COVID-19-Associated Pulmonary Aspergillosis in Russia
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
- CAPA develops mainly on the background of diabetes (33%), hematological or oncological diseases (31%), and COPD (13%).
- The probability of CAPA significantly increases with lymphocytopenia for >10 days (OR = 8.156 (3.056–21.771), p = 0.001), decompensated diabetes (29% vs. 7%, (OR = 5.688 (1.991–16.246), p = 0.001), use of steroids at a prednisone-equivalent dose > 60 mg/day (OR = 4.493 (1.896–10.647), p = 0.001) and monoclonal antibodies to IL-1ß and IL-6 (OR = 2.880 (1.272–6.518), p = 0.01)
- CAPA is characterized by pulmonary involvement (100%), and rarely characterized by trachea and bronchi (7%).
- Severe disease course with prolonged (median—15.5 (5–60) days) stays in the ICU (71%), mechanical ventilation (52%) and ARDS (31%) are typical in CAPA patients.
- The clinical signs of CAPA are nonspecific, but typically include: fever (98%), cough (89%) and hemoptysis (36%). The radiological signs of CAPA are foci of consolidation (89%) and destruction (47%), and hydrothorax (26%).
- The most effective method of diagnosing CAPA is the GM test in BAL.
- The overall 12-week survival rate of patients with CAPA was 47.2%.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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CAPA | COVID-19 without IA | p-Value | |||
---|---|---|---|---|---|
n = 45 | % | n = 90 | % | ||
Demographics | |||||
males | 31 | 69% | 60 | 67% | 0.66 |
females | 14 | 31% | 30 | 33% | |
age median (years) | 34–82 62 | 25–82 63 | 0.67 | ||
background diseases | |||||
hematological diseases | 9 | 20% | 11 | 12% | 0.2 |
lymphomas acute leukemia MM CLL others | 6 1 2 - - | 13% 2% 4% | 6 1 1 2 1 | 7% 1% 1% 1% | |
oncology | 5 | 11% | 5 | 5.5% | 0.1 |
active hematological/oncological disease | 11 | 24% | 2 | 2% | 0.03 |
DM decompensated DM | 15 13 | 33% 29% | 17 6 | 19% 7% | 0.06 0.0003 |
COPD | 6 | 13% | 5 | 5.5% | 0.09 |
ARF/CRF | 5 | 11% | 8 | 9% | 0.6 |
COVID-IA | COVID-19 without IA | p-Value | |||
---|---|---|---|---|---|
n/N | % | n/N | % | ||
neutropenia <0.5 × 109/L | 4/45 | 9% | 0/90 | 0.006 | |
duration (min-max)/ Me (days) | 5–25 10 | - | |||
lymphocytopenia <1.0 × 109/L | 38/43 | 88% | 68/88 | 77% | 0.1 |
duration (min-max)/ Me (days) | 5–100 15 | 2–42 9 | 0.00002 | ||
lymphocytopenia >10 days | 29/35 | 83% | 32/86 | 37% | 0.006 |
glucocorticoids (GCS): | 38/43 | 88% | 77/88 | 88% | 0.7 |
GCS >60 mg/d in prednisone-equivalent dose | 17/37 | 46% | 14/88 | 16% | 0.01 |
inhibitors of receptors IL-1β and IL-6 | 18/43 | 42% | 16/80 | 20% | 0.01 |
Risk Factors | CAPA | COVID-19 without IA | OR (95% CI) | p-Value |
---|---|---|---|---|
n/N(%) | n/N(%) | |||
decompensated DM | 13/45 (29%) | 6/90 (7%) | 5.688 (1.991–16.246) | 0.001 |
lymphocytopenia >10 days | 29/35 (83%) | 32/86 (37%) | 8.156 (3.056–21.771) | 0.0001 |
GCS >60 mg/d in prednisone-equivalent dose | 17/37 (46%) | 14/88 (16%) | 4.493 (1.896–10.647) | 0.001 |
inhibitors of receptors IL-1β and IL-6 | 18/43 (42%) | 16/80 (20%) | 2.880 (1.272–6.518) | 0.01 |
Features | CAPA n = 45 | COVID-19 without IA n = 90 | p-Value | ||
---|---|---|---|---|---|
N | % | n | % | ||
fever | 44 | 98% | 62/73 | 85% | 0.007 |
cough | 40 | 89% | 42/53 | 72% | 0.002 |
chest pain | 10/42 | 24% | 4/45 | 9% | 0.05 |
respiratory failure 2-3-4 (requiring O2 or ventilation) | 28 | 62% | 54 | 60% | 0.7 |
ARDS | 14 | 31% | 16 | 18% | 0.02 |
hemoptysis | 16 | 36% | 3/87 | 3% | 0.0001 |
ICU | 32 | 71% | 57 | 63% | 0.4 |
total days in ICU Me | 5–60 15.5 | 1–55 6 | 0.0004 | ||
mechanical ventilation | 14 | 52% | 8/54 | 15% | 0.004 |
CT-signs | |||||
bilateral lesion | 42 | 93% | 75/80 | 94% | 0.8 |
infiltrations | 40 | 89% | 37/63 | 59% | 0.004 |
the “frosted glass” symptom | 33 | 73% | 64/80 | 80% | 0.3 |
destruction cavity | 21 | 47% | 1 | 1% | 0.00001 |
the “halo” symptom | - | - | - | - | |
hydrothorax | 10/38 | 26% | 10/88 | 11% | 0.03 |
Method | Result | |
---|---|---|
n | % | |
microscopy (+) | 11 | 24% |
culture (+) | 14 | 31% |
GM in blood (+) | 3 | 7% |
GM in BAL (+) | 25 | 56% |
histology (+) | 3 | 7% |
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Shadrivova, O.; Gusev, D.; Vashukova, M.; Lobzin, D.; Gusarov, V.; Zamyatin, M.; Zavrazhnov, A.; Mitichkin, M.; Borzova, Y.; Kozlova, O.; et al. COVID-19-Associated Pulmonary Aspergillosis in Russia. J. Fungi 2021, 7, 1059. https://doi.org/10.3390/jof7121059
Shadrivova O, Gusev D, Vashukova M, Lobzin D, Gusarov V, Zamyatin M, Zavrazhnov A, Mitichkin M, Borzova Y, Kozlova O, et al. COVID-19-Associated Pulmonary Aspergillosis in Russia. Journal of Fungi. 2021; 7(12):1059. https://doi.org/10.3390/jof7121059
Chicago/Turabian StyleShadrivova, Olga, Denis Gusev, Maria Vashukova, Dmitriy Lobzin, Vitaliy Gusarov, Mikhail Zamyatin, Anatoliy Zavrazhnov, Mikhail Mitichkin, Yulia Borzova, Olga Kozlova, and et al. 2021. "COVID-19-Associated Pulmonary Aspergillosis in Russia" Journal of Fungi 7, no. 12: 1059. https://doi.org/10.3390/jof7121059