Pulmonary aspergillosis in two COVID-19 patients from Kuwait

Alobaid, Khaled; Yousuf, Beena; Al-Qattan, Eman; Muqeem, Zainab

doi:10.1099/acmi.0.000201

Cited by 6 publications

(6 citation statements)

References 17 publications

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“…The characteristics of the 57 eligible studies is presented in Table 1 (case reports, n = 33 and case series, n = 3) & Table 2 (cohort-studies, n = 21). Most of the studies published were from the five continents that included Europe [n = 24, 42.1%] (Denmark [ 23 ], Italy [ 27 , 34 , 35 ], Ireland [ 29 ], France [ 30 , 69 , 75 ], Spain [ 31 , 45 , 71 ], Greece [ 51 ], Austria [ 54 ], Netherlands [ 55 , 57 ], Germany [ 58 , 63 , 67 ], UK [ 62 , 64 , 78 ], Switzerland [ 74 , 77 ]), Asia [n = 18, 31.5%] (Iran [ 24 , 28 , 68 , 76 ], Iraq [ 39 ], Kuwait [ 33 ], Qatar [ 40 , 53 ], Japan [ 41 , 42 ], India [ 18 , 43 , 46 , 48 , 59 ], Indonesia [ 49 ], China [ 60 ], Pakistan [ 65 ]), North America [n = 10, 17.5%] (USA [ 26 , 32 , 36 , 38 , 44 , 50 , ...…”

Section: Resultsmentioning

confidence: 99%

“…Case report and case series: Based on the methodological quality & synthesis guide, twenty-four (72.7%) case reports were having low [ 18 , 23 – 31 , 33 – 35 , 37 , 38 , 40 , 41 , 43 – 45 , 49 , 52 – 54 ] and nine (27.2%) case reports were having medium risk of bias [ 32 , 36 , 39 , 42 , 46 – 48 , 50 , 51 ]. Whereas, all the three cases series were having low risk of bias [ 55 – 57 ] ( S3 Table ).…”

Section: Resultsmentioning

confidence: 99%

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Antifungal therapy in the management of fungal secondary infections in COVID-19 patients: A systematic review and meta-analysis

et al. 2022

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Objectives The prevalence of fungal secondary infections among COVID-19 patients and efficacy of antifungal therapy used in such patients is still unknown. Hence, we conducted this study to find the prevalence of fungal secondary infections among COVID-19 patients and patient outcomes in terms of recovery or all-cause mortality following antifungal therapy (AFT) in such patients. Methods We performed a comprehensive literature search in PubMed®, Scopus®, Web of Sciences™, The Cochrane Library, ClinicalTrial.gov, MedRxiv.org, bioRxiv.org, and Google scholar to identify the literature that used antifungal therapy for the management fungal secondary infections in COVID-19 patients. We included case reports, case series, prospective & retrospective studies, and clinical trials. Mantel Haenszel random-effect model was used for estimating pooled risk ratio for required outcomes. Results A total of 33 case reports, 3 case series, and 21 cohort studies were selected for final data extraction and analysis. The prevalence of fungal secondary infections among COVID-19 patients was 28.2%. Azoles were the most commonly (65.1%) prescribed AFT. Study shows that high survival frequency among patients using AFT, received combination AFT and AFT used for >28 days. The meta-analysis showed, no significant difference in all-cause mortality between patients who received AFT and without AFT (p = 0.17), between types of AFT (p = 0.85) and the duration of AFT (p = 0.67). Conclusion The prevalence of fungal secondary infections among COVID-19 patients was 28.2%. The survival frequency was high among patients who used AFT for fungal secondary infections, received combination AFT and AFT used for >28 days. However, meta-analysis results found that all-cause mortality in COVID-19 patients with fungal secondary infections is not significantly associated with type and duration of AFT, mostly due to presence of confounding factors such as small number of events, delay in diagnosis of fungal secondary infections, presence of other co-infections and multiple comorbidities.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Antifungal therapy in the management of fungal secondary infections in COVID-19 patients: A systematic review and meta-analysis

et al. 2022

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“…Only 62% of the CAPA cases had a positive respiratory culture, and the specimen was BAL in 45% of cases, which means that a large proportion of the diagnoses were based on cultures of less informative respiratory specimens. Only a few studies provided data concerning direct microscopic examinations of respiratory samples, and a positive result (septate branching hyphae suggesting Aspergillus) was reported in only 24 cases (7.4% of the positive cultures: 16 BAL, 5 TA, 1 BAS, and 2 unspecified respiratory specimens) [24,33,35,43,47,52,54,[65][66][67]71,76,[86][87][88][89]92,96,102]. According to Blot et al, positive direct examination of BAL is a crucial criterion for a diagnosis of putative IPA in ICU patients without host risk factors [103].…”

Section: Discussionmentioning

confidence: 99%

“…The most frequently isolated Aspergillus species were A. fumigatus (43 cultures, 67.2%) and A. niger (8 cultures, 12.5%), and the most frequent diagnostic samples were bronchoalveolar lavage (BAL) samples (25, 40.3%). Direct examination of respiratory samples showing septate branching hyphae was reported in 11 cases (17.7% of positive cultures) [65][66][67]71,76,[86][87][88][89]92,96,102]. Proven CAPA was reported in five studies: in three cases, the diagnosis was made post portem [69,72,95]; in the remaining two cases, the diagnosis was made using pulmonary tissue (biopsy in one case, lobectomy in the other) [89,92].…”

Section: Case Reports and Case Seriesmentioning

confidence: 99%

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

Casalini

Giacomelli

Ridolfo

et al. 2021

JoF

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Invasive fungal infections (IFIs) can complicate the clinical course of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients admitted to an intensive care unit (ICU). This narrative review concerns 4099 cases of IFIs in 58,784 COVID-19 patients involved in 168 studies. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is a diagnostic challenge because its non-specific clinical/imaging features and the fact that the proposed clinically diagnostic algorithms do not really apply to COVID-19 patients. Forty-seven observational studies and 41 case reports have described a total of 478 CAPA cases that were mainly diagnosed on the basis of cultured respiratory specimens and/or biomarkers/molecular biology, usually without histopathological confirmation. Candidemia is a widely described secondary infection in critically ill patients undergoing prolonged hospitalisation, and the case reports and observational studies of 401 cases indicate high crude mortality rates of 56.1% and 74.8%, respectively. COVID-19 patients are often characterised by the presence of known risk factors for candidemia such as in-dwelling vascular catheters, mechanical ventilation, and broad-spectrum antibiotics. We also describe 3185 cases of mucormycosis (including 1549 cases of rhino-orbital mucormycosis (48.6%)), for which the main risk factor is a history of poorly controlled diabetes mellitus (>76%). Its diagnosis involves a histopathological examination of tissue biopsies, and its treatment requires anti-fungal therapy combined with aggressive surgical resection/debridement, but crude mortality rates are again high: 50.8% in case reports and 16% in observational studies. The presence of other secondary IFIs usually diagnosed in severely immunocompromised patients show that SARS-CoV-2 is capable of stunning the host immune system: 20 cases of Pneumocystis jirovecii pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to Fusarium spp., and 1 case of pulmonary infection due to Scedosporium.

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“… Distribution ( a ) and co-occurrence ( b ) of fungal species across randomly selected 50 case studies, prospective and retrospective published reports on fungal co-infections in hospitalized COVID-19 patients [ 5 , 7 , 9 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ] (also see Supplementary Table S1 ). Searches were done on PubMed (Medline) and Google Scholar using query terms such as “Co-infections”, “coinfections”, “fungi” or “Fungal infections” in combination with either “COVID-19” or “SARS-CoV-2”.…”

Section: Figurementioning

confidence: 99%

Risk Factors for Fungal Co-Infections in Critically Ill COVID-19 Patients, with a Focus on Immunosuppressants

Ezeokoli

Gcilitshana

Pohl

2021

JoF

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Severe cases of coronavirus disease 2019 (COVID-19) managed in the intensive care unit are prone to complications, including secondary infections with opportunistic fungal pathogens. Systemic fungal co-infections in hospitalized COVID-19 patients may exacerbate COVID-19 disease severity, hamper treatment effectiveness and increase mortality. Here, we reiterate the role of fungal co-infections in exacerbating COVID-19 disease severity as well as highlight emerging trends related to fungal disease burden in COVID-19 patients. Furthermore, we provide perspectives on the risk factors for fungal co-infections in hospitalized COVID-19 patients and highlight the potential role of prolonged immunomodulatory treatments in driving fungal co-infections, including COVID-19-associated pulmonary aspergillosis (CAPA), COVID-19-associated candidiasis (CAC) and mucormycosis. We reiterate the need for early diagnosis of suspected COVID-19-associated systemic mycoses in the hospital setting.

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Pulmonary aspergillosis in two COVID-19 patients from Kuwait

Cited by 6 publications

References 17 publications

Antifungal therapy in the management of fungal secondary infections in COVID-19 patients: A systematic review and meta-analysis

Antifungal therapy in the management of fungal secondary infections in COVID-19 patients: A systematic review and meta-analysis

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

Risk Factors for Fungal Co-Infections in Critically Ill COVID-19 Patients, with a Focus on Immunosuppressants

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