galactomannan and Pneumonia--Viral

Superinfections, including invasive pulmonary aspergillosis (IPA), are well-known complications of critically ill patients with severe viral pneumonia. Aim of this study was to evaluate the incidence, risk factors and outcome of IPA in critically ill patients with severe COVID-19 pneumonia.. We prospectively screened 32 critically ill patients with severe COVID-19 pneumonia for a time period of 28 days using a standardized study protocol for oberservation of developement of COVID-19 associated invasive pulmonary aspergillosis (CAPA). We collected laboratory, microbiological, virological and clinical parameters at defined timepoints in combination with galactomannan-antigen-detection from nondirected bronchial lavage (NBL). We used logistic regression analyses to assess if COVID-19 was independently associated with IPA and compared it with matched controls.. CAPA was diagnosed at a median of 4 days after ICU admission in 11/32 (34%) of critically ill patients with severe COVID-19 pneumonia as compared to 8% in the control cohort. In the COVID-19 cohort, mean age, APACHE II score and ICU mortality were higher in patients with CAPA than in patients without CAPA (36% versus 9.5%; p<0.001). ICU stay (21 versus 17 days; p = 0.340) and days of mechanical ventilation (20 versus 15 days; p = 0.570) were not different between both groups. In regression analysis COVID-19 and APACHE II score were independently associated with IPA.. CAPA is highly prevalent and associated with a high mortality rate. COVID-19 is independently associated with invasive pulmonary aspergillosis. A standardized screening and diagnostic approach as presented in our study can help to identify affected patients at an early stage.

Topics: Adult; Aged; Aged, 80 and over; Bronchoalveolar Lavage Fluid; COVID-19; Critical Illness; Female; Galactose; Humans; Intensive Care Units; Invasive Pulmonary Aspergillosis; Male; Mannans; Middle Aged; Pneumonia, Viral; Prospective Studies; Respiration, Artificial; SARS-CoV-2; Superinfection

Patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications like invasive aspergillosis. Our study evaluates coronavirus disease 19 (COVID-19) associated invasive aspergillosis at a single centre in Cologne, Germany.. A retrospective chart review of all patients with COVID-19 associated ARDS admitted to the medical or surgical intensive care unit at the University Hospital of Cologne, Cologne, Germany.. COVID-19 associated invasive pulmonary aspergillosis was found in five of 19 consecutive critically ill patients with moderate to severe ARDS.. Clinicians caring for patients with ARDS due to COVID-19 should consider invasive pulmonary aspergillosis and subject respiratory samples to comprehensive analysis to detect co-infection.

Topics: Aged; Antifungal Agents; Bronchoalveolar Lavage Fluid; Coronavirus Infections; COVID-19; Female; Galactose; Germany; Hemorrhage; Hospitals, Teaching; Humans; Intensive Care Units; Lung Diseases; Male; Mannans; Metapneumovirus; Middle Aged; Nitriles; Pandemics; Paramyxoviridae Infections; Pneumonia, Viral; Pulmonary Aspergillosis; Pyridines; Respiratory Distress Syndrome; Retrospective Studies; Thorax; Tomography, X-Ray Computed; Triazoles; Voriconazole

Topics: Acute Kidney Injury; Aged; Aged, 80 and over; Betacoronavirus; Biomarkers; Bronchoalveolar Lavage Fluid; C-Reactive Protein; Coronavirus Infections; COVID-19; Disease Progression; Fatal Outcome; Galactose; Humans; Interleukin-6; Invasive Pulmonary Aspergillosis; Male; Mannans; Pandemics; Pneumonia, Viral; SARS-CoV-2; Severe Acute Respiratory Syndrome

Invasive pulmonary aspergillosis is increasingly reported in patients with influenza admitted to the intensive care unit (ICU). Classification of patients with influenza-associated pulmonary aspergillosis (IAPA) using the current definitions for invasive fungal diseases has proven difficult, and our aim was to develop case definitions for IAPA that can facilitate clinical studies.. A group of 29 international experts reviewed current insights into the epidemiology, diagnosis and management of IAPA and proposed a case definition of IAPA through a process of informal consensus.. Since IAPA may develop in a wide range of hosts, an entry criterion was proposed and not host factors. The entry criterion was defined as a patient requiring ICU admission for respiratory distress with a positive influenza test temporally related to ICU admission. In addition, proven IAPA required histological evidence of invasive septate hyphae and mycological evidence for Aspergillus. Probable IAPA required the detection of galactomannan or positive Aspergillus culture in bronchoalveolar lavage (BAL) or serum with pulmonary infiltrates or a positive culture in upper respiratory samples with bronchoscopic evidence for tracheobronchitis or cavitating pulmonary infiltrates of recent onset. The IAPA case definitions may be useful to classify patients with COVID-19-associated pulmonary aspergillosis (CAPA), while awaiting further studies that provide more insight into the interaction between Aspergillus and the SARS-CoV-2-infected lung.. A consensus case definition of IAPA is proposed, which will facilitate research into the epidemiology, diagnosis and management of this emerging acute and severe Aspergillus disease, and may be of use to study CAPA.

Topics: Antifungal Agents; Aspergillus; Betacoronavirus; Bronchoalveolar Lavage Fluid; Coronavirus Infections; COVID-19; Galactose; Humans; Influenza, Human; Intensive Care Units; Mannans; Pandemics; Pneumonia, Viral; Pulmonary Aspergillosis; SARS-CoV-2

Pathological data of critical ill COVID-19 patients is essential in the search for optimal treatment options.. We performed postmortem needle core lung biopsies in seven patients with COVID-19 related ARDS. Clinical, radiological and microbiological characteristics are reported together with histopathological findings.. Patients age ranged from 58 to 83 years, five males and two females were included. Time from hospital admission to death ranged from 12 to 36 days, with a mean of 20 ventilated days. ICU stay was complicated by pulmonary embolism in five patients and positive galactomannan on bronchoalveolar lavage fluid in six patients, suggesting COVID-19 associated pulmonary aspergillosis. Chest CT in all patients showed ground glass opacities, commonly progressing to nondependent consolidations. We observed four distinct histopathological patterns: acute fibrinous and organizing pneumonia, diffuse alveolar damage, fibrosis and, in four out of seven patients an organizing pneumonia. None of the biopsy specimens showed any signs of invasive aspergillosis.. In this case series common late histopathology in critically ill COVID patients is not classic DAD but heterogeneous with predominant pattern of organizing pneumonia. Postmortem biopsy investigations in critically COVID-19 patients with probable COVID-19 associated pulmonary aspergillosis obtained no evidence for invasive aspergillosis.

Topics: Aged; Aged, 80 and over; Autopsy; Betacoronavirus; Biopsy; Biopsy, Large-Core Needle; Bronchoalveolar Lavage Fluid; Coinfection; Coronavirus Infections; COVID-19; Critical Illness; Female; Galactose; Humans; Lung; Lung Diseases, Interstitial; Male; Mannans; Middle Aged; Pandemics; Phenotype; Pneumonia, Viral; Pulmonary Aspergillosis; Pulmonary Embolism; Respiratory Distress Syndrome; SARS-CoV-2; Tomography, X-Ray Computed

Bronchoalveolar lavage (BAL) is recommended for diagnosing lung infiltrates (LI) in patients with hematologic malignancy (HM). Prospective data on the impact of BAL on survival are still lacking. We conducted a prospective observational study on patients who performed BAL for LI among 3055 HM patients hospitalized from January to September 2018. The BAL was performed in 145 out of 434 patients who developed LI, at a median time of four days from LI detection. The median age was 60 (1-83). Most patients had an acute myeloid leukemia/myelodisplastic syndrome (81), followed by lymphoma (41), acute lymphoblastic leukemia (27), and other types of HM (36). A putative causal agent was detected in 111 cases (76%), and in 89 cases (61%) the BAL results provided guidance to antimicrobial treatment. We observed a significantly improved outcome of LI at day +30 in patients who could receive a BAL-driven antimicrobial treatment (improvement/resolution rate: 71% vs 55%; P = .04). Moreover, we observed a significantly improved outcome in 120-day overall survival (120d-OS) (78% vs 59%; P = .009) and 120-day attributable mortality (120d-AM) (11% vs 30%; P = 0.003) for patients who could receive a BAL-driven treatment. The multivariate analysis showed that BAL-driven antimicrobial treatment was significantly associated with better 120d-OS and lower 120d-AM. We did not observe any severe adverse events. In conclusion BAL allows detection of a putative agent of LI in about 75% of cases, it is feasible and well tolerated in most cases, demonstrating that a BAL-driven antimicrobial treatment allows improvement of clinical outcome and survival.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Infective Agents; Body Fluids; Bronchoalveolar Lavage; Child; Child, Preschool; Female; Galactose; Hematologic Neoplasms; Humans; Infant; Kaplan-Meier Estimate; Lung; Lung Diseases, Fungal; Male; Mannans; Middle Aged; Pneumonia, Bacterial; Pneumonia, Viral; Proportional Hazards Models; Prospective Studies; Young Adult