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Journal of the College of Physicians... May 2022Fungal infections have increased in number since the onset of this lethal pandemic. This study aimed to assess risk factors and case fatality in COVID-19 cases with...
Fungal infections have increased in number since the onset of this lethal pandemic. This study aimed to assess risk factors and case fatality in COVID-19 cases with aspergillosis or mucormycosis. A systematic review was done according to PRISMA guidelines. Databases used were Google scholar, Pakmedinet, PUBMED, and MEDLINE. Twenty-one case reports and case series of mucormycosis in COVID-19 patients were identified and the mean age was 56.3 years (36 men and 12 women). The most common comorbidity was diabetes and the site was rhino orbital mucormycosis. Case fatality of 48 combined cases was calculated to be 52%. Nineteen articles of aspergillosis were included. Diabetes was the most common comorbidity in cases. The number of affected men cases was more than women. The incidence of aspergillosis in critically sick COVID-19 patients was calculated to be 9.3%. Case fatality was calculated to be 51.2%. Screening can be a beneficial tool for decreasing morbidity and mortality. Key Words: COVID-19, Mucormycosis, Aspergillosis.
Topics: Aspergillosis; COVID-19; Diabetes Mellitus; Female; Humans; Male; Middle Aged; Mucormycosis; SARS-CoV-2
PubMed: 35546702
DOI: 10.29271/jcpsp.2022.05.639 -
Cureus Mar 2022The prevalence, incidence, and characteristics of bacterial infections in patients infected with severe acute respiratory syndrome coronavirus 2 are not well understood... (Review)
Review
The prevalence, incidence, and characteristics of bacterial infections in patients infected with severe acute respiratory syndrome coronavirus 2 are not well understood and have been raised as an important knowledge gap. Therefore, our study focused on the most common opportunistic infections/secondary infections/superinfections in coronavirus disease 2019 (COVID-19) patients. This systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eligible studies were identified using PubMed/Medline since inception to June 25, 2021. Studies meeting the inclusion criteria were selected. Statistical analysis was conducted in Review Manager 5.4.1. A random-effect model was used when heterogeneity was seen to pool the studies, and the result was reported as inverse variance and the corresponding 95% confidence interval. We screened 701 articles comprising 22 cohort studies which were included for analysis. The pooled prevalence of opportunistic infections/secondary infections/superinfections was 16% in COVID-19 patients. The highest prevalence of secondary infections was observed among viruses at 33%, followed by bacteria at 16%, fungi at 6%, and 25% among the miscellaneous group/wrong outcome. Opportunistic infections are more prevalent in critically ill patients. The isolated pathogens included Epstein-Barr virus, , , , , and invasive pulmonary aspergillosis. Large-scale studies are required to better identify opportunistic/secondary/superinfections in COVID-19 patients.
PubMed: 35505698
DOI: 10.7759/cureus.23687 -
Monaldi Archives For Chest Disease =... Apr 2022Bronchocele is an abnormal accumulation of mucus often with associated bronchial dilatation. It can be due to either increased production or impaired drainage of mucus...
Bronchocele is an abnormal accumulation of mucus often with associated bronchial dilatation. It can be due to either increased production or impaired drainage of mucus in the airways. Diseases like chronic bronchitis, bronchial asthma, bronchiectasis are characterized by high mucus production and other atypical conditions are bronchorrhea and plastic bronchitis with different physical characteristics and compositions of mucus. Improper drainage can lead to bronchocele formation due to underlying benign, malignant tumours or bronchial stenosis. Allergic bronchopulmonary aspergillosis (ABPA) has a peculiar appearance with high attenuated mucus (HAM) in imaging. Careful evaluation of bronchocele is needed as it can be associated with bronchial obstruction or rare causes like plastic bronchitis. Proper identification, evaluation for the underlying cause is key for not missing the underlying diagnosis and accurate treatment.
Topics: Humans; Tomography, X-Ray Computed; Bronchiectasis; Aspergillosis, Allergic Bronchopulmonary; Bronchitis; Plastics
PubMed: 35477240
DOI: 10.4081/monaldi.2022.2133 -
Transplant Infectious Disease : An... Jun 2022Invasive fungal infections (IFI), particularly invasive aspergillosis (IA), cause significant morbidity and mortality in lung transplant (LTx) recipients. The optimum... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Invasive fungal infections (IFI), particularly invasive aspergillosis (IA), cause significant morbidity and mortality in lung transplant (LTx) recipients. The optimum strategy and antifungal agents for prevention are unclear.
METHODS
We performed a comprehensive literature search, systematic review, and network meta-analysis using a frequentist framework to compare the efficacy of various antifungal drugs on the incidence of IA/IFI in the setting of universal prophylaxis or no prophylaxis following lung transplantation.
RESULTS
We included 13 eligible studies comprising of 1515 LTx recipients and 12 different prophylaxis strategies/antifungal combinations. The greatest number of direct comparisons were between the inhaled amphotericin formulations. The top three ranked treatments were inhaled liposomal amphotericin B (L-AmB), inhaled amphotericin deoxycholate (AmBd), and itraconazole plus inhaled amphotericin B (AmB). Among the azoles, isavuconazole ranked highest. The certainty of the evidence, assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework, was very low.
CONCLUSION
Although universal antifungal prophylaxis post lung transplantation is commonly used, robust data from randomized controlled trials (RCTs) to inform the choice of antifungal agent and prophylaxis strategy are lacking. This exploratory network meta-analysis provides insight into the probable relative effectiveness of various antifungal agents in preventing IA, and this analysis should serve as a guide when selecting antifungals to be assessed in a RCT.
Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Humans; Invasive Fungal Infections; Lung; Network Meta-Analysis; Transplant Recipients; Uncertainty
PubMed: 35388588
DOI: 10.1111/tid.13832 -
Indian Journal of Medical Microbiology 2022Chronic pulmonary aspergillosis (CPA) is an infection of the lung usually caused by Aspergillus fumigatus in patients with pre-existing pulmonary diseases. Its diagnosis... (Meta-Analysis)
Meta-Analysis
LDBio Aspergillus immunochromatographic test lateral flow assay for IgG/IgM antibody detection in chronic pulmonary aspergillosis: Single-centre evaluation and meta-analysis.
PURPOSE
Chronic pulmonary aspergillosis (CPA) is an infection of the lung usually caused by Aspergillus fumigatus in patients with pre-existing pulmonary diseases. Its diagnosis hinges on demonstrating IgG antibodies against A. fumigatus. Herein, we evaluated the performance of a newly introduced point of care test (POCT) kit, the LDBio Aspergillus IgG/IgM lateral flow assay (LFA) in India with the standard ImmunoCAP kit for diagnosing CPA.
METHODS
A total of 60 serum samples (30 CPA cases and 30 controls) were evaluated by the Aspergillus immunochromatographic test (ICT) IgG/IgM LFA. Fluorescent-enzyme immunoassay was used to determine specific A. fumigatus-IgG concentrations (positive >27 mgA/L). Further, a systematic review and meta-analysis of studies (up to August 26, 2021) reporting the performance of LDBio ICT for the diagnosis of CPA was performed.
RESULT
A sensitivity of 86.7%, specificity of 90%, negative predictive value of 87.1%, positive predictive value of 89.7%, negative likelihood ratio of 0.15, positive likelihood ratio of 8.67, and was observed for the LDBio IC. There was good agreement between LDBio ICT and ImmunoCAP (88.3%) with a Cohen's Kappa score of 0.77. Our systematic review identified four studies and the pooled sensitivity of 90%, specificity of 91%, area under the curve of 0.94 and diagnostic odds ratio of 57.2, for CPA diagnosis by LDBio ICT.
CONCLUSION
Aspergillus LDBio ICT assay exhibits good sensitivity and can be used to screen CPA cases.
Topics: Antibodies, Fungal; Aspergillus; Chronic Disease; Humans; Immunoglobulin G; Immunoglobulin M; Persistent Infection; Pulmonary Aspergillosis; Sensitivity and Specificity
PubMed: 35370006
DOI: 10.1016/j.ijmmb.2022.03.002 -
International Dental Journal Oct 2022Studies reviewing orofacial mycoses in coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome 2 (SARS-CoV-2) infection are sparse. Here we...
OBJECTIVES
Studies reviewing orofacial mycoses in coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome 2 (SARS-CoV-2) infection are sparse. Here we review the major oral and maxillofacial mycoses of COVID-19, the associated comorbidities, and the probable precipitating factors.
METHODS
English-language manuscripts published between March 2020 and October 2021 were searched using PubMed, OVID, SCOPUS, and Web of Science databases, using appropriate keywords.
RESULTS
We identified 30 articles across 14 countries, which met the inclusion criteria of PRISMA guidelines. These yielded a total of 292 patients with laboratory-confirmed COVID-19, 51.4% (n = 150) of whom presented with oral and maxillofacial fungal infections, mainly comprising candidosis, mucormycosis, and aspergillosis. Candida infections were the most prevalent, present in 64% (n = 96), followed by mucormycosis, and only a single case of aspergillosis was noted. Oral and maxillofacial mycoses were predominantly seen in those with comorbidities, especially in those with diabetes (52.4%). Oral mucormycosis was noted in 8.6% (n = 13) and mainly manifested on the hard palate. An overall event rate of oral/maxillofacial mucormycosis manifestation in patients with COVID-19 with diabetes mellitus type 1/2 was about 94% (49/52; 95% confidence interval, 0.73%-0.89%), implying a very high association between diabetes mellitus and the latter condition. All fungal infections appeared either concurrently with COVID-19 symptoms or during the immediate recovery period.
CONCLUSIONS
SARS-CoV-2 infection-related immunosuppression, steroid therapy, as well as comorbidities such as diabetic hyperglycemia appear to be the major predisposing factors for the onset of oral and maxillofacial mycoses in patients with COVID-19 across all age groups.
Topics: COVID-19; Comorbidity; Humans; Mycoses; SARS-CoV-2; Steroids
PubMed: 35367044
DOI: 10.1016/j.identj.2022.02.010 -
Neurosurgical Review Jun 2022The clinical features and prognostic factors of intracranial aspergillosis in immunocompetent patients without risk factors are not well known. PubMed, Scopus, Google... (Review)
Review
The clinical features and prognostic factors of intracranial aspergillosis in immunocompetent patients without risk factors are not well known. PubMed, Scopus, Google Scholar, and Web of Science were searched for all relevant case reports/series on adult patient (≥ 18 years) with aspergillosis published from 1976 to 2018. One hundred eighty-two patients (median age, 40 years; range, 18-83 years; male:female, 115:67) were identified. Types of intracranial aspergillosis included intracranial mass from the skull base (54.9%), pure intraparenchymal disease (23.6%), meningoencephalitis (13.2%), and dural-based mass (8.2%). Vascular complications occurred in 44 patients (26.3%). Eighty-one patients (44.5%) had favourable final clinical outcomes without any deficits, whereas 58 (31.9%) died. Disease-related mortality improved significantly over time (43.1% [28/65] before 2000, 25.9% [30/116] after 2001; p = 0.021). Patients with meningoencephalitis demonstrated the highest mortality rate (79.2%, 19/24). Medical non-responders (patients whose disease course worsened after receiving the initial medication regimen) and vascular complications (the presentation of subarachnoid haemorrhage, intracerebral haemorrhage, or infarction related to the rupture or occlusion of intracranial vessels) were significantly associated with mortality (p < 0.001). Findings from the current review may help predict patient prognosis at the initial assessment and determine potential prognostic factors.
Topics: Adult; Aspergillosis; Female; Humans; Male; Meningoencephalitis; Skull Base; Subarachnoid Hemorrhage
PubMed: 35278148
DOI: 10.1007/s10143-022-01738-y -
Annals of Palliative Medicine Jul 2022We aimed to identify studies systematically that describe the incidence and outcome of COVID-19-related pulmonary aspergillosis (CAPA). (Meta-Analysis)
Meta-Analysis
Incidence and outcomes of patients with COVID-19 associated pulmonary aspergillosis (CAPA) in intensive care units: a systematic review and meta-analysis of 31 cohort studies.
BACKGROUND
We aimed to identify studies systematically that describe the incidence and outcome of COVID-19-related pulmonary aspergillosis (CAPA).
METHODS
We searched ScienceDirect, PubMed, CNKI, and MEDLINE (OVID) from December 31, 2019 to November 20, 2021 for all eligible studies. Random-model was used to reported the incidence, all-cause case fatality rate (CFR) and 95% confidence intervals (CIs). The meta-analysis was registered with PROSPERO (CRD42021242179).
RESULTS
In all, thirty-one cohort studies were included in this study. A total of 3,441 patients with severe COVID-19 admitted to an intensive care unit (ICU) were investigated and 442 cases of CAPA were reported (30 studies). The pooled incidence rate of CAPA was 0.14 (95% CI: 0.11-0.17, I2=0.0%). Twenty-eight studies reported 287 deceased patients and 269 surviving patients. The pooled CFR of CAPA was 0.52 (95% CI: 0.47-0.56, I2=3.9%). Interestingly, patients with COVID19 would develop CAPA at 7.28 days after mechanical ventilation (range, 5.48-9.08 days). No significant publication bias was detected in this meta-analysis.
DISCUSSION
Patients with COVID-19 admitted to an ICU might develop CAPA and have high all-cause CFR. We recommend conducting prospective screening for CAPA among patients with severe COVID-19, especially for those who receive mechanical ventilation over 7 days.
Topics: COVID-19; Humans; Incidence; Intensive Care Units; Prospective Studies; Pulmonary Aspergillosis
PubMed: 35272474
DOI: 10.21037/apm-21-2043 -
Reviews in Medical Virology Nov 2022Coronavirus disease 2019 (COVID-19) is a novel disease caused by a newly identified virus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing diverse... (Review)
Review
Coronavirus disease 2019 (COVID-19) is a novel disease caused by a newly identified virus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing diverse systemic manifestations. The oral cavity too is not spared and the symptoms appear either independently, concurrently, or sequentially. In view of the rising documented cases of oral lesions of COVID-19, this systematic review aims to assess the prevalence of oral manifestations in COVID-19 confirmed individuals. An extensive literature search was conducted in databases like Scopus, Pubmed/Medline, Livivo, Lilacs and Google Scholar and varied oral signs and symptoms were reported as per the PRISMA guidelines. Studies published in English language literature only were included and were subjected to the risk of bias using the Joana Briggs Institute Appraisal tools for prevalence studies, case series and case reports. In a two-phase selection, 34 studies were included: 21 observational, 3 case-series and 10 case reports. These observational studies included approximately 14,003 patients from 10 countries. In this review, we explored the most commonly encountered oral and dental manifestations in COVID-19 and identified that loss of taste acuity, xerostomia and anosmia were frequently reported. Elevated incidence of opportunistic infections like mucormycosis and aspergillosis were reported during the treatment due to prolonged intake of steroids. Immunosuppression and poor oral hygiene led to secondary manifestations like enanthematous lesions. However, it is not clear that oral signs and symptoms are due to COVID-19 infection itself or are the result of extensive treatment regimen followed [PROSPERO CRD42021258264].
Topics: Humans; COVID-19; SARS-CoV-2; Prevalence
PubMed: 35271738
DOI: 10.1002/rmv.2345 -
Polish Archives of Internal Medicine May 2022Patients with COVID‑19 may develop concomitant viral, bacterial, or fungal infections. Such patients are at a higher risk of death, especially from a critical illness.... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Patients with COVID‑19 may develop concomitant viral, bacterial, or fungal infections. Such patients are at a higher risk of death, especially from a critical illness. Although much attention has been recently given to fungal infections that may have devastating consequences, data on this issue are scarce.
OBJECTIVES
The aim of the study was to assess the impact and prevalence of fungal infections in critically ill patients with COVID 19.
METHODS
We systematically searched for studies that focused on critically ill adults diagnosed with COVID‑19 and a fungal coinfection. Mortality was our outcome of interest. The search was conducted within MEDLINE, Web of Science, clinicaltrials.gov, Embase, and Cochrane Library on January 8, 2022.
RESULTS
We reviewed 38 papers covering 17 695 patients, 1182 (6.7%) of whom had an acquired fungal infection. The overall mortality in the papers retrieved for a systematic review (n = 38) varied from 29% to 100% (median [IQR], 56% [40%-77%]). In a meta‑analysis (19 studies), the patients with a fungal infection were more likely to die than the controls (odds ratio [OR], 2.987; 95% CI, 2.369-3.767; P <0.001; I2 = 26.63%). Subgroup analyses showed that COVID‑19-associated pulmonary aspergillosis (CAPA) increased mortality by 3 times (OR, 3.279; 95% CI, 2.692-3.994; P <0.001; I2 = 0%), and that COVID‑19-associated candidiasis (CAC) increased mortality by 2 times (OR, 2.254; 95% CI, 1.322-3.843; I2 = 26.14%).
CONCLUSIONS
In critically ill patients with COVID‑ 19, CAPA is rather common and significantly increases mortality. The evidence regarding other fungal infections is weaker, with CAC occurring less frequently but also impacting mortality. Therefore, clinical awareness and screening are needed, followed by personalized antifungal therapy stewardship, which is strongly recommended in order to improve the patients' prognosis.
Topics: Adult; Antifungal Agents; COVID-19; Critical Illness; Humans; Mycoses
PubMed: 35238324
DOI: 10.20452/pamw.16221