COVID-19-associated pulmonary aspergillosis: A lesson learned from COVID sequel
Invasive pulmonary aspergillosis (IPA) is now been recognized as a possible secondary infection affecting COVID-19 recovery and increasing mortality. It can be explained due to factors such as direct epithelial injury, hypercoagulable and hyperinflammatory states, and the use of immunosuppressive tr...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-07-01
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| Series: | Journal of Current Research in Scientific Medicine |
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| Online Access: | https://journals.lww.com/10.4103/jcrsm.jcrsm_32_23 |
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| author | Priyanka Singh Aanchal Kakkar |
| author_facet | Priyanka Singh Aanchal Kakkar |
| author_sort | Priyanka Singh |
| collection | DOAJ |
| description | Invasive pulmonary aspergillosis (IPA) is now been recognized as a possible secondary infection affecting COVID-19 recovery and increasing mortality. It can be explained due to factors such as direct epithelial injury, hypercoagulable and hyperinflammatory states, and the use of immunosuppressive treatment. We managed five such cases in a post-COVID intensive care unit facility at a tertiary care institute in North India. All patients had high oxygen demand, positive serum galactomannan (GM) index, and significant chest X-ray changes. All patients showed an initial improvement after receiving intravenous antifungal treatment with voriconazole. Systemic markers were suboptimal for the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA) with a sensitivity of less than 50%. GM assay has been validated in BAL and serum in numerous studies. Serum GM is a sensitive marker for IPA in patients with neutropenia; however, in nonneutropenic critically ill patients, serum GM exhibited a sensitivity of 25%, although a negative serum result cannot exclude the diagnosis of CAPA. The diagnosis of CAPA is challenging, and in patients with severe COVID-19 pneumonia may be associated with a worse prognosis. GM levels can be used for the diagnostic purpose of probable CAPA cases and administration of prophylactic treatment with voriconazole is still under debate. |
| format | Article |
| id | doaj-art-1b3bc0653d344aa0b9722ffc0d507de6 |
| institution | DOAJ |
| issn | 2542-6273 2455-3069 |
| language | English |
| publishDate | 2023-07-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Current Research in Scientific Medicine |
| spelling | doaj-art-1b3bc0653d344aa0b9722ffc0d507de62025-08-20T03:16:21ZengWolters Kluwer Medknow PublicationsJournal of Current Research in Scientific Medicine2542-62732455-30692023-07-019217317610.4103/jcrsm.jcrsm_32_23COVID-19-associated pulmonary aspergillosis: A lesson learned from COVID sequelPriyanka SinghAanchal KakkarInvasive pulmonary aspergillosis (IPA) is now been recognized as a possible secondary infection affecting COVID-19 recovery and increasing mortality. It can be explained due to factors such as direct epithelial injury, hypercoagulable and hyperinflammatory states, and the use of immunosuppressive treatment. We managed five such cases in a post-COVID intensive care unit facility at a tertiary care institute in North India. All patients had high oxygen demand, positive serum galactomannan (GM) index, and significant chest X-ray changes. All patients showed an initial improvement after receiving intravenous antifungal treatment with voriconazole. Systemic markers were suboptimal for the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA) with a sensitivity of less than 50%. GM assay has been validated in BAL and serum in numerous studies. Serum GM is a sensitive marker for IPA in patients with neutropenia; however, in nonneutropenic critically ill patients, serum GM exhibited a sensitivity of 25%, although a negative serum result cannot exclude the diagnosis of CAPA. The diagnosis of CAPA is challenging, and in patients with severe COVID-19 pneumonia may be associated with a worse prognosis. GM levels can be used for the diagnostic purpose of probable CAPA cases and administration of prophylactic treatment with voriconazole is still under debate.https://journals.lww.com/10.4103/jcrsm.jcrsm_32_23covid-19 retropneumoniapulmonary aspergillosisvoriconazole |
| spellingShingle | Priyanka Singh Aanchal Kakkar COVID-19-associated pulmonary aspergillosis: A lesson learned from COVID sequel Journal of Current Research in Scientific Medicine covid-19 retro pneumonia pulmonary aspergillosis voriconazole |
| title | COVID-19-associated pulmonary aspergillosis: A lesson learned from COVID sequel |
| title_full | COVID-19-associated pulmonary aspergillosis: A lesson learned from COVID sequel |
| title_fullStr | COVID-19-associated pulmonary aspergillosis: A lesson learned from COVID sequel |
| title_full_unstemmed | COVID-19-associated pulmonary aspergillosis: A lesson learned from COVID sequel |
| title_short | COVID-19-associated pulmonary aspergillosis: A lesson learned from COVID sequel |
| title_sort | covid 19 associated pulmonary aspergillosis a lesson learned from covid sequel |
| topic | covid-19 retro pneumonia pulmonary aspergillosis voriconazole |
| url | https://journals.lww.com/10.4103/jcrsm.jcrsm_32_23 |
| work_keys_str_mv | AT priyankasingh covid19associatedpulmonaryaspergillosisalessonlearnedfromcovidsequel AT aanchalkakkar covid19associatedpulmonaryaspergillosisalessonlearnedfromcovidsequel |