Affiliation:
1. Medical School, Aristotle University of Thessaloniki, Leoforos Agiou Dimitriou, 54124 Thessaloniki, Greece
2. 1st ICU, General Hospital of Thessaloniki “Georgios Papanikolaou”, Leoforos Papanikolaou, 57010 Thessaloniki, Greece
Abstract
Invasive pulmonary aspergillosis (IPA) presents a known risk to critically ill patients with SARS-CoV-2; quantifying the global burden of IPA in SARS-CoV-2 is extremely challenging. The true incidence of COVID-19-associated pulmonary aspergillosis (CAPA) and the impact on mortality is difficult to define because of indiscriminate clinical signs, low culture sensitivity and specificity and variability in clinical practice between centers. While positive cultures of upper airway samples are considered indicative for the diagnosis of probable CAPA, conventional microscopic examination and qualitative culture of respiratory tract samples have quite low sensitivity and specificity. Thus, the diagnosis should be confirmed with serum and BAL GM test or positive BAL culture to mitigate the risk of overdiagnosis and over-treatment. Bronchoscopy has a limited role in these patients and should only be considered when diagnosis confirmation would significantly change clinical management. Varying diagnostic performance, availability, and time-to-results turnaround time are important limitations of currently approved biomarkers and molecular assays for the diagnosis of IA. The use of CT scans for diagnostic purposes is controversial due to practical concerns and the complex character of lesions presented in SARS-CoV-2 patients. The key objective of management is to improve survival by avoiding misdiagnosis and by initiating early, targeted antifungal treatment. The main factors that should be considered upon selection of treatment options include the severity of the infection, concomitant renal or hepatic injury, possible drug interactions, requirement for therapeutic drug monitoring, and cost of therapy. The optimal duration of antifungal therapy for CAPA is still under debate.
Subject
Pulmonary and Respiratory Medicine
Reference116 articles.
1. Delaying the empiric treatment of candida bloodstream infection until positive blood culture results are obtained: A potential risk factor for hospital mortality;Morrell;Antimicrob. Agents Chemother.,2005
2. Septic shock attributed to Candida infection: Importance of empiric therapy and source control;Kollef;Clin. Infect. Dis.,2012
3. Invasive fungal disease in humans: Are we aware of the real impact?;Firacative;Mem. Inst. Oswaldo Cruz,2020
4. (2023, February 03). Gaffi—Global Action Fund for Fungal Infections. Available online: https://www.gaffi.org.
5. (2023, February 03). Burden of Fungal Diseases in the United States. Fungal Diseases. CDC, Available online: https://www.cdc.gov/fungal/cdc-and-fungal/burden.html.