Invasive pulmonary aspergillosis after treatment with tocilizumab in a patient with COVID-19 ARDS: a case report

Witting, Celeste; Quaggin-Smith, Jessica; Mylvaganam, Ruben; Peigh, Graham; Angarone, Michael; Flaherty, James

doi:10.1016/j.diagmicrobio.2020.115272

Cited by 19 publications

(12 citation statements)

References 13 publications

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“…In our series, 13.1% received tocilizumab which is IL-6 inhibitor and causes significant immunosuppression and a known risk factor for invasive fungal infection. [ 29 ] There have been no reports of remdesivir increasing the risk of developing infections.…”

Section: Discussionmentioning

confidence: 99%

Rhino-Orbito-Cerebral Mycosis and COVID-19

Kulkarni¹,

Pujari²,

Gupta³

et al. 2022

Annals of Indian Academy of Neurology

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Background: There has been an increase an alarming rise in invasive mycoses during COVID-19 pandemic, especially during the second wave. Aims: Compare the incidence of invasive mycoses in the last three years and study the risk factors, manifestations and outcomes of mycoses in the COVID era. Methodology: Multicentric study was conducted across 21 centres in a state of western India over 12-months. The clinico-radiological, laboratory and microbiological features, treatment and outcomes of patients were studied. We also analysed yearly incidence of rhino-orbito-cerebral mycosis. Results: There was more than five-times rise in the incidence of invasive mycoses compared to previous two-years. Of the 122 patients analysed, mucor, aspergillus and dual infection were seen in 86.9%, 4.1%, and 7.4% respectively. Fifty-nine percent had simultaneous mycosis and COVID-19 while rest had sequential infection. Common presenting features were headache (91%), facial pain (78.7%), diplopia (66.4%) and vison loss (56.6%). Rhino-orbito-sinusitis was present in 96.7%, meningitis in 6.6%, intracranial mass lesions in 15.6% and strokes in 14.8%. A total of 91.8% patients were diabetic, while 90.2% were treated with steroids during COVID-19 treatment. Mortality was 34.4%. Conclusion: Invasive fungal infections having high mortality and morbidity have increased burden on already overburdened healthcare system. Past illnesses, COVID-19 itself and its treatment and environmental factors seem responsible for the rise of fungal infection. Awareness and preventive strategies are the need of hours and larger studies are needed for better understanding of this deadly disease.

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Section: Discussionmentioning

confidence: 99%

Rhino-Orbito-Cerebral Mycosis and COVID-19

Kulkarni¹,

Pujari²,

Gupta³

et al. 2022

Annals of Indian Academy of Neurology

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“…Recent clinical trials have suggested that combining corticosteroids with anti-IL-6 treatment (tocilizumab) improves the outcomes in terms of morbidity and mortality in severe COVID-19 patients ( 543 , 544 ). Nevertheless, COVID-19 patients receiving tocilizumab are reported to be at higher risk of developing CAPA ( 65 , 69 , 82 , 545 , 546 ). As IL-6 is essential for inducing protective Th17 responses ( 170 – 172 ) and controlling the effector functions of phagocytes ( 547 ), anti-IL-6 therapy increases the susceptibility for fungal infections.…”

Section: From Clinical Observations To Copathogenesismentioning

confidence: 99%

Pathogenesis of Respiratory Viral and Fungal Coinfections

et al. 2022

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“…Complementary to dexamethasone, Tocilizumab, an IL-6 receptor antagonist, has been widely used to treat COVID-19 in critically ill patients ( 63 – 65 ). IL-6 plays a critical role not only in the cytokine storm in severe COVID-19 ( 63 , 65 ), but also in the innate immunity against fungal pathogens such as A. fumigatus ( 66 ). Accordingly, IL-6 inhibition has been associated with an increase in secondary infections in COVID-19 patients ( 67 ).…”

Section: Respiratory Fungal Infectionsmentioning

confidence: 99%

“…Accordingly, IL-6 inhibition has been associated with an increase in secondary infections in COVID-19 patients ( 67 ). A recent case report described an invasive Aspergillus infection in a COVID-19 patient following treatment with tocilizumab ( 65 ). Moreover, IL-6 inhibiting drugs may predispose COVID-19 patients to invasive mucormycosis ( 62 ).…”

Section: Respiratory Fungal Infectionsmentioning

confidence: 99%

“…The main reason for the increase in invasive mucormycosis cases has been pointed out to be the elevated iron levels in the serum of convalescent COVID-19 patients ( 62 ). Complementary to dexamethasone, Tocilizumab, an IL-6 receptor antagonist, has been widely used to treat COVID-19 in critically ill patients ( 63 – 65 ). IL-6 plays a critical role not only in the cytokine storm in severe COVID-19 ( 63 , 65 ), but also in the innate immunity against fungal pathogens such as A. fumigatus ( 66 ).…”

Section: Respiratory Fungal Infectionsmentioning

confidence: 99%

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Recent Advances in Fungal Infections: From Lung Ecology to Therapeutic Strategies With a Focus on Aspergillus spp.

et al. 2022

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Fungal infections are estimated to be the main cause of death for more than 1.5 million people worldwide annually. However, fungal pathogenicity has been largely neglected. This is notably the case for pulmonary fungal infections, which are difficult to diagnose and to treat. We are currently facing a global emergence of antifungal resistance, which decreases the chances of survival for affected patients. New therapeutic approaches are therefore needed to face these life-threatening fungal infections. In this review, we will provide a general overview on respiratory fungal infections, with a focus on fungi of the genus Aspergillus. Next, the immunological and microbiological mechanisms of fungal pathogenesis will be discussed. The role of the respiratory mycobiota and its interactions with the bacterial microbiota on lung fungal infections will be presented from an ecological perspective. Finally, we will focus on existing and future innovative approaches for the treatment of respiratory fungal infections.

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Invasive pulmonary aspergillosis after treatment with tocilizumab in a patient with COVID-19 ARDS: a case report

Cited by 19 publications

References 13 publications

Rhino-Orbito-Cerebral Mycosis and COVID-19

Rhino-Orbito-Cerebral Mycosis and COVID-19

Pathogenesis of Respiratory Viral and Fungal Coinfections

Recent Advances in Fungal Infections: From Lung Ecology to Therapeutic Strategies With a Focus on Aspergillus spp.

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