COVID-19-associated pulmonary aspergillosis in intensive care unit: A real-life experience
Since 2020, cases of COVID-19-associated pulmonary aspergillosis (CAPA) have been frequently described, representing an important cause of mortality, especially among patients admitted to intensive care unit (ICU). A predisposition to invasive infection caused by Aspergillus spp. in SARS-CoV-2 infec...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-01-01
|
| Series: | Heliyon |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844024003293 |
| _version_ | 1827360914652790784 |
|---|---|
| author | Alessandro Russo Riccardo Serraino Francesca Serapide Andrea Bruni Eugenio Garofalo Federico Longhini Enrico Maria Trecarichi Carlo Torti |
| author_facet | Alessandro Russo Riccardo Serraino Francesca Serapide Andrea Bruni Eugenio Garofalo Federico Longhini Enrico Maria Trecarichi Carlo Torti |
| author_sort | Alessandro Russo |
| collection | DOAJ |
| description | Since 2020, cases of COVID-19-associated pulmonary aspergillosis (CAPA) have been frequently described, representing an important cause of mortality, especially among patients admitted to intensive care unit (ICU). A predisposition to invasive infection caused by Aspergillus spp. in SARS-CoV-2 infected patients can be ascribed either to the direct viral-mediated damage of the respiratory epithelium or to the dysregulated immunity associated with COVID-19.In this case series we have collected the clinical, laboratory and radiological data of 10 patients admitted to the ICU with diagnosis of probable CAPA, according to the recent expert consensus statement, from March 2020 to December 2022 in the Teaching Hospital of Catanzaro in Italy. Overall, 249 patients were admitted to the COVID-19-ICU from March 2020 to December 2022; out of these, 4% developed a probable CAPA. Most of patients were male with a mean age of 62 years. Only two patients had an underlying immunocompromising condition. The observed mortality was 70%. In our institution, all COVID-19 patients requiring invasive mechanical ventilation systematically underwent bronchoscopy with bronchoalveolar lavage for an early evaluation of bacterial and/or fungal co- or super-infections, including galactomannan test. Patients were re-evaluated by an infectious diseases consultant team every 24–48 hours and the galactomannan test was systematically repeated based on patient's clinical course.Even though the numbers in this study are very small, we report our experience about the role of early diagnosis and careful choice of antifungal therapy, considering the fragility of these patients, and its relationship with outcomes. Despite a systemic approach allowing early diagnosis and initiation of anti-fungal therapy, the mortality rate turned out to be very high (70%). |
| first_indexed | 2024-03-08T06:56:21Z |
| format | Article |
| id | doaj.art-da2a1b32b605434594d0340ed8ae251f |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-03-08T06:56:21Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-da2a1b32b605434594d0340ed8ae251f2024-02-03T06:36:52ZengElsevierHeliyon2405-84402024-01-01102e24298COVID-19-associated pulmonary aspergillosis in intensive care unit: A real-life experienceAlessandro Russo0Riccardo Serraino1Francesca Serapide2Andrea Bruni3Eugenio Garofalo4Federico Longhini5Enrico Maria Trecarichi6Carlo Torti7Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, Italy; Corresponding author. Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences Viale Europa, 88100, ‘Magna Graecia’ University of Catanzaro, Italy.Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, ItalyInfectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, ItalyAnesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, ItalyAnesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, ItalyAnesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, ItalyInfectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, ItalyInfectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, ItalySince 2020, cases of COVID-19-associated pulmonary aspergillosis (CAPA) have been frequently described, representing an important cause of mortality, especially among patients admitted to intensive care unit (ICU). A predisposition to invasive infection caused by Aspergillus spp. in SARS-CoV-2 infected patients can be ascribed either to the direct viral-mediated damage of the respiratory epithelium or to the dysregulated immunity associated with COVID-19.In this case series we have collected the clinical, laboratory and radiological data of 10 patients admitted to the ICU with diagnosis of probable CAPA, according to the recent expert consensus statement, from March 2020 to December 2022 in the Teaching Hospital of Catanzaro in Italy. Overall, 249 patients were admitted to the COVID-19-ICU from March 2020 to December 2022; out of these, 4% developed a probable CAPA. Most of patients were male with a mean age of 62 years. Only two patients had an underlying immunocompromising condition. The observed mortality was 70%. In our institution, all COVID-19 patients requiring invasive mechanical ventilation systematically underwent bronchoscopy with bronchoalveolar lavage for an early evaluation of bacterial and/or fungal co- or super-infections, including galactomannan test. Patients were re-evaluated by an infectious diseases consultant team every 24–48 hours and the galactomannan test was systematically repeated based on patient's clinical course.Even though the numbers in this study are very small, we report our experience about the role of early diagnosis and careful choice of antifungal therapy, considering the fragility of these patients, and its relationship with outcomes. Despite a systemic approach allowing early diagnosis and initiation of anti-fungal therapy, the mortality rate turned out to be very high (70%).http://www.sciencedirect.com/science/article/pii/S2405844024003293CAPACOVID-19AspergillusGalactomannanIsavuconazole |
| spellingShingle | Alessandro Russo Riccardo Serraino Francesca Serapide Andrea Bruni Eugenio Garofalo Federico Longhini Enrico Maria Trecarichi Carlo Torti COVID-19-associated pulmonary aspergillosis in intensive care unit: A real-life experience Heliyon CAPA COVID-19 Aspergillus Galactomannan Isavuconazole |
| title | COVID-19-associated pulmonary aspergillosis in intensive care unit: A real-life experience |
| title_full | COVID-19-associated pulmonary aspergillosis in intensive care unit: A real-life experience |
| title_fullStr | COVID-19-associated pulmonary aspergillosis in intensive care unit: A real-life experience |
| title_full_unstemmed | COVID-19-associated pulmonary aspergillosis in intensive care unit: A real-life experience |
| title_short | COVID-19-associated pulmonary aspergillosis in intensive care unit: A real-life experience |
| title_sort | covid 19 associated pulmonary aspergillosis in intensive care unit a real life experience |
| topic | CAPA COVID-19 Aspergillus Galactomannan Isavuconazole |
| url | http://www.sciencedirect.com/science/article/pii/S2405844024003293 |
| work_keys_str_mv | AT alessandrorusso covid19associatedpulmonaryaspergillosisinintensivecareunitareallifeexperience AT riccardoserraino covid19associatedpulmonaryaspergillosisinintensivecareunitareallifeexperience AT francescaserapide covid19associatedpulmonaryaspergillosisinintensivecareunitareallifeexperience AT andreabruni covid19associatedpulmonaryaspergillosisinintensivecareunitareallifeexperience AT eugeniogarofalo covid19associatedpulmonaryaspergillosisinintensivecareunitareallifeexperience AT federicolonghini covid19associatedpulmonaryaspergillosisinintensivecareunitareallifeexperience AT enricomariatrecarichi covid19associatedpulmonaryaspergillosisinintensivecareunitareallifeexperience AT carlotorti covid19associatedpulmonaryaspergillosisinintensivecareunitareallifeexperience |