摘要
ABSTRACT Introduction. Data on the prevalence of fungal coinfections/superinfections in patients with COVID-19 are limited. Objective. To describe the prevalence of fungal coinfections/superinfections in patients with COVID-19, as well as risk factors and demographic, clinical, and microbiological characteristics. Material and methods. We included patients with a confirmed COVID-19 diagnosis and a confirmed fungal infection hospitalized in the ICU from March 2020 to December 2021. We collected data on age, sex, comorbidities, hospital length of stay (days), laboratory (ferritin) and microbiological results, treatment for COVID-19, antifungal therapy, and outcomes obtained from the clinical records. Results. Only 11 out of 740 patients met the inclusion criteria. The coinfection rate was 0.3% and the superinfection was 1.2%. The most affected population was male adults. The coinfections/superinfections diagnosed were candiduria and candidemia, caused by Candida albicans, C. tropicalis, C. glabrata, C. lusitaniae, and Kluyveromyces marxianus (C. kefyr). In addition, tracheobronchitis due to Aspergillus fumigatus was found. The most used antifungals were fluconazole and caspofungin. The lethality in patients with fungal coinfections was 50% and superinfections, 22%. The length of hospital stay was 11-65 days. Eight patients required mechanical ventilation and six received corticosteroids. The main comorbidity was diabetes mellitus (81.8%). Conclusions. The rate of fungal coinfections/superinfections in COVID-19 patients was low, but the lethality found urges for routine fungal screening in patients with severe COVID-19 to timely detect fungal infections that may further compromise the patient's life.
RESUMEN Introducción. Los datos sobre la prevalencia de coinfecciones o sobreinfecciones fúngicas en pacientes con COVID-19 son limitados. Objetivo. Describir la prevalencia de coinfecciones o sobreinfecciones fúngicas en pacientes con COVID-19, así como los factores de riesgo y las características demográficas, clínicas y microbiológicas. Material y métodos. Se incluyeron pacientes con diagnóstico confirmado de COVID-19, hospitalizados en la unidad de cuidados intensivos y con infección fúngica confirmada entre marzo del 2020 y diciembre del 2021. Del expediente clínico se obtuvieron datos sobre edad, sexo, comorbilidades, días de estancia hospitalaria, resultados de laboratorio (ferritina) y microbiológicos, tratamiento contra COVID-19, terapia antifúngica y desenlace. Resultados. Once de 740 pacientes cumplieron con los criterios de inclusión. La tasa de coinfección fue del 0,3 % y la de sobreinfección fue del 1,2 %. La población más afectada fue la de hombres adultos. Las coinfecciones o sobreinfecciones diagnosticadas fueron candiduria y candidemia, causadas por Candida albicans, C. tropicalis, C. glabrata, C. lusitaniae y Kluyveromyces marxianus (C. kefyr). Además, se encontró una traqueobronquitis por Aspergillus fumigatus. Los antifúngicos más administrados fueron fluconazol y caspofungina. La letalidad en pacientes con coinfecciones fue del 50 % y con sobreinfecciones fúngicas, del 22 %. El tiempo de estancia intrahospitalaria fue de 11 a 65 días. Ocho de los pacientes requirieron asistencia respiratoria mecánica y seis recibieron corticoides. La principal comorbilidad fue diabetes mellitus (81,8 %). Conclusiones. La tasa de coinfecciones o sobreinfecciones por hongos en pacientes con COVID-19 fue baja, pero la letalidad de estas requiere, con urgencia, la realización de pruebas de rutina para detectar hongos en pacientes con COVID-19 grave para diagnosticar oportunamente infecciones fúngicas que puedan comprometer aún más la vida del paciente.
摘要
RESUMEN La aspergilosis pulmonar, causada por el hongo oportunista Aspergillus, afecta principalmente a individuos inmunocomprometidos. Este reporte presenta tres casos: Una mujer de 18 años con leucemia aguda desarrolló dificultad respiratoria y patrones bilaterales de "árbol en brote" en la tomografía computarizada (TC). A pesar del tratamiento con voriconazol, falleció debido a insuficiencia respiratoria. Una mujer de 58 años con diabetes y EPOC presentó disnea y hemoptisis. Las imágenes revelaron una lesión cavitada, confirmando un aspergiloma. Se consideró la cirugía debido a la hemoptisis activa. Una mujer de 41 años con antecedentes de tuberculosis presentó fiebre y síntomas respiratorios. La TC mostró lesiones cavitadas y bronquiectasias, confirmando aspergilosis crónica. Respondió bien al voriconazol. Estos casos destacan la variabilidad en la aspergilosis pulmonar y subrayan la importancia de un diagnóstico y tratamiento oportunos para mejorar los resultados en los pacientes.
ABSTRACT Pulmonary aspergillosis, caused by the opportunistic fungus Aspergillus, primarily affects immunocompromised individuals. This report presents three cases: An 18-year-old female with acute leukemia developed respiratory distress and bilateral "tree-in-bud" patterns on CT. Despite voriconazole treatment, she succumbed to respiratory failure. A 58-year-old female with diabetes and COPD had dyspnea and hemoptysis. Imaging revealed a cavitated lesion, confirming aspergilloma. Surgery was considered due to active hemoptysis. A 41-year-old female with a history of tuberculosis presented with fever and respiratory symptoms. CT showed cavitated lesions and bronchiectasis, confirming chronic aspergillosis. She responded well to voriconazole. These cases highlight the variability in pulmonary aspergillosis and underscore the importance of timely diagnosis and treatment to improve patient outcomes.
摘要
Objective:To investigate the clinical characteristics, risk factors, and prognosis of invasive pulmonary aspergillosis (IPA) in patients with dermatomyositis associated with positive anti-melanoma differentiation-associated gene 5 (MDA5-DM).Methods:A total of 55 patients with MDA5-DM were analyzed. Patients were divided into IPA (+) group (14 cases) and IPA (-) group (41 cases) based on the presence of IPA. Microbiological examination and clinical data were analyzed. Risk factor analysis was performed using Binary Logistic regression, and survival analysis was carried out using Kaplan-Meier method.Results:Aspergillus flavus (5/14, 35.7%) and Aspergillus fumigatus (4/14, 28.6%) were the most common species in MDA5-DM patients with IPA. Compared to the IPA (-) group, IPA (+) group had higher serum level of α-hydroxybutyrate dehydrogenase (246 U/L vs. 191 U/L, Z=-2.02, P=0.043) and ferritin [1 306.7(518.7, 2 977.8)ng/ml vs. 472.6(269.0, 792.1)ng/ml, Z=-2.09, P=0.036], lower CD8 + T lymphocyte counts {[111.5 (68.3, 214.0)]×10 6/L vs. [188.0(141.0, 270.0)]×10 6/L, Z=-2.18, P=0.029}, and more positive BALF GM tests [70.0%(7/10) vs. 18.9%(7/37), χ2=9.82, P=0.004]. Elevated serum ferritin was found to be an independent risk factor for IPA occurrence [adjusted OR (95% CI)=1.001 (1.000, 1.002), P=0.031)]. In addition, the 6-month cumulative survival rate was significantly lower in the IPA (+) group than in the IPA (-) group (78.6% vs. 97.6%, P=0.021). Conclusion:The mortality of MDA5-DM patients is increased after IPA infection. Elevated serum ferritin is an independent risk factor for IPA occurrence, and active prevention and treatment of IPA are expected to improve the prognosis of patients.
摘要
Objective:To review and analyze clinical data of patients with invasive pulmonary aspergillosis and mucormycosis, and to explore the surgical indication.Methods:Clinical data of 10 patients with invasive pulmonary aspergillosis and mucormycosis were analyzed retrospectively from March 2018 to November 2022 in our hospital, Department of Thoracic Surgery.Results:The age of children varied from 2.58 years old to 16.00 years old and 6 children were males while 4 females. Five patients suffer from invasive pulmonary aspergillosis. Five patients suffer from invasive pulmonary mucormycosis. The operative indication of 7 patients was the risk of massive bleeding in the airway. The surgical indication for two patients is to control infection and continue treating malignant tumors. One patient chose surgical treatment because the infection could not be cured after long-term antifungal treatment but the focus was limited. Two patients died of sudden acute hemoptysis before operation, the prognosis of 8 patients undergoing surgical treatment was good.Conclusion:The lethal rate of invasive pulmonary aspergillosis and mucormycosis is very high. Antifungal drug treatment combined with timely surgical treatment can save patients lives.
摘要
Objective To analyze the clinical characteristics of organizing pneumonia secondary to inva-sive pulmonary aspergillosis.Methods A total of 13 patients with organizing pneumonia secondary to invasive pulmonary aspergillosis in the Department of Respiratory,the First Affiliated Hospital of Zhengzhou Univer-sity diagnosed by pathology from January 2019 to January 2021 were retrospectively included,and their clinical characteristics,laboratory examination,imaging characteristics,treatment and prognosis were comprehensively analyzed.Results Most cases of pulmonary aspergillosis occurred within 2-3 weeks of diagnosis,with coug-hing,expectoration,fever,and elevated C-reactive protein and erythrocyte sedimentation rate.Chest computed tomography showed patchy shadows around the original infection focus,mostly accompanied by consolidation,halo sign,bronchial inflation sign,and might be accompanied by cavity and pleural effusion;secondary multi lobed involvement of both lungs was observed,mostly with small patchy shadows,nodular shadows,and tree bud signs.After receiving glucocorticoid treatment,the symptoms were controlled within one week,and the glucocorticoid treatment course was mostly 3-6 months.Conclusion The clinical characteristics of organi-zing pneumonia secondary to invasive pulmonary aspergillosis are somewhat similar to those of cryptogenic or-ganizing pneumonia and have a better prognosis.
摘要
With widespread application of solid organ transplantation (SOT), the incidence of postoperative invasive fungal disease (IFD) in SOT recipients has been increased year by year. In recent years, the awareness of preventive antifungal therapy for SOT recipients has been gradually strengthened. However, the problem of fungal resistance has also emerged, leading to unsatisfactory efficacy of original standardized antifungal regimens. Drug-drug interaction and hepatorenal toxicity induced by drugs are also challenges facing clinicians. In this article, the characteristics of drug-drug interaction and hepatorenal toxicity among triazole, echinocandin and polyene antifungal drugs and immunosuppressants were reviewed, and postoperative preventive strategies for IFD in different types of SOT recipients and treatment strategies for IFD caused by infection of different pathogens were summarized, aiming to provide reference for physicians in organ transplantation and related disciplines.
摘要
Abstract Invasive fungal infection (IFI) is frequent in patients with hematologic malignancies or submitted hematopoietic stem cell transplantation (HSCT). Objectives To evaluate the role of the GM (galactomannan) test in prescribing therapeutic antifungals; to determine invasive aspergillosis (IA) frequency, the factors associated with positive GM test, and the in-hospital mortality. Methods We conducted a retrospective observational study including patients aged 18 or over with hematological malignancy or submitted to HSCT. GM test was measured twice weekly. The hypothesis of IFI was considered in patients with neutropenia and persistent fever despite broad-spectrum antibiotics. Results A total of 496 patients were evaluated; the mean of GM tests performed per patient was 4.2 (+3.1), and 86 (17.3 %) had positive results. IFI was diagnosed in 166 (33.5 %) and IA in 22 (24.6 %) patients. Positive GM test was more frequent in patients with IFI (72.2 % and 25.1 %; OR 8.1; 95 % CI 4.8 - 13.8), and was associated with therapeutic antifungals prescription (52, 9 % and 20.5 %; OR 4.3, 95CI% 2.0 - 9.4), as well as lung abnormalities on HRCT (45.3% vs. 21.5 %; OR 3.0, 95 %CI 1.4 - 6.5). Mortality was 31.6 %. In the multivariate analysis, the variables associated with mortality were the hypothesis of IFI (OR 6.35; 95 % CI 3.63-11.12.0), lung abnormalities on HRCT (57.9 % and 26.9 %; OR 2 0.6; 95 % CI 1.5 - 4.4), and positive GM test (57.9 % and 26.9 %; OR 2.7 95 % CI 1.6 - 4.5). Conclusions Positive GM test was associated with lung abnormalities on HRCT and with the introduction of therapeutic antifungals. If adequate anti-mold prophylaxis is available, the GM test should not be used as screening, but to investigate IFI in high-risk patients. The diagnosis of IFI, positive GM test and lung abnormalities on HRCT were predictors of hospital mortality in patients with hematological malignancies or undergoing HSCT.
摘要
Abstract Aspergillus species can colonize and infect immunocompetent and immunocompromised hosts. Conventional fungal identification depends on microscopic analysis and microorganism medium growth. Other diagnostic methods, non-growth dependent, to invasive fungal infections, are the biomarkers that detect circulating polysaccharides, for example, 1-3-β-d-Glucan and galactomannan. Both are polysaccharides present on the external layer of fungi cell wall and can be detected in clinical samples during the growth of the fungus in the patient. This study aimed to compare the galactomannan detection of Lateral Flow Assay and Enzyme Immunoassay methods in Bronchoalveolar Lavage Fluid. The galactomannan antigen in Bronchoalveolar Lavage Fluid was measured using Enzyme Immunoassay according to the manufacturer's instructions (PLATELIA ASPERGILLUS™ BioRad) and, using a Lateral Flow Assay according to the manufacturer's instructions (Galactomannan LFA IMMY©). The 71 samples were Bronchoalveolar Lavage Fluid of patients hospitalized at Unicamp Clinical Hospital between 2019 and 2021; of these samples 12/71 (16.9 %) resulted in positive Galactomannan-Lateral Flow Assay. In contrast, Galactomannan-Enzyme Immunoassay resulted as positive in 9/71 (12.6 %) samples, a difference that showed not significant statistically (p-value = 0.36) Comparing both assays' results identified 8 divergences between them, about 11 % of the total sample. The Sensitivity (73.3 %), Specificity (92.35 %), Positive Predictive Value (62.85 %) and Negative Predictive Value (95.15 %) of Lateral Flow Assay were calculated using the Galactomannan Enzyme Immunoassay as standard. The Lateral Flow Assay demonstrated good results when compared with the Enzyme Immunoassay.
摘要
Introducción. La aspergilosis invasiva presenta alta mortalidad en pacientes con enfermedades crónicas e inmunocomprometidos. Aspergillus fumigatus sensu stricto (AFSS) es el principal agente etiológico y su tipificación requiere de métodos moleculares. La incidencia incrementada de AI resistentes a los antifúngicos demanda un diagnóstico certero y oportuno. Métodos. Se estudiaron 20 cepas de la micoteca del Instituto de Medicina Tropical - Universidad Nacional Mayor de San Marcos, aisladas de muestras respiratorias e identificadas como Aspergillus fumigatus sensu lato mediante el estudio macroscópico y microscópico. Las cepas fueron referidas a la Universidad Nacional del Litoral para su tipificación mediante una PCR screening para AFSS basada en secuencias del gen CYP51A y el estudio de sensibilidad antifúngica para voriconazol (VOR), itraconazol (ITC), posaconazol (POS), isavuconazol (ISA), anidulafungina (ANF), caspofungina (CSF) y anfotericina B (AMB) obteniendo la concentración inhibitoria mínima (CIM) mediante el protocolo de CLSI M38M51S-Ed3. Resultados. Las 20 cepas fueron identificadas como AFSS. Ninguna de las cepas tuvo una CIM por encima del punto de corte clínico (VOR), ni epidemiológico (ITC, ISA, AMB y CSF). POS fue la droga más potente frente a la colección de cepas evaluadas (media geométrica (GM) de CIM de 0,042 µg/ml). Conclusiones. Todos los aislamientos fueron tipificados como AFSS sensibles a los azoles según los puntos de corte clínico, posaconazol tuvo la mayor actividad antifúngica. Nuestros hallazgos aportan a incrementar la escasa información sobre la etiología y sensibilidad a los antifúngicos de uso clínico de las aspergilosis invasiva en nuestro país.
Introduction. Invasive Aspergillosis (IA) poses a significant threat to patients with chronic diseases and compromised immune systems, with Aspergillus fumigatus sensu stricto (AFSS) being the primary etiological agent. Accurate and timely diagnosis is crucial, particularly given the rising incidence of IA strains resistant to antifungals, necessitating molecular methods for typing. Methods. Twenty strains from Instituto de Medicina Tropical - Universidad Nacional Mayor de San Marcos, mycological collection, previously identified as Aspergillus fumigatus sensu lato through macroscopic and microscopic analysis, were studied. These strains were forwarded to the Universidad Nacional del Litoral for AFSS typing using a PCR screening based on CYP51A gene sequences. Antifungal susceptibility testing was performed for Voriconazole (VOR), Itraconazole (ITC), Posaconazole (POS), Isavuconazole (ISA), Anidulafungin (ANF), Caspofungin (CSF), and Amphotericin B (AMB), obtaining Minimum Inhibitory Concentrations (MICs) according to CLSI M38M51S-Ed3. Results. All 20 strains were identified as AFSS. None of the strains exhibited MICs above the clinical breakpoint (VOR) or the epidemiological cutoffs (ITC, ISA, AMB, and CSF). POS demonstrated the highest potency against the strain collection, with a geometric mean MIC of 0,042 µg/ml. Conclusions. All isolates were classified as azole-sensitive Aspergillus fumigatus sensu stricto (AFSS) based on clinical cutoff points, particularly posaconazole, which exhibited superior antifungal activity. Our findings contribute to augmenting the limited information on the etiology and clinical antifungal sensitivity of IA in our country.
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Es poco común encontrar en la literatura casos de traqueobronquitis invasiva por aspergillus que se manifiesten como tumores endobronquiales que produzcan atelectasia pulmonar total. Aunque relatada en inmunocomprometidos, la morbimortalidad es considerable aun en pacientes sin enfermedad de base.
It is rare to find in the literature cases of invasive aspergillus tracheobronchitis that manifest as endobronchial tumors that produce total pulmonary atelectasis. Although reported in immunocompromised patients, morbidity and mortality are considerable even in patients without underlying disease.
摘要
Es poco común encontrar en la literatura casos de traqueobronquitis invasiva por aspergillus que se manifiesten como tumores endobronquiales que produzcan atelectasia pulmonar total. Aunque relatada en inmunocomprometidos, la morbimortalidad es considerable aun en pacientes sin enfermedad de base.
It is rare to find in the literature cases of invasive aspergillus tracheobronchitis that manifest as endobronchial tumors that produce total pulmonary atelectasis. Although reported in immunocompromised patients, morbidity and mortality are considerable even in patients without underlying disease.
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La aspergilosis es una infección fúngica causada por el microorganismo Aspergillus spp. Las manifestaciones clínicas dependen del estado inmunológico del paciente y de las alteraciones estructurales del parénquima pulmonar. Pese a su baja incidencia, siempre se debe considerar como diagnóstico diferencial en el contexto de pacientes con enfermedades pulmonares de base. Se presenta un caso de hombre de 66 años, agricultor, con antecedente de tuberculosis pulmonar y enfermedad pulmonar obstructiva crónica, quien consultó por cuadro de 5 meses de disnea progresiva, fiebre, tos, hemoptisis y pérdida de peso. Los hallazgos imagenológicos fueron sugestivos de tuberculosis pulmonar asociado a aspergiloma, lo que fue confirmado por tinción de hidróxido de potasio (KOH) y cultivo de hongos positivo para Aspergillus fumigatus. El Gene Xpert fue positivo para Mycobacterium tuberculosis demostrando coinfección activa.
Aspergillosis is a fungal infection caused by the microorganism Aspergillus spp. Clinical manifestations depend on the patient's immune status and structural alterations of the lung parenchyma. Despite its low incidence, it should always be considered as a differential diagnosis in the context of patients with underlying lung diseases. We present the case of a 66-year-old male farmer, with a history of pulmonary tuberculosis and chronic obstructive pulmonary disease, who presented with progressive dyspnea months, fever, cough, hemoptysis and weight loss for 5 months. Imaging findings were suggestive of aspergiloma- associated pulmonary tuberculosis, which was confirmed by potassium hydroxide (KOH) staining and positive fungal culture for Aspergillus fumigatus. Gene Xpert was positive for Mycobacterium tuberculosis showing active co-infection.
Subject(s)
Humans , Male , Aged , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/diagnosis , Pulmonary Aspergillosis/complications , Pulmonary Aspergillosis/diagnosis , Aspergillus fumigatus/isolation & purification , Tuberculosis, Pulmonary/microbiology , Chronic Disease , Pulmonary Disease, Chronic Obstructive , Diagnosis, Differential , Pulmonary Aspergillosis/microbiology , Coinfection , Mycobacterium tuberculosis/isolation & purification摘要
Context and Aim: There is increasing prevalence of post-COVID fungal infection of rhinoorbitocerebral region especially mucormycosis and aspergillosis in India.[1] Early diagnosis of these fungal infections are of utmost importance, since it may improve outcome and survival.[2],[3],[4],[5],[6],[7],[8] The objective of this study was to evaluate and compare routine laboratory diagnostic methods, that is, histopathological examination, KOH wet mount and fungal culture in the diagnosis of post-COVID fungal infections. Materials and Methods: A total of 106 specimens of clinically suspected patients of post-COVID fungal infection of rhinoorbitocerebral region received in histopathology department were included in this study. The data of KOH wet mount and culture were acquired from the microbiology department after histopathological examination. Result: Approximately 88.68% of patients were diagnosed having fungal infections by one of the laboratory methods. The sensitivity of histopathological examination was highest (79.78%), followed by KOH wet mount (58.51%) and fungal culture (35.10%). Rhizopus species of zygomycetes group were the most common isolate (24.24%) on SDA culture. Overall 76% concordance was found between histopathological examination and fungal culture report for morphological identification of fungi. Conclusion: For the diagnosis of post-COVID fungal infection of Rhino-orbito-cerebral region, histopathological examination is was found to be more sensitive and rapid method to detect fungal hyphae. It leads to early treatment, prevents morbidity and mortality.
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INTRODUCCIÓN: Desde el inicio de la pandemia por COVID-19 se han registrado casos de infecciones de aspergilosis pulmonar asociada a esta infección, la cual tiene características diferentes a la aspergilosis pulmonar clásica y, por lo tanto, han significado un desafío diagnóstico. OBJETIVO: Validar una reacción de polimerasa en cadena (RPC) en tiempo real (sigla en inglés RT-PCR) comercial, como herramienta diagnóstica alternativa a la técnica de galactomanano (GM) en el diagnóstico de aspergilosis pulmonar asociada a COVID-19 (sigla en inglés CAPA). PACIENTES Y MÉTODO: Se analizaron resultados de RT-PCR de Aspergillus spp y GM en lavado bronco-alveolar (LBA) de 72 pacientes, hospitalizados por COVID-19 de Clínica Dávila entre los años 2020 y 2021. De estos pacientes, 33 presentaron CAPA. RESULTADOS: La RT-PCR de Aspergillus y GM presentaron una correlación positiva (r = 0,6351, valor p < 0,0001). La técnica de RT-PCR presentó una sensibilidad (S), especificidad (E), valor predictor positivo (VPP) y valor predictor negativo (VPN) de 100, 44, 66 y 100%, respectivamente, mientras que en GM fueron de 64, 89, 84 y 73%, respectivamente para LBA. Al utilizar ambas técnicas en combinación se obtuvo una S, E, VPP y VPN de 100, 82, 88 y 100%, respectivamente. CONCLUSIÓN: Este estudio concluyó que usar una técnica de RT-PCR de Aspergillus y GM en conjunto en LBA mejoraron los parámetros de desempeño de ambas técnicas usadas de manera individual para diagnosticar CAPA. Se requieren más estudios para evaluar el desempeño de técnicas combinadas en otros tipos de aspergilosis.
BACKGROUND: Since the beginning of the COVID-19 pandemic, there have been cases of pulmonary aspergillosis infections associated with this infection, which has different characteristics from classical pulmonary aspergillosis and therefore, have been diagnostic challenges. AIM: To validate a commercial real-time PCR (RT-PCR) method as an alternative diagnostic tool to the galactomannan (GM) technique in the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA). METHODS: Results of RT-PCR of Aspergillus spp and GM in broncho-alveolar lavage (BAL) of 72 patients hospitalized for COVID-19 at Clínica Dávila between 2020 and 2021 were analyzed. Of these patients, 33 presented CAPA. RESULTS: The RT-PCR for Aspergillus and GM showed a positive correlation (r = 0.6351, p-value < 0.0001). The RT-PCR for Aspergillus technique presented a sensitivity (S), specificity (S), positive predictive value (PPV) and negative predictive value (NPV) of 100, 44, 66 and 100% respectively, while the GM technique presented 64, 89, 84 and 73%, respectively for BAL. Using both techniques in combination a S, E, PPV and NPV of 100, 82, 88 and 100% were obtained respectively. CONCLUSION: This study concluded that using RT-PCR and GM techniques in combination in BAL improved the performance parameters of both techniques from those used individually to diagnose CAPA. Further studies are required to evaluate the performance of combined techniques in other aspergillosis focus.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pulmonary Aspergillosis/diagnosis , Real-Time Polymerase Chain Reaction , COVID-19/complications , Aspergillus/isolation & purification , Enzyme-Linked Immunosorbent Assay , Bronchoalveolar Lavage Fluid/microbiology , Chile , Predictive Value of Tests , Sensitivity and Specificity , Pulmonary Aspergillosis/complications , Galactose/analogs & derivatives , Mannans/analysis摘要
Introduction: Aspergillus fumigatus is the most prevalent fungal pathogen reported to cause diseases such as aspergilloma or aspergillosis in humans. Aspergillomas are commonly seen in a poorly drained and avascular cavitary space. Paranasal sinuses are most commonly involved, especially maxillary sinus. In the past two decades, the incidence of aspergillosis has increased substantially. Aims: To evaluate cases reported as aspergilloma of the maxillary sinus and to determine the percentage of cases involving aspergilloma of the maxillary sinus in healthy individuals. Materials and Methods: After the final full-text review,16 articles were included in this systematic review. Data extracted from these full-text articles was reviewed. Results: 83 % of cases had a history of dental procedures, with 42 % of those being due to infection from previous extraction sockets and 41 % due to root canal therapy (RCT). About 43% of the patients were immunocompromised, while 56% were healthy without any predisposing conditions. Conclusion: Aspergillus fungal infections of the paranasal sinuses are common and can occur in apparently healthy as well as immunocompromised individuals. Aspergilloma is the most common fungal infection involving the maxillary sinus with iatrogenic-dentogenic factors being predominant for initiation and progression of the infection. About 43% of the patients in this review were immunocompromised patients whereas 56% of the patients were healthy without any known predisposing condi- tions. The progression and prognosis of this disease depends on the location and immunologic status of the patient. So, it is very important for dentists to be cautious while performing any dental procedures so as not to initiate any iatrogenic infections.
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Resumen La aspergilosis invasiva (AI) es una enfermedad grave y con alta mortalidad. Existen factores de riesgo y se describen brotes intrahospitalarios relacionados con construcciones. También se des cribe una entidad relacionada con la infección por COVID-19, conocida como aspergilosis pulmonar asociada a COVID-19 (APAC). Es de vital importancia implementar un tratamiento adecuado y precoz, especialmente en pacientes inmunocomprometidos y críticamente enfermos. El diagnóstico se basa en reconocer los factores predisponentes, la clínica, la obtención de imágenes, exámenes directos, cultivos, histopatología y biomarca dores como el galactomanano. La droga de elección es el voriconazol, pero se deben conocer las alternativas terapéuticas dada la creciente presencia de aislamientos resistentes.
Abstract Invasive aspergillosis (IA) is a serious disease with high mortality. There are several risk factors and in-hospital outbreaks related with construction have been described. An entity related to COVID-19 infection, known as COVID-19 associated pulmonary aspergillosis (CAPA), has recently appeared. Early and appropriate treatment is of paramount importance, especially in immunocompromised and critically ill patients. Diagnosis is based on recognition of predisposing factors, clinical signs, imaging, direct examination, culture, histopathology, and biomarkers such as galactomannan. The drug of choice is voriconazole, but alternative therapies must be taken into account given the increasing presence of resistant isolates.
摘要
La sinusitis micótica es una condición patológica que puede presentarse en pacientes con diabetes mellitus y estar asociada a una crisis hiperglucémica. Es una entidad agresiva con complicaciones locales que incluyen afectación de la órbita y el sistema nervioso central, y compromiso vascular. A pesar del tratamiento quirúrgico y antimicótico, la mortalidad es de hasta el 75 %. Se describe el caso de una paciente con diagnóstico de cetoacidosis diabética y signos de oftalmoplejía unilateral que llevaron al estudio con resonancia magnética del sistema nervioso central; se encontraron signos de sinusitis, meningitis y cerebritis. Los estudios microbiológicos iniciales fueron negativos, y los biomarcadores galactomanano sérico y el antígeno de Cryptococcus también fueron negativos. Tras el manejo quirúrgico, se llegó a la identificación de Aspergillus flavus y Rhizopus spp. en el tejido de los senos paranasales. La paciente recibió tratamiento con posaconazol y, tras dos meses de seguimiento, había presentado mejoría clínica. La infección fúngica dual y la infección por A. flavus son entidades poco frecuentes y de relevancia clínica, sin casos presentados previamente en nuestro país por lo que este corresponde a un caso de interés clínico.
Fungal sinusitis is a pathology that can occur in patients with diabetes mellitus and be associated with a hyperglycemic crisis. It is an aggressive entity with local complications that include involvement of the orbit or the central nervous system, and vascular involvement. Despite surgical and antifungal treatment, mortality raises up to 75%. We report the case of a female patient with a diagnosis of diabetic ketoacidosis and signs of unilateral ophthalmoplegia, which led to the study with magnetic resonance imaging of the central nervous system, finding signs of sinusitis, meningitis, and cerebritis. Initial microbiological studies were negative, and biomarkers such as serum galactomannan and Cryptococcus antigen were also negative. After surgical management and the identification of Aspergillus flavus and Rhizopus spp. in sinus tissue, the patient received treatment with posaconazole and after two months of follow-up she presented clinical improvement. Dual fungal infection and infection by A. flavus are uncommon and clinically relevant entities, with no cases previously reported in our country, therefore this corresponds to a case of clinical interest.
Subject(s)
Aspergillus flavus , Diabetes Mellitus , Rhizopus oryzae , Aspergillosis , Sinusitis , Invasive Fungal Infections , Mucormycosis摘要
Objective To investigate vascular characteristics and efficacy of interventional embolization in treatment of pulmonary aspergillosis induced massive hemoptysis.Methods A total of 103 patients with pulmonary aspergillosis were analyzed retrospectively,and there were 34 patients with massive hemoptysis.Gelatin sponges,microspheres and coils were chosen for treatment.The number of embolized blood vessels and the vascular characteristics were recorded,and follow-up efficacy and complications were evaluated.Results The mean follow-up time for all the patients was(11.0±2.2)months.A total of 139 vessels were embolized,and the mean number of embolized vessels was 4.0±1.1.The main blood supply arteries included bronchial artery,intercostal artery,internal thoracic artery,superior thoracic artery,lateral thoracic artery and thyroid neck trunk.The cumulative recurrence rates were 5.8％,14.7％and 20.5％at the 1 month,3 months,and 6 months follow-up after operation,respectively.The postoperative complications were mild and could be relieved after symptomatic support treatment.Conclusion Interventional embolization is effective,high safety,and has mild complications can be tolerated by patients in treating massive hemoptysis induced by pulmonary aspergillosis,which is worthy of further clinical application.
摘要
Objective:To investigate the efficacy and safety of posaconazole in the prevention of invasive pulmonary aspergillosis (IPA) in patients with liver failure treated with glucocorticoids (GC).Methods:The study was an observational study. Patients with early and middle stages of liver failure hospitalized in the Department of Infectious Diseases of Hebei Medical University Third Hospital, who received GC treatment between February 2016 and February 2022 were included. The patients were divided into trial group (with posaconazole suspension (200 mg each time, three times daily)) and control group (without posaconazole) according to whether posaconazole was used during treatment. Two groups of patients were matched of 1∶2 ratio according to age, gender and baseline model for end-stage liver disease (MELD) score. The basic information, laboratory examination results, adverse reactions of posaconazole, incidence of invasive Aspergillus infection and therapeutic effect of patients were collected. Statistical analysis was performed using the chi-square test, logistic regression analysis was used to screen risk factors for IPA, the receiver operator characteristic (ROC) curve was used to evaluate the predictive ability of the risk factors, Kaplan-Meier survival curves was used to analyze patient′s survival, and Log-rank test was used to compare the survival rates between the trial group and control group. Results:A total of 108 patients (36 in trial group and 72 in control group) were enrolled. There were no statistical differences between the two groups in terms of the etiology of liver diseases, baseline laboratory findings and risk factors for invasive Aspergillus infection (all P>0.05). There were 21 cases of IPA during hospitalization, with a total infection rate of 19.4%(21/108), including 5.6%(2/36) in the trial group and 26.4%(19/72) in the control group. The difference of IPA incidences between the two groups was statistically significant ( χ2=6.65, P=0.010). Logistic regression analysis suggested that elevated C-reactive protein, GC application more than seven days and cumulative dose of GC were independent risk factors for IPA in patients with liver failure treated with GC (odds ratio ( OR)=1.080, 15.266, 1.004, respectively, all P<0.05). The ROC curve showed that the cut-off value of C-reactive protein was 6.00 mg/L, and cumulative dose of GC was 490 mg. There were no statistical differences between the two groups in terms of adverse effects such as neutropenia, thrombocytopenia, gastrointestinal bleeding, nausea and vomiting rates (all P>0.05), and there were no patients with visual disturbances or discontinuation of medication. Cumulative deaths were 20(18.5%), and 88(81.5%) patients survived in this study. There were 11(52.4%) deaths among 21 patients with IPA and nine (10.3%) deaths among 87 patients without IPA. The difference of survival rates between patients who developed and did not develop IPA was statistically significant ( χ2=21.31, P<0.001). Conclusions:Posaconazole may be helpful in reducing the incidence of concurrent IPA morbidity in patients with liver failure treated with GC, thereby improving survival rates with few adverse effects.
摘要
Aspergillus fumigatus ( A. fumigatus) is an environmental filamentous fungus and an opportunistic pathogen that can cause chronic and invasive aspergillosis. The development of aspergillosis is the result of the interaction between the host and the pathogen, and the symptoms of A. fumigatus infection varied in patients with different immune status. The host innate immune response to inhaled fungal spores is a key determinant of the development of aspergillosis. This review focused on the role of innate immune cells including macrophages, neutrophils, natural killer cells, natural killer T cells and mast cells in host defense against A. fumigatus, aiming to provide reference for further research on the pathogenesis, clinical prevention and treatment of aspergillosis.