Detection of Invasive Pulmonary Aspergillosis in COVID-19 with Nondirected BAL

Biesen, Stefaan Van; Kwa, David; Bosman, R. J.; Juffermans, Nicole P.

doi:10.1164/rccm.202005-2018le

Cited by 72 publications

(96 citation statements)

References 10 publications

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“…Three studies compared ICU CFR and outcomes between patients with CAPA and those with COVID-19 but no evidence of aspergillosis. Van Biesen et al, reported longer ICU stay with CAPA (37 days in CAPA vs. 19 days in non-CAPA, p < 0.05) without a difference in mortality (22.2% in those with CAPA vs. 15.1% in non-CAPA, p = 0.61) [ 39 ]; however, CAPA was diagnosed earlier in this study as part of active surveillance with serial fungal marker measurement. Alanio et al observed similar mortality between CAPA and non-CAPA COVID-19 patients in the ICU (4/9, 44% vs. 7/18, 39%; p = 0.99) [ 41 ].…”

Section: Discussionmentioning

confidence: 61%

“…Exceptions included (i) one patient who was a renal transplant recipient on maintenance immunosuppressive therapy (mycophenolate mofetil 1 g twice daily and prednisone 20 mg daily) [ 39 ], (ii) one patient who had a remote history of lung transplant on maintenance immunosuppressive therapy with tacrolimus and prednisone (unspecified doses) [ 40 ], (iii) one patient who was on chronic steroids for pemphigus foliaceus [ 9 ], (iv) one patient who had history of multiple myeloma and was on steroids [ 41 ], (v) one patient with history of rheumatoid arthritis on long-term leflunomide [ 33 ], (vi) one patient with a history of chronic myelomonocytic leukemia [ 40 ] and (vii) one patient with a history of unspecified hematologic malignancy [ 42 ]. For the last two patients, it was not specified in the studies whether their disease was active or in remission, and whether they were neutropenic at baseline or not.…”

Section: Risk Factorsmentioning

confidence: 99%

“…A total of 19 out of 21 studies reported information on corticosteroid use prior to the diagnosis of IPA. For one additional study, information regarding prior corticosteroid use was obtained after communication with the corresponding author, for a total of 72 patients [ 39 ]. Of these 72 patients, 38 patients (53%) had recently received systemic corticosteroids and one patient was on inhaled fluticasone for asthma prior to the diagnosis of IPA.…”

Section: Risk Factorsmentioning

confidence: 99%

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Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

et al. 2020

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In this systematic review, we investigate the epidemiology, pathogenesis, risk factors, clinical manifestations, diagnosis and treatment of COVID-19-associated pulmonary aspergillosis (CAPA). We identified 85 cases from 22 studies. The frequency of CAPA is currently unknown but ranges between <5% to >30% in different case series; the possibility of colonization rather than invasive disease is the most important confounder. The vast majority of patients with CAPA did not have any of the classic host risk factors, such as immunosuppression from organ transplant or neutropenia, although a significant proportion (46%) had received corticosteroids. Age, pulmonary comorbidities and male sex were associated with higher mortality. Patients treated with voriconazole had numerically lower case-fatality rate. Clinical vigilance for CAPA is advisable in critically ill patients with COVID-19 who are not improving, even those who do not meet classic host criteria for invasive mycoses, especially if they are receiving corticosteroids. A thorough, multi-faceted diagnostic work-up and early initiation of a mold-active triazole may be lifesaving. Further research studies using standardized, uniform definitions of invasive disease and colonization are urgently needed.

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Section: Discussionmentioning

confidence: 61%

Section: Risk Factorsmentioning

confidence: 99%

Section: Risk Factorsmentioning

confidence: 99%

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Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

et al. 2020

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“…In this issue of the Journal , Van Biesen and colleagues (pp. 1171–1173 ) report the performance of nondirected BAL in a cohort of 42 ventilated patients with COVD-19 ( 9 ). Based on clinical symptoms and a positive GM testing on directed BAL fluid, the proportion of putative aspergillosis was 21.4%.…”

Section: How Can We Explain These Findings?mentioning

confidence: 99%

“…On the other, it draws attention to the matter of Aspergillus colonization, an issue that remains unresolved in this population. The second manuscript from Van Biesen and colleagues ( 9 ) recommends the use of nondirected BAL in mechanically ventilated patients with COVID-19 to minimize aerosolization but maintains a good performance for Aspergillus diagnosis (GM + cultures).…”

Section: How Can We Explain These Findings?mentioning

confidence: 99%

Invasive Pulmonary Aspergillosis in Ventilator-associated Pneumonia: The Hidden Enemy?

Torres

Martín‐Loeches

2020

Am J Respir Crit Care Med

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room air between interventions, resulting in low probability of contamination between sequential experimental conditions. Sufficient time to ensure that the particle concentrations return to baseline is necessary between interventions in future studies, especially if frequent air exchange is not available. Optimal respiratory management of patients suffering from COVID-19 pneumonia is debated; the potential benefits of early intubation, NIV, and HFNC, to be put into balance with the potential risk of bioaerosol generation and dispersion, are controversial; and practice is heterogeneous between units and over time during the pandemic spread (13, 14). As evidence is accumulating against a significantly increased bioaerosol generation associated with the use of HFNC and NIV, clinicians may consider those therapeutic options as they do when caring for patients with hypoxemia without COVID-19, not overemphasizing the potential theoretical risk of increased infectious transmission. In any case, personal protective equipment should be worn by professionals caring for patients with suspected or confirmed COVID-19. Beyond bioaerosol generation and dispersion, the crucial question that needs to be answered remains the infectious potential of the virus carried by the bioaerosols generated by the patients or various procedures and its relative quantitative importance compared with other routes of viral dissemination such as surface contact. n Author disclosures are available with the text of this article at www.atsjournals.org.

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Pulmonary disease diagnosis using African vulture optimized weighted support vector machine approach

Siva

Saravanan

et al. 2021

Int J Imaging Syst Tech

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Pulmonary disease is a kind of disease that affects the lungs and other parts of the respiratory system and is mainly caused by smoking, asbestos, secondhand smoke, and other forms of air pollutants. Several types of pulmonary diseases are emphysema, fibrosis, pneumothorax, asthma, lung cancer, chronic obstructive pulmonary disease (COPD), and so on. Pulmonary diseases are otherwise known as lung disorders and respiratory diseases. Pulmonary diseases are predicted by several methods using x‐ray images and CT scan images. Some of the recent works predict only a specific disease, and optimal prediction is not yet achieved. Hence, we proposed a novel method known as African vulture optimization (AVO) algorithm‐based weighted support vector machine approach (w‐SVM). The proposed method in this article predicts emphysema, fibrosis, pneumothorax, and normal kinds from the NIH chest x‐ray dataset. The X‐images are preprocessed after data acquisition to obtain the desired size and to remove undesirable noise. The preprocessed images are then sent into the SVM for feature extraction, and the AVO is used to improve the SVM so that a kernel function may be obtained. The proposed w‐SVM effectively predicts the emphysema, fibrosis, pneumothorax, and normal classes from the dataset. The experimental analyses are conducted and compared with existing works and concluded that the proposed work outperforms other approaches in terms of accuracy, sensitivity, specificity, and Matthews's correlation coefficient, prediction time, and modeling time.

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Detection of Invasive Pulmonary Aspergillosis in COVID-19 with Nondirected BAL

Cited by 72 publications

References 10 publications

Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

Invasive Pulmonary Aspergillosis in Ventilator-associated Pneumonia: The Hidden Enemy?

Pulmonary disease diagnosis using African vulture optimized weighted support vector machine approach

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