Ali Syed Ahsan, Jabeen Kausar, Farooqi Joveria, Niamatullah Hammad, Siddiqui Aisha Fareed, Awan Safia, Akbar Alishah, Irfan Muhammad
Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan.
Curr Med Mycol. 2022 Jun;8(2):16-24. doi: 10.18502/cmm.8.2.10328.
Influenza A and SARS-CoV-2 are risk factors for invasive pulmonary aspergillosis. Both influenza-associated pulmonary aspergillosis and COVID-19-associated pulmonary aspergillosis result in high mortality and poor clinical outcomes. No prospective study has so far compared the features, treatment, and outcomes of influenza-associated pulmonary aspergillosis and COVID-19-associated pulmonary aspergillosis within a similar time frame. Therefore, this study aimed to determine the frequency, risk factors, and outcomes of invasive pulmonary aspergillosis in critically ill patients with influenza, COVID-19, and community-acquired pneumonia.
This prospective study included adult patients with pneumonia and was conducted at The Aga Khan University Hospital in Karachi, Pakistan. Patients were divided into three groups, including community-acquired pneumonia, influenza pneumonia, and COVID-19 pneumonia. The data collected included information on demographic characteristics, comorbidities, clinical features, laboratory results, treatment, and outcomes.
A total of 140 patients were included in this study. These included 35 (25%), 70 (50%), and 35 (25%) patients with community-acquired pneumonia, influenza pneumonia, and COVID-19 pneumonia, respectively. In addition, 20 (14.2%) patients were found to have invasive aspergillosis, of whom 10/35 (28.5%), 9/70 (12.8%), and 1/35 (2.8%) patients were in the COVID-19, influenza, and community-acquired pneumonia groups, respectively. Moreover, nine (90%) COVID-19-associated pulmonary aspergillosis patients required vasopressors, compared to three (33%) patients with influenza-associated pulmonary aspergillosis (). In total, seven (70%) COVID-19-associated pulmonary aspergillosis patients required invasive mechanical ventilation compared to four (44%) influenza-associated pulmonary aspergillosis patients (). The mean±SD length of hospital stay was highest in the COVID-19-associated pulmonary aspergillosis patients (18.3±7.28 days) compared to influenza-associated pulmonary aspergillosis patients (11.7±5.34 days) (). The number of deaths in influenza-associated pulmonary aspergillosis and COVID-19-associated pulmonary aspergillosis patients was three (33.3%) and five (50%), respectively ().
A higher proportion of patients with COVID-19 developed invasive aspergillosis compared to those with influenza. Although the mortality rate in COVID-19-associated pulmonary aspergillosis was comparable to that in influenza-associated pulmonary aspergillosis patients, COVID-19-associated pulmonary aspergillosis patients had a significantly longer stay in the hospital.
甲型流感和严重急性呼吸综合征冠状病毒2（SARS-CoV-2）是侵袭性肺曲霉病的危险因素。流感相关肺曲霉病和新型冠状病毒肺炎（COVID-19）相关肺曲霉病均导致高死亡率和不良临床结局。迄今为止，尚无前瞻性研究在相似时间范围内比较流感相关肺曲霉病和COVID-19相关肺曲霉病的特征、治疗及结局。因此，本研究旨在确定流感、COVID-19及社区获得性肺炎重症患者中侵袭性肺曲霉病的发生率、危险因素及结局。
本前瞻性研究纳入了成年肺炎患者，在巴基斯坦卡拉奇的阿迦汗大学医院开展。患者被分为三组，包括社区获得性肺炎、流感肺炎和COVID-19肺炎。收集的数据包括人口统计学特征、合并症、临床特征、实验室检查结果、治疗及结局等信息。
本研究共纳入140例患者。其中社区获得性肺炎患者35例（25%）、流感肺炎患者70例（50%）、COVID-19肺炎患者35例（25%）。此外，发现20例（14.2%）患者患有侵袭性曲霉病，其中COVID-19组10/35例（28.5%）、流感组9/70例（12.8%）、社区获得性肺炎组1/35例（2.8%）。此外，9例（90%）COVID-19相关肺曲霉病患者需要血管活性药物支持，而流感相关肺曲霉病患者为3例（33%）。总体而言，7例（70%）COVID-19相关肺曲霉病患者需要有创机械通气，而流感相关肺曲霉病患者为4例（44%）。COVID-19相关肺曲霉病患者的平均住院时间（18.3±7.28天）高于流感相关肺曲霉病患者（11.7±5.34天）。流感相关肺曲霉病和COVID-19相关肺曲霉病患者的死亡人数分别为3例（33.3%）和5例（50%）。
与流感患者相比，COVID-19患者发生侵袭性曲霉病的比例更高。虽然COVID-19相关肺曲霉病的死亡率与流感相关肺曲霉病患者相当，但COVID-19相关肺曲霉病患者的住院时间明显更长。
