COVID-19 Associated Pulmonary Aspergillosis in Patients on Extracorporeal Membrane Oxygenation Treatment—A Retrospective Study
Background: The incidence and outcome of pulmonary aspergillosis in coronavirus disease (COVID-19) patients on extracorporeal membrane oxygenation (ECMO) are unknown and have not been fully addressed. We investigated the incidence, risk factors and outcome of pulmonary aspergillosis in COVID-19 ECMO...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-03-01
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| Series: | Journal of Fungi |
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| Online Access: | https://www.mdpi.com/2309-608X/9/4/398 |
| _version_ | 1797604807750451200 |
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| author | Ali Nuh Newara Ramadan Lisa Nwankwo Jackie Donovan Brijesh Patel Anand Shah Sujal R. Desai Darius Armstrong-James |
| author_facet | Ali Nuh Newara Ramadan Lisa Nwankwo Jackie Donovan Brijesh Patel Anand Shah Sujal R. Desai Darius Armstrong-James |
| author_sort | Ali Nuh |
| collection | DOAJ |
| description | Background: The incidence and outcome of pulmonary aspergillosis in coronavirus disease (COVID-19) patients on extracorporeal membrane oxygenation (ECMO) are unknown and have not been fully addressed. We investigated the incidence, risk factors and outcome of pulmonary aspergillosis in COVID-19 ECMO patients. In addition, the diagnostic utility of bronchoalveolar lavage fluid and CT scans in this setting were assessed. Methods: We conducted a retrospective study on incidence and outcome of pulmonary aspergillosis in COVID-19 ECMO patients by reviewing clinical, radiological, and mycological evidence. These patients were admitted to a tertiary cardiothoracic centre during the early COVID-19 surge between March 2020 and January 2021. Results and measurements: The study included 88 predominantly male COVID-19 ECMO patients with a median age and a BMI of 48 years and 32 kg/m<sup>2</sup>, respectively. Pulmonary aspergillosis incidence was 10% and was associated with very high mortality. Patients with an Aspergillus infection were almost eight times more likely to die compared with those without infection in multivariate analysis (OR 7.81, 95% CI: 1.20–50.68). BALF GM correlated well with culture results, with a Kappa value of 0.8 (95% CI: 0.6, 1.0). However, serum galactomannan (GM) and serum (1–3)-β-D-glucan (BDG) lacked sensitivity. Thoracic computed tomography (CT) diagnostic utility was also inconclusive, showing nonspecific ground glass opacities in almost all patients. Conclusions: In COVID-19 ECMO patients, pulmonary aspergillosis incidence was 10% and associated with very high mortality. Our results support the role of BALF in the diagnosis of pulmonary aspergillosis in COVID-19 ECMO patients. However, the diagnostic utility of BDG, serum GM, and CT scans is unclear. |
| first_indexed | 2024-03-11T04:52:00Z |
| format | Article |
| id | doaj.art-672c737c0f6443228bd17b68f0bd1264 |
| institution | Directory Open Access Journal |
| issn | 2309-608X |
| language | English |
| last_indexed | 2024-03-11T04:52:00Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Fungi |
| spelling | doaj.art-672c737c0f6443228bd17b68f0bd12642023-11-17T19:57:35ZengMDPI AGJournal of Fungi2309-608X2023-03-019439810.3390/jof9040398COVID-19 Associated Pulmonary Aspergillosis in Patients on Extracorporeal Membrane Oxygenation Treatment—A Retrospective StudyAli Nuh0Newara Ramadan1Lisa Nwankwo2Jackie Donovan3Brijesh Patel4Anand Shah5Sujal R. Desai6Darius Armstrong-James7Laboratory Medicine, Department of Microbiology, Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UKLaboratory Medicine, Department of Microbiology, Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UKPharmacy Department, Royal Brompton Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 6NP, UKDepartment of Chemical Pathology, Royal Brompton Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 6NP, UKDivision of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Centre for Haematology, Department of Immunology and Inflammation, and 5 National Heart and Lung Institute, Imperial College London, London SW3 6LY, UKMRC Centre of Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London SW7 2AZ, UKImaging Department, Royal Brompton Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 6NP, UKLaboratory Medicine, Department of Microbiology, Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SW3 6NP, UKBackground: The incidence and outcome of pulmonary aspergillosis in coronavirus disease (COVID-19) patients on extracorporeal membrane oxygenation (ECMO) are unknown and have not been fully addressed. We investigated the incidence, risk factors and outcome of pulmonary aspergillosis in COVID-19 ECMO patients. In addition, the diagnostic utility of bronchoalveolar lavage fluid and CT scans in this setting were assessed. Methods: We conducted a retrospective study on incidence and outcome of pulmonary aspergillosis in COVID-19 ECMO patients by reviewing clinical, radiological, and mycological evidence. These patients were admitted to a tertiary cardiothoracic centre during the early COVID-19 surge between March 2020 and January 2021. Results and measurements: The study included 88 predominantly male COVID-19 ECMO patients with a median age and a BMI of 48 years and 32 kg/m<sup>2</sup>, respectively. Pulmonary aspergillosis incidence was 10% and was associated with very high mortality. Patients with an Aspergillus infection were almost eight times more likely to die compared with those without infection in multivariate analysis (OR 7.81, 95% CI: 1.20–50.68). BALF GM correlated well with culture results, with a Kappa value of 0.8 (95% CI: 0.6, 1.0). However, serum galactomannan (GM) and serum (1–3)-β-D-glucan (BDG) lacked sensitivity. Thoracic computed tomography (CT) diagnostic utility was also inconclusive, showing nonspecific ground glass opacities in almost all patients. Conclusions: In COVID-19 ECMO patients, pulmonary aspergillosis incidence was 10% and associated with very high mortality. Our results support the role of BALF in the diagnosis of pulmonary aspergillosis in COVID-19 ECMO patients. However, the diagnostic utility of BDG, serum GM, and CT scans is unclear.https://www.mdpi.com/2309-608X/9/4/398<i>Aspergillus species</i>pulmonary aspergillosisECMOincidenceoutcomeCOVID-19 |
| spellingShingle | Ali Nuh Newara Ramadan Lisa Nwankwo Jackie Donovan Brijesh Patel Anand Shah Sujal R. Desai Darius Armstrong-James COVID-19 Associated Pulmonary Aspergillosis in Patients on Extracorporeal Membrane Oxygenation Treatment—A Retrospective Study Journal of Fungi <i>Aspergillus species</i> pulmonary aspergillosis ECMO incidence outcome COVID-19 |
| title | COVID-19 Associated Pulmonary Aspergillosis in Patients on Extracorporeal Membrane Oxygenation Treatment—A Retrospective Study |
| title_full | COVID-19 Associated Pulmonary Aspergillosis in Patients on Extracorporeal Membrane Oxygenation Treatment—A Retrospective Study |
| title_fullStr | COVID-19 Associated Pulmonary Aspergillosis in Patients on Extracorporeal Membrane Oxygenation Treatment—A Retrospective Study |
| title_full_unstemmed | COVID-19 Associated Pulmonary Aspergillosis in Patients on Extracorporeal Membrane Oxygenation Treatment—A Retrospective Study |
| title_short | COVID-19 Associated Pulmonary Aspergillosis in Patients on Extracorporeal Membrane Oxygenation Treatment—A Retrospective Study |
| title_sort | covid 19 associated pulmonary aspergillosis in patients on extracorporeal membrane oxygenation treatment a retrospective study |
| topic | <i>Aspergillus species</i> pulmonary aspergillosis ECMO incidence outcome COVID-19 |
| url | https://www.mdpi.com/2309-608X/9/4/398 |
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