Yusuf Erlangga, Seghers Leonard, Hoek Rogier A S, van den Akker Johannes P C, Bode Lonneke G M, Rijnders Bart J A
Department of Medical Microbiology and Infectious Disease, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
Department of Pulmonary Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.
J Clin Med. 2021 Jun 2;10(11):2469. doi: 10.3390/jcm10112469.
Several reports have been published on findings in COVID-19 patients leading to a proposition of new disease entity COVID-19-associated pulmonary aspergillosis. This scoping review is designed at clarifying the concepts on how the findings of spp. in COVID-19 patients were interpreted. We searched Medline to identify the studies on spp. findings in COVID-19 patients. Included were observational studies containing the following information: explicit mention of the total number of the study population, study period, reason for obtaining respiratory samples, case definition, and clinical outcomes. Excluded were case series, case reports and reviews. Identified were 123 publications, and 8 observational studies were included. From the included studies the following issues were identified. The proportion of immunocompromised patients considered as host factors varied from 0 to 17%. Most of the studies did not mention radiographic findings explicitly. Respiratory samples were mostly obtained to investigate clinical deterioration. culture, antigen or PCR testing on bronchoalveolar lavage (BAL) fluid were performed in between 23.3% and 66.3% of the study population. Two studies performed periodic samples of BAL. Galactomannan index (GI) positivity in BAL was between 10% and 28%. GI in blood was found in 0.9% to 6.7% of the available samples. The prevalence of COVID-19-associated pulmonary aspergillosis ranged from 2.7% to 27.7%. Studies compared the mortality between defined cases and non-cases, and all showed increased mortality in cases. No studies showed that antifungal treatment reduced mortality. Concluding, this review showed how studies defined the clinical entity COVID-19-associated pulmonary aspergillosis where positive test in the respiratory sample was the main driver for the diagnosis. There were many differences between studies in terms of test algorithm and test used that largely determined the prevalence. Whether antifungal therapy, either as prophylaxis, pre-emptive or targeted therapy will lead to better outcomes of COVID-19-associated pulmonary aspergillosis patients is still need to be answered.
已有多篇关于新冠病毒病（COVID-19）患者相关发现的报告发表，这些发现促使人们提出了一种新的疾病实体——COVID-19相关肺曲霉病。本综述旨在阐明关于如何解读COVID-19患者曲霉属物种发现的概念。我们检索了Medline数据库，以确定关于COVID-19患者曲霉属物种发现的研究。纳入的是包含以下信息的观察性研究：明确提及研究人群总数、研究期间、获取呼吸道样本的原因、病例定义和临床结局。排除的是病例系列、病例报告和综述。共识别出123篇出版物，纳入了8项观察性研究。从纳入的研究中发现了以下问题。被视为宿主因素的免疫功能低下患者比例在0%至17%之间。大多数研究未明确提及影像学检查结果。获取呼吸道样本主要是为了调查临床病情恶化情况。在23.3%至66.3%的研究人群中对支气管肺泡灌洗（BAL）液进行了曲霉培养、抗原或PCR检测。两项研究对BAL进行了定期采样。BAL中半乳甘露聚糖指数（GI）阳性率在10%至28%之间。在0.9%至6.7%的可用样本中发现血液中GI阳性。COVID-19相关肺曲霉病的患病率在2.7%至27.7%之间。研究比较了确诊病例和非病例之间的死亡率，所有研究均显示病例组死亡率增加。没有研究表明抗真菌治疗能降低死亡率。综上所述，本综述展示了各研究如何定义临床实体COVID-19相关肺曲霉病，其中呼吸道样本曲霉检测呈阳性是诊断的主要依据。各研究在检测算法和所使用的曲霉检测方法方面存在许多差异，这些差异在很大程度上决定了患病率。抗真菌治疗作为预防性、先发制性或靶向性治疗是否会使COVID-19相关肺曲霉病患者获得更好的结局仍有待解答。
