pulmonary Aspergillosis in Critically Ill Patients: The Relationship between Case Definitions and Autoptic Data Journal of Fungi COVID-19 invasive fungal infections CAPA aspergillosis autopsy histopathology |
| title | Challenges in Diagnosing COVID-19-Associated Pulmonary Aspergillosis in Critically Ill Patients: The Relationship between Case Definitions and Autoptic Data |
| title_full | Challenges in Diagnosing COVID-19-Associated Pulmonary Aspergillosis in Critically Ill Patients: The Relationship between Case Definitions and Autoptic Data |
| title_fullStr | Challenges in Diagnosing COVID-19-Associated Pulmonary Aspergillosis in Critically Ill Patients: The Relationship between Case Definitions and Autoptic Data |
| title_full_unstemmed | Challenges in Diagnosing COVID-19-Associated Pulmonary Aspergillosis in Critically Ill Patients: The Relationship between Case Definitions and Autoptic Data |
| title_short | Challenges in Diagnosing COVID-19-Associated Pulmonary Aspergillosis in Critically Ill Patients: The Relationship between Case Definitions and Autoptic Data |
| title_sort | challenges in diagnosing covid 19 associated pulmonary aspergillosis in critically ill patients the relationship between case definitions and autoptic data |
| topic | COVID-19 invasive fungal infections CAPA aspergillosis autopsy histopathology |
| url | https://www.mdpi.com/2309-608X/8/9/894 |
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