A Case Series of Lung Sequelae and Aspergillus Antigenemia- A Hidden Entity in Post-COVID-19 Critically ILL Patients

Banwait, Sonali; Gupta, Poonam

doi:10.7860/jcdr/2021/48272.14902

Cited by 2 publications

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Section: Uncited Referencesunclassified

Defining COVID-19–associated pulmonary aspergillosis: systematic review and meta-analysis

Kariyawasam

Dingle

Kula

et al. 2022

Clinical Microbiology and Infection

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Background Pulmonary aspergillosis may complicate COVID-19 and contribute to excess mortality in intensive care unit (ICU) patients. The disease is poorly understood, in part due to discordant definitions across studies. Objectives We sought to review the prevalence, diagnosis, treatment, and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA) and compare research definitions. Methods . Data Sources PubMed, Embase, Web of Science, and MedRxiv were searched from inception to October 12, 2021. Study eligibility criteria ICU cohort studies and CAPA case series including ≥3 patients were included. Participants Adult patients in ICUs with COVID-19. Definitions Patients were reclassified according to 4 research definitions (respectively described by Verweij et al, White et al, Koehler et al, and Bassetti et al). Assessment of risk of bias We assessed risk of bias with an adaptation of the Joanna Briggs Institute cohort checklist tool for systematic reviews. Methods of data synthesis We calculated CAPA prevalence using Freeman-Tukey random effects method. Correlations between definitions were assessed with Spearman’s rank test. Associations between antifungals and outcome were assessed with random effects meta-analysis. Results 51 studies were included. Among 3,297 COVID-19 patients in ICU cohort studies, 313 were diagnosed with CAPA (prevalence 10%, 95% confidence interval 8-13%). 277 patients had patient-level data allowing reclassification. Definitions had limited correlation with one another (ρ=0.268 to 0.447, p<0.001) with the exception of Koehler and Verweij (ρ=0.893, p<0.001). 33.9% of patients reported to have CAPA did not fulfill any research definitions. Patients were diagnosed after a median of 8 days (interquartile range 5-14) in ICUs. Tracheobronchitis occurred in 3% of patients examined with bronchoscopy. The mortality rate was high (59.2%). Applying CAPA research definitions did not strengthen the association between mould-active antifungals and survival. Conclusions The reported prevalence of CAPA is significant, but may be exaggerated by non-standard definitions.

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Section: Uncited Referencesunclassified

Defining COVID-19–associated pulmonary aspergillosis: systematic review and meta-analysis

Kariyawasam

Dingle

Kula

et al. 2022

Clinical Microbiology and Infection

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Antibacterials/dexamethasone/methylprednisolone

2021

Reactions Weekly

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Antibacterials/dexamethasone/methylprednisolone Suspected invasive bronchopulmonary aspergillosis: case reportIn a case series, five patients including three men and two women aged 27-75 years were described, who developed suspected invasive bronchopulmonary aspergillosis during off label treatment with treatment with methylprednisolone and dexamethasone for COVID-19 and antibacterial therapy with colistin, meropenem and teicoplanin [routes and duration of treatments to reactions onset not stated; not all dosages and outcomes stated].Case 1: A 55-year-old man developed suspected invasive bronchopulmonary aspergillosis during off label treatment with methylprednisolone for COVID-19 and antibacterial treatment with meropenem and colistin. The man, who was diagnosed with recent-onset depression, had received remdesivir, enoxaparin sodium [Clexane] and off label methylprednisolone 40mg twice a day for COVID-19. Additionally, he received antibacterial therapy with meropenem and colistin. After 33 days of COVID ICU stay, he was transferred to non-COVID ICU for further management. On admission, his Horowitz index was <250 and acute physiology and chronic health evaluation-II (APACHE-II) score was 11. He required oxygen therapy with non-rebreathing mask (NRBM). A chest HRCT findings were consistent with acute respiratory distress syndrome (ARDS). His serum galactomannan was found to be positive. Subsequently, he developed type 1 respiratory failure requiring mechanical ventilation. These findings were highly suggestive of invasive bronchopulmonary aspergillosis. Eventually, he died of after 12 days of post-COVID-19 ICU stay [cause of death not stated]. A fungal culture, biopsy or autopsy could not be performed due to logistic reasons.Case 2: A 46-year-old man developed suspected invasive bronchopulmonary aspergillosis during off label treatment with dexamethasone and antibacterial treatment with meropenem. The man, who was diagnosed with epiglottitis and diabetes mellitus, had received off label treatment with dexamethasone 8mg once a day for COVID-19. Additionally, he received antibacterial treatment with meropenem. Ten days after the diagnosis, he was transferred to the non-COVID ICU. His Horowitz score was <200 and APACHE-II score was 8. He required oxygen therapy with non-rebreathing mask (NRBM). A chest HRCT findings were consistent with ARDS. A serum galactomannan was found to be positive. An ultrasound scan of the chest showed significant bilateral pleural fluid. These findings were highly suggestive of invasive bronchopulmonary aspergillosis; however, fungal culture or biopsy could not be performed due to logistic reasons. The pleural fluid was drained with intercostal drain insertion resulting in dramatical improvement and tapering oxygen. Eventually, he was discharged after 7 days of post-COVID-19 ICU stay.Case 3: A 75-year-old woman developed suspected invasive bronchopulmonary aspergillosis during off label treatment with dexamethasone and antibacterial treatment with meropenem. The woman had received off lab...

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A Case Series of Lung Sequelae and Aspergillus Antigenemia- A Hidden Entity in Post-COVID-19 Critically ILL Patients

Cited by 2 publications

References 0 publications

Defining COVID-19–associated pulmonary aspergillosis: systematic review and meta-analysis

Defining COVID-19–associated pulmonary aspergillosis: systematic review and meta-analysis

Antibacterials/dexamethasone/methylprednisolone

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