Incidence, risk factors and pre-emptive screening for COVID-19 associated pulmonary aspergillosis in an era of immunomodulant therapy

Grootveld, Rebecca van; Beek, Martha T. van der; Janssen, Nico; Ergün, Mehmet; Dijk, Karin van; Bethlehem, Carina; Stads, Susanne; Paassen, Judith van; Heunks, Leo; Bouman, Catherine S. C.; Reijers, Monique H.; Brüggeman, Roger J.; Veerdonk, Frank L. van de; Bree, Sjoerd H. W. van; Berg, CP; Kuindersma, Marnix; Wauters, Joost; Beishuizen, Albertus; Verweij, Paul E.; Schouten, Jeroen

doi:10.1016/j.jcrc.2023.154272

Cited by 14 publications

(18 citation statements)

References 24 publications

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“…In a meta-analysis of Kariyawasam et al [44 ▪▪ ], only 6.7% of patients with CAPA had immunosuppression with the classic ‘host factors’, while in the 70% of the cases, immunomodulatory therapy was present alone or in combination [corticosteroids, tocilizumab (anti-IL-6), anakinra (anti-IL-1)]. However, a multicenter, retrospective Dutch-Belgian study found that in their cohort neither anti-IL-6 alone or in combination with corticosteroids, nor the cumulative dose prior to CAPA development was associated with increase in CAPA development [45 ▪▪ ]. The current recommendation is not to stop dexamethasone or corticosteroid therapy in patients with COVID-19, albeit that the strength of recommendation is weak and based on very low evidence [5].…”

Section: The History Of Risk Profiles: Broadening Risk Profile and Im...mentioning

confidence: 99%

“…The current recommendation is not to stop dexamethasone or corticosteroid therapy in patients with COVID-19, albeit that the strength of recommendation is weak and based on very low evidence [5]. Risk factors recognized for CAPA include older age, male sex, and higher severity of illness on ICU admission [45 ▪▪ ].…”

Section: The History Of Risk Profiles: Broadening Risk Profile and Im...mentioning

confidence: 99%

“…The mortality of CAPA is high, but with a wide reported range, from 36% to 74% [5,49,50 ▪▪ ,51]. The attributable mortality of CAPA is not fully elucidated [45 ▪▪ ]. It has been hypothesized that CAPA is a disease with a continuous spectrum, and this hypothesis was corroborated by the results of a study that showed higher mortality when diagnostic tests were indicative of a higher fungal load [45 ▪▪ ,53].…”

Section: The History Of Risk Profiles: Broadening Risk Profile and Im...mentioning

confidence: 99%

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Invasive pulmonary aspergillosis in the ICU: tale of a broadening risk profile

Koulenti,

Papathanakos,

Blot

2023

Current Opinion in Critical Care

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Purpose of review In the absence of histopathological proof, the diagnosis of invasive pulmonary aspergillosis (IPA) is usually based on mycology (not on tissue), medical imaging, and the patient's risk profile for acquiring invasive fungal disease. Here, we review the changes in risk profile for IPA that took place over the past decades. Recent findings In the early 2000s IPA was considered exclusively a disease of immunocompromised patients. Particularly in the context of critical illness, the risk profile has been broadened steadily. Acute viral infection by influenza or SARS-Cov-2 are now well recognized risk factors for IPA. Summary The classic risk profile (‘host factors’) reflecting an immunocompromised status was first enlarged by a spectrum of chronic conditions such as AIDS, cirrhosis, and chronic obstructive pulmonary disease. In the presence of critical illness, especially characterized by sepsis and/or severe respiratory distress, any chronic condition could add to the risk profile. Recently, acute viral infections have been associated with IPA leading to the concepts of influenza-associated IPA and COVID-19-associated IPA. These viral infections may affect patients without underlying disease. Hence, the risk for IPA is now a reality for ICU patients, even in the absence of any chronic conditions.

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Section: The History Of Risk Profiles: Broadening Risk Profile and Im...mentioning

confidence: 99%

Section: The History Of Risk Profiles: Broadening Risk Profile and Im...mentioning

confidence: 99%

Section: The History Of Risk Profiles: Broadening Risk Profile and Im...mentioning

confidence: 99%

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Invasive pulmonary aspergillosis in the ICU: tale of a broadening risk profile

Koulenti,

Papathanakos,

Blot

2023

Current Opinion in Critical Care

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“…CAPA infection has fatal outcomes in immunocompromised patients and is a robust predictor of ICU related mortalities, with negative implications for antifungal therapy and the rise of azole resistance 157,158 . Grootveld et al reported ICU mortalities associated with CAPA at 65.3% 159 . Moreover, A. fumigatus isolates from critically ill patients diagnosed with CAPA, across a twelve‐month observational study, were found to have a 3.7% rate of azole‐resistance 160 .…”

Section: Covid‐19‐associated Pulmonary Aspergillosis (Capa)mentioning

confidence: 99%

“…Grootveld et al reported ICU mortalitiesassociated with CAPA at 65.3% 159. Moreover, A. fumigatus isolates from critically ill patients diagnosed with CAPA, across a twelvemonth observational study, were found to have a 3.7% rate of azoleresistance 160.…”

mentioning

confidence: 99%

Exploring the intersection of Aspergillus fumigatus biofilms, infections, immune response and antifungal resistance

Kashyap

Mishra

Bordoloi

et al. 2023

Mycoses

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Aspergillus fumigatus is a filamentous saprophytic fungus that is commonly found in soil and plays an important role in the decomposition of organic debris as well as the recycling of environmental carbon and nitrogen. 1 In addition to its ecological significance, A. fumigatus is also a ubiquitous airborne fungus that has been found to be associated with a wide range of clinical manifestations in humans, including both allergic and invasive infections that can be fatal in nature. 2 The incidence of infection caused by A. fumigatus is relatively low in immunocompetent individuals. However, in patients with severely compromised immune systems, A. fumigatus has the potential to cause life-threatening infections. The genus Aspergillus encompasses over 250 species; however, A. fumigatus, A. flavus, A. terreus and A. niger are responsible for the majority of Aspergillusassociated infections in humans, comprising more than 90% of all

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