A National Strategy to Diagnose Coronavirus Disease 2019-Associated Invasive Fungal Disease in the Intensive Care Unit.

BACKGROUND: Fungal coinfection is a recognized complication of respiratory virus infections, increasing morbidity and mortality, but can be readily treated if diagnosed early. An increasing number of small studies describing aspergillosis in coronavirus disease 2019 (COVID-19) patients with severe respiratory distress are being reported, but comprehensive data are lacking. The aim of this study was to determine the incidence, risk factors, and impact of invasive fungal disease in adult COVID-19 patients with severe respiratory distress. METHODS: An evaluation of a national, multicenter, prospective cohort evaluation of an enhanced testing strategy to diagnose invasive fungal disease in COVID-19 intensive care patients. Results were used to generate a mechanism to define aspergillosis in future COVID-19 patients. RESULTS: One-hundred and thirty-five adults (median age: 57, M/F: 2.2/1) were screened. The incidence was 26.7% (14.1% aspergillosis, 12.6% yeast infections). The overall mortality rate was 38%; 53% and 31% in patients with and without fungal disease, respectively (P = .0387). The mortality rate was reduced by the use of antifungal therapy (mortality: 38.5% in patients receiving therapy vs 90% in patients not receiving therapy (P = .008). The use of corticosteroids (P = .007) and history of chronic respiratory disease (P = .05) increased the likelihood of aspergillosis. CONCLUSIONS: Fungal disease occurs frequently in critically ill, mechanically ventilated COVID-19 patients. The survival benefit observed in patients receiving antifungal therapy implies that the proposed diagnostic and defining criteria are appropriate. Screening using a strategic diagnostic approach and antifungal prophylaxis of patients with risk factors will likely enhance the management of COVID-19 patients.

Bacteraemia and breast abscess: unusual extra-intestinal manifestations of Clostridium difficile infection.

Extra-intestinal manifestations of Clostridium difficile infection are uncommon. Most cases are associated with gastrointestinal disease and often occur as a mixed infection with other gut flora. We report a case of breast abscess following monomicrobial C. difficile bacteraemia in a female with background chronic hepatitis C infection and alcoholic liver disease. No evidence of colitis was found. Our case shows that C. difficile is indeed capable of spreading from the gastrointestinal tract.

A successfully treated case of peritonitis due to Fusarium dimerum.

SUMMARY: Fungal peritonitis is a rare but serious complication of continuous ambulatory peritoneal dialysis (CAPD). We report the first known case of CAPD peritonitis due to Fusarum dimerum successfully treated with antifungals and catheter removal.

Disseminated protothecosis following traumatic Hickman line removal in a patient with leukaemia.

Human protothecosis is a rare infection caused by a member of the genus Prototheca, an ubiquitous alga. Traumatic inoculation can cause infections in the immunocompetent host while disseminated infection is mainly seen in patients with compromised immunity. We report here an unusual case of disseminated infection in a cancer patient. Traumatic removal of a Hickman catheter in this patient, led to the development of a severe skin and subcutaneous tissue infection with algaemia. These infections are often indolent and difficult to treat, with paucity of information available as to guidelines for diagnosis and effective therapeutic options.