COVID-19-Associated Pulmonary Aspergillosis in Intensive Care Unit Patients from Poland

doi:10.3390/jof9060666

. 2023 Jun 13;9(6):666.

doi: 10.3390/jof9060666.

COVID-19-Associated Pulmonary Aspergillosis in Intensive Care Unit Patients from Poland

Affiliations

¹ Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18 Street, 31-121 Krakow, Poland.
² Department of Microbiology, University Hospital in Krakow, Macieja Jakubowskiego 2 Street, 30-688 Krakow, Poland.
³ Interdisciplinary Intensive Care Clinic, Jagiellonian University Medical College, Macieja Jakubowskiego 2 Street, 30-688 Krakow, Poland.
⁴ Center for Innovative Medical Education, Jagiellonian University Medical College, Medyczna 7 Street, 30-688 Krakow, Poland.
⁵ Intensive Care Unit, University Hospital in Krakow, Macieja Jakubowskiego 2 Street, 30-688 Krakow, Poland.
⁶ Department of Internal Diseases and Circulatory Failure, Center of Pulmonology and Thoracic Surgery in Bystra, Juliana Fałata 2 Street, 43-360 Bystra, Poland.
⁷ Department of Pulmonology and Respiratory Failure, Center of Pulmonology and Thoracic Surgery in Bystra, Juliana Fałata 2 Street, 43-360 Bystra, Poland.
⁸ Center for Innovative Therapy, Clinical Research Coordination Center, University Hospital in Krakow, Macieja Jakubowskiego 2 Street, 30-688 Krakow, Poland.

PMID: 37367602
PMCID: PMC10303628
DOI: 10.3390/jof9060666

COVID-19-Associated Pulmonary Aspergillosis in Intensive Care Unit Patients from Poland

Magdalena Skóra et al. J Fungi (Basel). 2023.

. 2023 Jun 13;9(6):666.

doi: 10.3390/jof9060666.

Authors

Affiliations

¹ Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18 Street, 31-121 Krakow, Poland.
² Department of Microbiology, University Hospital in Krakow, Macieja Jakubowskiego 2 Street, 30-688 Krakow, Poland.
³ Interdisciplinary Intensive Care Clinic, Jagiellonian University Medical College, Macieja Jakubowskiego 2 Street, 30-688 Krakow, Poland.
⁴ Center for Innovative Medical Education, Jagiellonian University Medical College, Medyczna 7 Street, 30-688 Krakow, Poland.
⁵ Intensive Care Unit, University Hospital in Krakow, Macieja Jakubowskiego 2 Street, 30-688 Krakow, Poland.
⁶ Department of Internal Diseases and Circulatory Failure, Center of Pulmonology and Thoracic Surgery in Bystra, Juliana Fałata 2 Street, 43-360 Bystra, Poland.
⁷ Department of Pulmonology and Respiratory Failure, Center of Pulmonology and Thoracic Surgery in Bystra, Juliana Fałata 2 Street, 43-360 Bystra, Poland.
⁸ Center for Innovative Therapy, Clinical Research Coordination Center, University Hospital in Krakow, Macieja Jakubowskiego 2 Street, 30-688 Krakow, Poland.

PMID: 37367602
PMCID: PMC10303628
DOI: 10.3390/jof9060666

Abstract

Coronavirus disease 2019 (COVID-19) has been shown to be a favoring factor for aspergillosis, especially in a severe course requiring admission to the intensive care unit (ICU). The aim of the study was to assess the morbidity of CAPA among ICU patients in Poland and to analyze applied diagnostic and therapeutic procedures. Medical documentation of patients hospitalized at the temporary COVID-19 dedicated ICU of the University Hospital in Krakow, Poland, from May 2021 to January 2022 was analyzed. In the analyzed period, 17 cases of CAPA were reported with an incidence density rate of 9 per 10 000 patient days and an incidence rate of 1%. Aspergillus fumigatus and Aspergillus niger were isolated from lower respiratory samples. Antifungal therapy was administered to 9 patients (52.9%). Seven patients (77.8%) received voriconazole. The CAPA fatality case rate was 76.5%. The results of the study indicate the need to increase the awareness of medical staff about the possibility of fungal co-infections in ICU patients with COVID-19 and to use the available diagnostic and therapeutic tools more effectively.

Keywords: Aspergillus; CAPA; COVID-associated pulmonary aspergillosis; SARS-CoV-2; invasive aspergillosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Timeline of mycological diagnostics in CAPA patients from admission to the intensive care unit. The figure template was taken from Lackner et al., 2022 [21]. ICU—intensive care unit, GM—galactomannan, BDG—1-3-β-D-glucan, VCZ—voriconazole, FCZ—fluconazole, CAS—caspofungin.

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References

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1. Donnelly J.P., Chen S.C., Kauffman C.A., Steinbach W.J., Baddley J.W., Verweij P.E., Clancy C.J., Wingard J.R., Lockhart S.R., Groll A.H., et al. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin. Infect. Dis. 2020;71:1367–1376. doi: 10.1093/cid/ciz1008. - DOI - PMC - PubMed
1. van de Veerdonk F.L., Kolwijck E., Lestrade P.P., Hodiamont C.J., Rijnders B.J., van Paassen J., Haas P.J., Oliveira Dos Santos C., Kampinga G.A., Bergmans D.C., et al. Influenza-associated aspergillosis in critically ill patients. Am. J. Respir. Crit. Care Med. 2017;196:524–527. doi: 10.1164/rccm.201612-2540LE. - DOI - PubMed
1. Jenks J.D., Nam H.H., Hoenigl M. Invasive aspergillosis in critically ill patients: Review of definitions and diagnostic approaches. Mycoses. 2021;64:1002–1014. doi: 10.1111/myc.13274. - DOI - PMC - PubMed
1. Koehler P., Cornely O.A., Böttiger B.W., Dusse F., Eichenauer D.A., Fuchs F., Hallek M., Jung N., Klein F., Persigehl T., et al. COVID-19 associated pulmonary aspergillosis. Mycoses. 2020;63:528–534. doi: 10.1111/myc.13096. - DOI - PMC - PubMed

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[1] GAFFI—Global Action For Fungal Infections. [(accessed on 2 November 2022)]. Available online: https://gaffi.org/why/fungal-disease-frequency/

[2] GAFFI—Global Action For Fungal Infections. [(accessed on 2 November 2022)]. Available online: https://gaffi.org/why/fungal-disease-frequency/

[3] Donnelly J.P., Chen S.C., Kauffman C.A., Steinbach W.J., Baddley J.W., Verweij P.E., Clancy C.J., Wingard J.R., Lockhart S.R., Groll A.H., et al. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin. Infect. Dis. 2020;71:1367–1376. doi: 10.1093/cid/ciz1008. - DOI - PMC - PubMed

[4] Donnelly J.P., Chen S.C., Kauffman C.A., Steinbach W.J., Baddley J.W., Verweij P.E., Clancy C.J., Wingard J.R., Lockhart S.R., Groll A.H., et al. Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clin. Infect. Dis. 2020;71:1367–1376. doi: 10.1093/cid/ciz1008. - DOI - PMC - PubMed

[5] van de Veerdonk F.L., Kolwijck E., Lestrade P.P., Hodiamont C.J., Rijnders B.J., van Paassen J., Haas P.J., Oliveira Dos Santos C., Kampinga G.A., Bergmans D.C., et al. Influenza-associated aspergillosis in critically ill patients. Am. J. Respir. Crit. Care Med. 2017;196:524–527. doi: 10.1164/rccm.201612-2540LE. - DOI - PubMed

[6] van de Veerdonk F.L., Kolwijck E., Lestrade P.P., Hodiamont C.J., Rijnders B.J., van Paassen J., Haas P.J., Oliveira Dos Santos C., Kampinga G.A., Bergmans D.C., et al. Influenza-associated aspergillosis in critically ill patients. Am. J. Respir. Crit. Care Med. 2017;196:524–527. doi: 10.1164/rccm.201612-2540LE. - DOI - PubMed

[7] Jenks J.D., Nam H.H., Hoenigl M. Invasive aspergillosis in critically ill patients: Review of definitions and diagnostic approaches. Mycoses. 2021;64:1002–1014. doi: 10.1111/myc.13274. - DOI - PMC - PubMed

[8] Jenks J.D., Nam H.H., Hoenigl M. Invasive aspergillosis in critically ill patients: Review of definitions and diagnostic approaches. Mycoses. 2021;64:1002–1014. doi: 10.1111/myc.13274. - DOI - PMC - PubMed

[9] Koehler P., Cornely O.A., Böttiger B.W., Dusse F., Eichenauer D.A., Fuchs F., Hallek M., Jung N., Klein F., Persigehl T., et al. COVID-19 associated pulmonary aspergillosis. Mycoses. 2020;63:528–534. doi: 10.1111/myc.13096. - DOI - PMC - PubMed

[10] Koehler P., Cornely O.A., Böttiger B.W., Dusse F., Eichenauer D.A., Fuchs F., Hallek M., Jung N., Klein F., Persigehl T., et al. COVID-19 associated pulmonary aspergillosis. Mycoses. 2020;63:528–534. doi: 10.1111/myc.13096. - DOI - PMC - PubMed

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COVID-19-Associated Pulmonary Aspergillosis in Intensive Care Unit Patients from Poland

Affiliations

COVID-19-Associated Pulmonary Aspergillosis in Intensive Care Unit Patients from Poland

Authors

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Abstract

Conflict of interest statement

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