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. 2023 Mar;29(3):239-243.
doi: 10.1016/j.jiac.2022.11.001. Epub 2022 Nov 12.

Clinical characteristics of patients with coronavirus disease 2019-associated pulmonary aspergillosis on mechanical ventilation: A single-center retrospective study in Japan

Yoshihiko Ogawa  1 , Kenya Murata  2 , Kohei Hasegawa  2 , Koji Nishida  3 , Iwao Gohma  3 , Kei Kasahara  4
Affiliations

Clinical characteristics of patients with coronavirus disease 2019-associated pulmonary aspergillosis on mechanical ventilation: A single-center retrospective study in Japan

Yoshihiko Ogawa et al. J Infect Chemother. 2023 Mar.

Abstract

Background: Aspergillus is one of the important pathogens that contribute to high mortality in patients with coronavirus disease 2019 (COVID-19) in intensive care units (ICUs). Although incidence rates of Aspergillus coinfection are high globally, a Japanese national survey reported a low incidence. This study aimed to describe the clinical characteristics of patients with COVID-19-associated pulmonary aspergillosis at our institute.

Methods: We identified patients with microbiologically confirmed COVID-19 on mechanical ventilation in the ICU. Of these patients, we identified patients in whom Aspergillus was cultured from the respiratory specimen.

Results: Of a total of 169 patients, seven had aspergillosis (4.1%), which included three patients, three patients, and one patient with possible, probable, and proven aspergillosis, respectively, according to the criteria of the European Confederation of Medical Mycology International Society. All patients received systemic steroid therapy. Two patients (one each with proven and probable aspergillosis) had tracheobronchitis diagnosed by bronchoscopy. All patients in whom Aspergillus was repeatedly isolated from samples died. The mortality rates for all cases and probable and proven cases were 57% (4/7) and 75% (3/4), respectively.

Conclusions: The incidence rate of aspergillosis in patients with COVID-19 in the ICU was higher in our institute than that reported by a Japanese national survey (4.1% vs. 0.5%). Repeated detection of Aspergillus might suggest a true Aspergillus infection, such as chronic aspergillosis, rather than colonization. In patients with severe COVID-19 patients, it is important to always keep CAPA in mind.

Keywords: Aspergillosis; Bronchoscopy; COVID-19; Mechanical ventilation; Transbronchial aspirate.

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Conflict of interest statement

Declaration of competing interest None.

Figures

Fig. 1
Fig. 1
Images of Gram stained respiratory specimens ( × 1000) from (a) case 2, (b) case 3, (c) case 4, and (d) case 7.
Fig. 2
Fig. 2
Bronchial mucosal findings of bronchoscopy; multiple ulcerations and mucosal ulcers with black plaque in tracheobronchial mucosa can be seen (left: case 5. right: case 7).
See this image and copyright information in PMC

References

    1. White P.L., Dhillon R., Cordey A., Hughes H., Faggian F., Soni S., et al. A national strategy to diagnose coronavirus disease 2019-associated invasive fungal disease in the intensive care unit. Clin Infect Dis. 2021;73:e1634–e1644. doi: 10.1093/cid/ciaa1298. - DOI - PMC - PubMed
    1. Permpalung N., Chiang T.P.U., Massie A.B., Zhang S.X., Avery R.K., Nematollahi S., et al. Coronavirus disease 2019-associated pulmonary aspergillosis in mechanically ventilated patients. Clin Infect Dis. 2022;74:83–91. doi: 10.1093/cid/ciab223. - DOI - PMC - PubMed
    1. Dupont D., Menotti J., Turc J., Miossec C., Wallet F., Richard J.C., et al. Pulmonary aspergillosis in critically ill patients with coronavirus Disease 2019 (COVID-19) Med Mycol. 2021;59:110–114. doi: 10.1093/mmy/myaa078. - DOI - PMC - PubMed
    1. Machado M., Valerio M., Álvarez-Uría A.A., Olmedo M., Veintimilla C., Padilla B., et al. Invasive pulmonary aspergillosis in the COVID-19 era: an expected new entity. Mycoses. 2021;64:132–143. doi: 10.1111/myc.13213. - DOI - PMC - PubMed
    1. Rutsaert L., Steinfort N., Van Hunsel T., Bomans P., Naesens R., Mertes H., et al. COVID-19-associated invasive pulmonary aspergillosis. Ann Intensive Care. 2020;10:71. doi: 10.1186/s13613-020-00686-4. - DOI - PMC - PubMed

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