galactomannan and Respiratory-Distress-Syndrome

Invasive aspergillosis is extremely rare in immunocompetent children. Here we describe the clinical, radiologic, and laboratory course of fatal invasive pulmonary and central nervous system aspergillosis in a previously healthy child after a near-drowning incident with submersion in a pond. Findings were compared with data from the literature, which is reviewed. Serum Aspergillus galactomannan levels were determined retrospectively and were compared with the results of routine microbiological and radiologic examinations, showing a significant diagnostic and therapeutic delay of the routine diagnostic approach in comparison with the use of the Aspergillus galactomannan assay. This delay may have contributed to the fatal course. Serial determination of serum Aspergillus galactomannan may be helpful in diagnosing invasive aspergillosis early in case of pulmonary disease after near-drowning and may contribute to an early appropriate treatment. Currently voriconazole, eventually in combination with caspofungin, should be considered as the drug of choice in the management of invasive aspergillosis after near-drowning.

Topics: Aspergillosis; Aspergillus fumigatus; Disease Susceptibility; Early Diagnosis; Epilepsy; Fatal Outcome; Female; Fresh Water; Galactose; Gram-Negative Bacterial Infections; Humans; Infant; Lung Diseases, Fungal; Mannans; Near Drowning; Neuroaspergillosis; Paraplegia; Pneumonia, Aspiration; Pneumonia, Bacterial; Respiratory Distress Syndrome; Respiratory Insufficiency; Stenotrophomonas maltophilia; Water Microbiology

Coronavirus disease 2019 or COVID-19 is a new infectious disease responsible for potentially severe respiratory impairment associated with initial immunosuppression. Similarly to influenza, several authors have described a higher risk of fungal infection after COVID-19, in particular for invasive pulmonary aspergillosis. The main objective here is to define the prevalence of invasive pulmonary aspergillosis (IPA) in a cohort of COVID-19 patients with moderate to severe acute respiratory disease syndrome (ARDS).. We conducted a large monocentric retrospective study investigating all the ventilated COVID-19 patients with ARDS hospitalized at Valenciennes' general hospital, France, between March 15, 2020 and April 30, 2020. In the center a systematic IPA screening strategy was carried out for all ARDS patients, with weekly tests of serum galactomannan and beta-D-glucan. Bronchoalveolar lavage with culture and chest CT scan were performed when the serum assays were positives.. A total of 54 patients were studied. Their median age was 65 years, and 37 of the patients (71%) were male. Two patients had chronic immunosuppression and among all the patients, only 2 non-immunocompromised presented a putative IPA during their stay.. The prevalence of IPA in this cohort of COVID-19 patients (3.7%) is not higher than what is described in the other ARDS populations in the literature. These results are however different from the previous publications on COVID-19 patients and must therefore be confirmed by larger and multicentric studies.

Topics: Adult; Aged; Aged, 80 and over; beta-Glucans; Biomarkers; Comorbidity; COVID-19; Critical Illness; Female; France; Galactose; Hospitals, General; Humans; Immunocompromised Host; Intensive Care Units; Invasive Pulmonary Aspergillosis; Male; Mannans; Middle Aged; Opportunistic Infections; Respiration, Artificial; Respiratory Distress Syndrome; Retrospective Studies; Risk Factors

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

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

Topics: Adult; Amphotericin B; Antifungal Agents; Antigens, Fungal; Area Under Curve; Bronchoalveolar Lavage Fluid; Extracorporeal Membrane Oxygenation; Female; Galactose; Humans; Invasive Pulmonary Aspergillosis; Liposomes; Mannans; Respiratory Distress Syndrome

This study was conducted to get a complete clinical and mycological picture of invasive aspergillosis (IA) in respiratory medicine ICU of a tertiary care hospital.. From the cohort of 235 patients only one had proven IA. Based on AspICU algorithm, 21 had putative IA (8.9%), 12 were colonised (5.1%).. Adjusting the confounding factors, significant risk factors for IA were chronic obstructive pulmonary disease (COPD), temperature of ≥38°C, pneumonia and acute respiratory distress syndrome (ARDS). The best predictor of IA was AspICU algorithm (AUC, 1) followed by serum galactomannan antigen (GM) cut-off (≥1.24) calculated based on AspICU algorithm (AUC, 0.822). For 37% of patients, IA diagnoses was made earlier with serum GM than radiology. There were 70/235 (29.8%) deaths within 30 days of enrolment in the study. Aspergillus culture positivity (34/235, 14.5%) was associated with very high mortality (27/34, 79.4%), (p<0.05). The best predictor of mortality was GM cut-off (≥1.24) calculated based on AspICU algorithm (AUC, 0.835).. This study imparts the focus on relatively underestimated Aspergillus infections prevalent in ICUs. The AspICU algorithm was found to be useful over others for IA diagnosis. The prognostic usefulness of serum GM antigen detection test highlighted overlooking the same may not be rewarding for the outcome of IA suspected ICU subpopulation.

Topics: Adult; Algorithms; Aspergillosis; Biomarkers; Cross-Sectional Studies; Early Diagnosis; Female; Fever; Galactose; Humans; Intensive Care Units; Male; Mannans; Middle Aged; Pneumonia; Prognosis; Respiratory Distress Syndrome; Risk Factors