TY - JOUR
T1 - Pervasive but Neglected
T2 - A Perspective on COVID-19-Associated Pulmonary Mold Infections Among Mechanically Ventilated COVID-19 Patients
AU - Ghazanfari, Mona
AU - Arastehfar, Amir
AU - Davoodi, Lotfollah
AU - Yazdani Charati, Jamshid
AU - Moazeni, Maryam
AU - Abastabar, Mahdi
AU - Haghani, Iman
AU - Mirzakhani, Roghayeh
AU - Mayahi, Sabah
AU - Fang, Wenjie
AU - Liao, Wanqing
AU - Nguyen, M. Hong
AU - Perlin, David S.
AU - Hoenigl, Martin
AU - Pan, Weihua
AU - Hedayati, Mohammad T.
N1 - Funding Information:
The participating patients are thanked for their kind cooperation, which was essential for the completion of the study. The authors wish to thank Dr. Roudbari, Salari, and Divsalar at Zareh University Hospital for their kind support. Funding. This study was supported by a research fund (No. 7697) from the Invasive Fungi Research Center of Mazandaran University of Medical Sciences, Sari, Iran.
Funding Information:
This study was supported by a research fund (No. 7697) from the Invasive Fungi Research Center of Mazandaran University of Medical Sciences, Sari, Iran.
Funding Information:
Conflict of Interest: DSP received grant and contract funds from Merck, Regeneron, and Pfizer for COVID-19-related research programs. MHN received CDC-sponsored grant, CAPA. MH received research funding from Agile AS and Pfizer.
Publisher Copyright:
© Copyright © 2021 Ghazanfari, Arastehfar, Davoodi, Yazdani Charati, Moazeni, Abastabar, Haghani, Mirzakhani, Mayahi, Fang, Liao, Nguyen, Perlin, Hoenigl, Pan and Hedayati.
PY - 2021/6/14
Y1 - 2021/6/14
N2 - Background: Recent studies from multiple countries have shown a high prevalence of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) among severely ill patients. Despite providing valuable insight into the clinical management of CAPA, large-scale prospective studies are limited. Here, we report on one of the largest multicenter epidemiological studies to explore the clinical features and prevalence of COVID-19-associated pulmonary mold infections (CAPMIs) among mechanically ventilated patients. Methods: Bronchoalveolar lavage (BAL) and serum samples were collected for culture, galactomannan (GM), and β-D-glucan (BDG) testing. Patients were classified as probable CAPMI based on the presence of host factors, radiological findings, and mycological criteria. Results: During the study period, 302 COVID-19 patients were admitted to intensive care units (ICUs), among whom 105 were mechanically ventilated for ≥4 days. Probable CAPMI was observed among 38% of patients (40/105), among whom BAL culture of 29 patients turned positive for molds, while galactomannan testing on BAL (GM index ≥1) and serum (GM index >0.5) samples were positive for 60% (24/40) and 37.5% (15/39) of patients, respectively. Aspergillus (22/29; 75.8%) and Fusarium (6/29; 20.6%) constituted 96.5% of the molds isolated. Diaporthe foeniculina was isolated from a COVID-19 patient. None of the patients who presented with CAPMI were treated with antifungal drugs. Conclusion: Despite being prevalent, the absence of appropriate antifungal treatment highlights that CAPMI is a neglected complication among mechanically ventilated COVID-19 patients admitted to ICUs. CAPMI can be caused by species other than Aspergillus.
AB - Background: Recent studies from multiple countries have shown a high prevalence of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) among severely ill patients. Despite providing valuable insight into the clinical management of CAPA, large-scale prospective studies are limited. Here, we report on one of the largest multicenter epidemiological studies to explore the clinical features and prevalence of COVID-19-associated pulmonary mold infections (CAPMIs) among mechanically ventilated patients. Methods: Bronchoalveolar lavage (BAL) and serum samples were collected for culture, galactomannan (GM), and β-D-glucan (BDG) testing. Patients were classified as probable CAPMI based on the presence of host factors, radiological findings, and mycological criteria. Results: During the study period, 302 COVID-19 patients were admitted to intensive care units (ICUs), among whom 105 were mechanically ventilated for ≥4 days. Probable CAPMI was observed among 38% of patients (40/105), among whom BAL culture of 29 patients turned positive for molds, while galactomannan testing on BAL (GM index ≥1) and serum (GM index >0.5) samples were positive for 60% (24/40) and 37.5% (15/39) of patients, respectively. Aspergillus (22/29; 75.8%) and Fusarium (6/29; 20.6%) constituted 96.5% of the molds isolated. Diaporthe foeniculina was isolated from a COVID-19 patient. None of the patients who presented with CAPMI were treated with antifungal drugs. Conclusion: Despite being prevalent, the absence of appropriate antifungal treatment highlights that CAPMI is a neglected complication among mechanically ventilated COVID-19 patients admitted to ICUs. CAPMI can be caused by species other than Aspergillus.
KW - Aspergillus
KW - COVID-19-associated pulmonary mold infections
KW - Fusarium
KW - galactomannan
KW - mechanically ventilation
UR - http://www.scopus.com/inward/record.url?scp=85108946388&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85108946388&partnerID=8YFLogxK
U2 - 10.3389/fmed.2021.649675
DO - 10.3389/fmed.2021.649675
M3 - Article
AN - SCOPUS:85108946388
SN - 2296-858X
VL - 8
JO - Frontiers in Medicine
JF - Frontiers in Medicine
M1 - 649675
ER -