Challenges in Diagnosing COVID-19-Associated Pulmonary Aspergillosis in Critically Ill Patients: The Relationship between Case Definitions and Autoptic Data
Articolo
Data di Pubblicazione:
2022
Citazione:
Challenges in Diagnosing COVID-19-Associated Pulmonary Aspergillosis in Critically Ill Patients: The Relationship between Case Definitions and Autoptic Data / G. Casalini, A. Giacomelli, L. Galimberti, R. Colombo, E. Ballone, G. Pozza, M. Zacheo, M. Galimberti, L. Oreni, L. Carsana, M. Longo, M.R. Gismondo, C. Tonello, M. Nebuloni, S. Antinori. - In: JOURNAL OF FUNGI. - ISSN 2309-608X. - 8:9(2022 Sep), pp. 894.1-894.16. [10.3390/jof8090894]
Abstract:
Critically ill COVID-19 patients can develop invasive pulmonary aspergillosis (CAPA). Considering the weaknesses of diagnostic tests/case definitions, as well as the results from autoptic studies, there is a debate on the real burden of aspergillosis in COVID-19 patients. We performed a retrospective observational study on mechanically ventilated critically ill COVID-19 patients in an intensive care unit (ICU). The primary objective was to determine the burden of CAPA by comparing clinical diagnosis (through case definitions/diagnostic algorithms) with autopsy results. Twenty patients out of 168 (11.9%) developed probable CAPA. Seven (35%) were females, and the median age was 66 [IQR 59-72] years. Thirteen CAPA patients (65%) died and, for six, an autopsy was performed providing a proven diagnosis in four cases. Histopathology findings suggest a focal pattern, rather than invasive and diffuse fungal disease, in the context of prominent viral pneumonia. In a cohort of mechanically ventilated patients with probable CAPA, by performing a high rate of complete autopsies, invasive aspergillosis was not always proven. It is still not clear whether aspergillosis is the major driver of mortality in patients with CAPA.
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
CAPA; COVID-19; aspergillosis; autopsy; histopathology; invasive fungal infections
Elenco autori:
G. Casalini, A. Giacomelli, L. Galimberti, R. Colombo, E. Ballone, G. Pozza, M. Zacheo, M. Galimberti, L. Oreni, L. Carsana, M. Longo, M.R. Gismondo, C. Tonello, M. Nebuloni, S. Antinori
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