COVID-19-associated pulmonary aspergillosis - Revision history

Aidan: /* Clinical Manifestations */

2022-01-21T12:29:18Z

Clinical Manifestations

← Older revision		Revision as of 12:29, 21 January 2022
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	** [[Hemoptysis]]		** [[Hemoptysis]]
	** Pleural friction rub or chest pain		** Pleural friction rub or chest pain
			*Typically occurs within 1 to 3 weeks or intubation

	=== Prognosis ===		=== Prognosis ===

Aidan: /* Investigations */

2022-01-21T12:27:28Z

Investigations

← Older revision		Revision as of 12:27, 21 January 2022
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	*** Non-BAL galactomannan index >1.2 twice or more		*** Non-BAL galactomannan index >1.2 twice or more
	*** Non-BAL galactomannan index >1.2 plus another non-BAL mycology test positive (non-BAL PCR or LFA)		*** Non-BAL galactomannan index >1.2 plus another non-BAL mycology test positive (non-BAL PCR or LFA)

			== Management ==

			* Either [[voriconazole]] or [[isavuconazole]] is recommended for possible, probable, and proven CAPA[[CiteRef::koehler2021de]]
			** [[Voriconazole]] 6 mg/kg bid for 2 doses followed by 4 mg/kg bid
			** [[Isavuconazole]] 300 mg tid for 6 doses followed by 200 mg daily
			* [[Liposomal amphotericin B]] is the recommended salvage therapy
			* Alternatives include [[posaconazole]] and [[echinocandins]], though the latter should ideally not be used as monotherapy

	[[Category:Respiratory infections]]		[[Category:Respiratory infections]]

Aidan: /* Clinical Manifestations */

2022-01-21T12:20:11Z

Clinical Manifestations

← Older revision		Revision as of 12:20, 21 January 2022
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	== Clinical Manifestations ==		== Clinical Manifestations ==

			* The diagnosis should be considered in any critically ill patient with COVID-19 who has any of the following
			** Refractory fever lasting more than 3 days or a new fever after defervescing for more than 48 hours while on appropriate antibiotics
			** [[Hemoptysis]]
			** Pleural friction rub or chest pain

	=== Prognosis ===		=== Prognosis ===

Aidan: Created page with "== Background == * Defined as invasive pulmonary aspergillosis following COVID-19 * Similar to influenza-associated pulmonary aspergillosis === Pathophysiology =..."

2022-01-21T12:18:36Z

Created page with "== Background == * Defined as invasive pulmonary aspergillosis following COVID-19 * Similar to influenza-associated pulmonary aspergillosis === Pathophysiology =..."

New page

== Background ==

* Defined as [[invasive pulmonary aspergillosis]] following [[COVID-19]]
* Similar to [[influenza-associated pulmonary aspergillosis]]

=== Pathophysiology ===

* Viral infection damages airway epithelium, allowing [[Aspergillus]] to invade
* May also be a component of immune dysfunction, with [[COVID-19]] affecting T cells
* Probably also made more likely by treatment for [[COVID-19]], including [[corticosteroids]] and [[IL-6 inhibitors]]

== Clinical Manifestations ==

=== Prognosis ===

* Mortality increased 16 to 25% compared to patients without [[aspergillosis]]

== Investigations ==

* CT chest for [[COVID-19]] can mimic IPA and vice-versa, made more complicated in patients with [[ARDS]]
** Multiple pulmonary nodules or lung cavitation is suggestive, since they are less likely to be due to [[COVID-19]] alone
** Halo sign indicates local infarction, which can occur with COVID-19 even in the absence of IPA
* BAL for galactomannan is highly suggestive of IPA
* Serum galactamannan is insensitive (positive in about 20% of patients)

== Diagnosis ==

* Diagnostic criteria have been developed by ECMM/ISHAM[[CiteRef::koehler2021de]]
* Criteria only apply to patients with COVID-19 needing intensive care and who have a temporal relationship
* Proven tracheobronchitis or other pulmonary form:
** At least one of the following:
*** Histopathological or direct microscopic detection of fungal hyphae, showing invasive growth with associated tissue damage
*** Aspergillus recovered by culture or microscopy or histology or PCR obtained by a sterile aspiration or biopsy from a pulmonary site
* Probable tracheobronchitis
** Tracheobronchitis, indicated by tracheobronchial ulceration, nodule, pseudomembrane, plaque, or eschar seen on bronchoscopy
** At least one of the following:
*** Microscopic detection of fungal elements in BAL, indicating a mold
*** Positive BAL culture or PCR
*** Serum galactomannan >0.5 or serum LFA >0.5
*** BAL galactomannan ≥1 or BAL LFA ≥1
* Probable pulmonary forms excluding tracheobronchitis
** Pulmonary infiltrate, preferably documented by CT chest, or cavitating infiltrate, not attributed to another cause
** At least one of the following:
*** Microscopic detection of fungal elements in BAL, indicating a mold
*** Positive BAL culture
*** Serum galactomannan >0.5 or serum LFA >0.5
*** BAL galactomannan ≥1 or BAL LFA ≥1
*** Two or more positive Aspergillus PCR tests in plasma, serum, or whole blood
*** A single positive Aspergillus PCR on BAL <36 cycles
*** A single positive Aspergillus PCR in plasma, serum, or whole blood, plus a single positive PCR in BAL
* Possible pulmonary forms excluding tracheobronchitis
** Pulmonary infiltrate, preferably documented by CT chest, or cavitating infiltrate, not attributed to another cause
** At least one of the following:
*** Microscopic detection of fungal elements in non-bronchoscopic lavage indicating a mould; positive non-bronchoscopic lavage culture
*** Single non-BAL galactomannan index >4.5
*** Non-BAL galactomannan index >1.2 twice or more
*** Non-BAL galactomannan index >1.2 plus another non-BAL mycology test positive (non-BAL PCR or LFA)

[[Category:Respiratory infections]]