Araya-Rojas Fernando, Lasso-Barreto Martín
Servicio de Medicina Interna, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile.
Rev Chilena Infectol. 2021 Dec;38(6):754-760. doi: 10.4067/s0716-10182021000600754.
Aspergillus spp. fungal coinfections have been described in critically ill COVID-19 patients.
To describe the clinical characteristics, diagnosis, treatment and evolution of patients with acute respiratory distress syndrome with COVID-19, who present with COVID-19 associated pulmonary aspergillosis (CAPA) in a single public hospital.
Retrospective review of clinical records during 12 months in patients diagnosed with CAPA by cultures of respiratory samples or determination of galactomannan (GM).
Probable CAPA was diagnosed in 11 patients (average APACHE II score of 11.7). Respiratory samples were obtained in 73% of cases by bronchoalveolar lavage and in 27% by tracheal aspirate. A. fumigatus was isolated in 4 cultures, A. niger, A. terreus and Aspergillus spp on one occasion each and the cultures were negative in 4 samples. Respiratory sample GM was performed in 7 patients, median: 3.6 (IQR: 1.71 - 4.4). In 10 patients, serum GM was performed, median: 0.5 (IQR: 0.265 - 0.9 75) with 50% of them > 0.5. Two patients showed classic findings suggestive of CAPA on computed tomography. All received antifungal therapy with voriconazole, mean time 14 days. Four patients died.
The presence of CAPA should be a diagnosis to be considered in critically ill COVID-19 patients.
已在危重症 COVID-19 患者中描述了曲霉属真菌合并感染情况。
描述在一家公立医院中，患有 COVID-19 相关肺曲霉病（CAPA）的急性呼吸窘迫综合征 COVID-19 患者的临床特征、诊断、治疗及病情演变。
对通过呼吸道样本培养或半乳甘露聚糖（GM）测定诊断为 CAPA 的患者 12 个月期间的临床记录进行回顾性分析。
11 例患者被诊断为可能的 CAPA（急性生理与慢性健康状况评分系统 II 平均评分为 11.7）。73%的病例通过支气管肺泡灌洗获取呼吸道样本，27%通过气管抽吸获取。4 次培养分离出烟曲霉，黑曲霉、土曲霉和曲霉属各有 1 次，4 份样本培养结果为阴性。7 例患者进行了呼吸道样本 GM 检测，中位数为 3.6（四分位间距：1.71 - 4.4）。10 例患者进行了血清 GM 检测，中位数为 0.5（四分位间距：0.265 - 0.975），其中 50%大于 0.5。2 例患者在计算机断层扫描上显示出提示 CAPA 的典型表现。所有患者均接受伏立康唑抗真菌治疗，平均治疗时间 14 天。4 例患者死亡。
在危重症 COVID-19 患者中应考虑 CAPA 的诊断。
