Russo Alessandro, Serraino Riccardo, Serapide Francesca, Bruni Andrea, Garofalo Eugenio, Longhini Federico, Trecarichi Enrico Maria, Torti Carlo
Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Italy.
Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, 'Magna Graecia' University of Catanzaro, Italy.
Heliyon. 2024 Jan 7;10(2):e24298. doi: 10.1016/j.heliyon.2024.e24298. eCollection 2024 Jan 30.
Since 2020, cases of COVID-19-associated pulmonary aspergillosis (CAPA) have been frequently described, representing an important cause of mortality, especially among patients admitted to intensive care unit (ICU). A predisposition to invasive infection caused by spp. in SARS-CoV-2 infected patients can be ascribed either to the direct viral-mediated damage of the respiratory epithelium or to the dysregulated immunity associated with COVID-19. In this case series we have collected the clinical, laboratory and radiological data of 10 patients admitted to the ICU with diagnosis of probable CAPA, according to the recent expert consensus statement, from March 2020 to December 2022 in the Teaching Hospital of Catanzaro in Italy. Overall, 249 patients were admitted to the COVID-19-ICU from March 2020 to December 2022; out of these, 4% developed a probable CAPA. Most of patients were male with a mean age of 62 years. Only two patients had an underlying immunocompromising condition. The observed mortality was 70%. In our institution, all COVID-19 patients requiring invasive mechanical ventilation systematically underwent bronchoscopy with bronchoalveolar lavage for an early evaluation of bacterial and/or fungal co- or super-infections, including galactomannan test. Patients were re-evaluated by an infectious diseases consultant team every 24-48 hours and the galactomannan test was systematically repeated based on patient's clinical course. Even though the numbers in this study are very small, we report our experience about the role of early diagnosis and careful choice of antifungal therapy, considering the fragility of these patients, and its relationship with outcomes. Despite a systemic approach allowing early diagnosis and initiation of anti-fungal therapy, the mortality rate turned out to be very high (70%).
自2020年以来，新型冠状病毒肺炎相关肺曲霉病（CAPA）病例屡有报道，是导致死亡的重要原因，在重症监护病房（ICU）患者中尤为如此。严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染患者易发生曲霉属真菌感染，其原因可能是病毒直接介导的呼吸道上皮损伤，也可能是与新型冠状病毒肺炎相关的免疫失调。在本病例系列中，我们收集了2020年3月至2022年12月期间，意大利卡坦扎罗教学医院收治的10例根据近期专家共识声明诊断为可能CAPA的ICU患者的临床、实验室和影像学数据。总体而言，2020年3月至2022年12月期间，共有249例患者入住新型冠状病毒肺炎ICU；其中，4%发生了可能的CAPA。大多数患者为男性，平均年龄62岁。只有两名患者有基础免疫功能低下情况。观察到的死亡率为70%。在我们机构，所有需要有创机械通气的新型冠状病毒肺炎患者都系统地接受了支气管镜检查及支气管肺泡灌洗，以便早期评估细菌和/或真菌合并或重叠感染，包括半乳甘露聚糖检测。每24 - 48小时由感染病会诊团队对患者进行重新评估，并根据患者的临床病程系统地重复半乳甘露聚糖检测。尽管本研究中的病例数非常少，但考虑到这些患者的脆弱性，我们报告了我们关于早期诊断和谨慎选择抗真菌治疗的作用及其与预后关系的经验。尽管采用了系统方法实现了早期诊断并启动了抗真菌治疗，但死亡率仍然很高（70%）。
