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COVID-19-Associated Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Series in a Portuguese Hospital
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Orientador(es)
Resumo(s)
Invasive pulmonary aspergillosis (IPA) has become a recognizable complication in
coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs). Alveolar
damage in the context of acute respiratory distress syndrome (ARDS) appears to be the culprit in
facilitating fungal invasion in COVID-19 patients, leading to a COVID-19-associated pulmonary
aspergillosis (CAPA) phenomenon. From November 2020 to 15 February 2021, 248 COVID-19
patients were admitted to our ICUs, of whom ten patients (4% incidence) were classified as either
probable (six) or possible (four) CAPA cases. Seven patients had positive cultural results: Aspergillus
fumigatus sensu stricto (five), A. terreus sensu stricto (one), and A. welwitschiae (one). Five patients
had positive bronchoalveolar lavage (BAL) and galactomannan (GM), and two patients had both
positive cultural and GM criteria. All but two patients received voriconazole. Mortality rate was
30%. Strict interpretation of classic IPA definition would have resulted in eight overlooked CAPA
cases. Broader diagnostic criteria are essential in this context, even though differentiation between
Aspergillus colonization and invasive disease might be more challenging. Herein, we aim to raise
awareness of CAPA in view of its potential detrimental outcome, emphasizing the relevance of a
low threshold for screening and early antifungal treatment in ARDS patients.
Descrição
Palavras-chave
COVID-19 Intensive Care Unit Aspergillus Invasive Pulmonary Aspergillosis COVID-19-Associated Invasive Pulmonary Aspergillosis CAPA Infecções Respiratórias Portugal
Contexto Educativo
Citação
J Fungi (Basel). 2021 Oct 19;7(10):881. doi: 10.3390/jof7100881.
Editora
MDPI