aspergillus complicating covid-19
TRANSCRIPT
The University of Sydney Page 1
Aspergillus complicating COVID-19
Presented byDr Justin Beardsley
Marie Bashir Institute, University of SydneyOxford University Clinical Research Unit, HCMCPrince of Wales Hospital, SESLHD
The University of Sydney Page 2
The University of Sydney Page 3
– Allergic (SAFS / ABPA)
– Nodule / aspergilloma
– Chronic pulmonary aspergillosis (CPA)
– Invasive aspergillosis (IA)
Aspergillosis
The University of Sydney Page 4
The University of Sydney Page 5
The University of Sydney Page 6
The University of Sydney Page 7
Diagnostic criteria Blot et al
Putative IA – requires all 41. Evidence of Aspergillus in lower respiratory tract
- Culture- ?PCR ?galactomannan
2. Consistent signs and symptoms - Fever refractory to 3d ABx- Recrudescent fever on Rx- Chest pain, rub, dyspnoea, haemoptysis- Worsening respiratory function
3. Abnormal radiology Xray or CT
4(a). Host factors OR Neutropenia, malignancy, steroid therapy, immunodeficiency
4(b). Smear Semiquant culture + or ++, and smear with branching hyphae
– Confirmed case - examination of tissue with hyphae + tissue damage seen OR Culture of a lung biopsy sample
The University of Sydney Page 8
Aspergillosis in influenza
– Incidence rates reported vary widely, from very rare to surprisingly common– Sharma et al Chest 2020 0.17% (477,566 US hospital admissions with
influenza)– Schauwvlieghe et al Lancet Resp Med 2018 19% (14-32%) (432 Euro
ICU admission with influenza)
– Clear evidence of significant clinical impact– Sharma et al Mortality flu + IA 20.6% vs flu 1.4%, adjusted OR
mortality 2.08 (p 0.043)– Schauwvlieghe et al Mortality flu + IA 51% vs flu 28%, adjusted OR
mortality 5.19 (p<0.0001)– Develops after median 3 days in ICU
The University of Sydney Page 9
Aspergillus in COVID-19
– Rapidly emerging data. From March 6 until 14 July, 25 papers have appeared on PubMed. https://www.asid.net.au/eknowledge/area?command=record&id=1447
– Incidence range– Zhang et al J Clin Virol June 2020 3.2% (221 Wuhan hospital COVID-
19 admissions)– Arkel et al Am J Resp CCM 2020 19.4% (31 Dutch ICU COVID-19
admissions)– Nasir et al Mycoses 2020 21.7% (23 Pakistani ICU COVID-19
admissions)– Alanio et al Lancet Resp Med 2020 33.3% (27 French ICU COVID-19
admissions)– Koehler et al Mycoses 2020 26.3% (19 German ICU COVID-19
admissions)
The University of Sydney Page 10
CASE REMOVED AS NOT FOR DISTRIBUTION AT THIS STAGE
The University of Sydney Page 11
Take home messages
– IA is likely to complicate COVID-19 frequently in critically ill patients
– There may be significant attributable mortality, based on evidence from influenza
– Frequent lower respiratory sampling is required for diagnosis, based on culture or galactomannan
– Treatment with voriconazole monotherapy
The University of Sydney Page 12
Aspergillus complicating COVID-19
With thanksDr Nguyen Van Vinh Chau (director)Dr Lan Huong Nguyen (head micro)Dr Duong Bich Thuy (ICU doctor)Hospital for Tropical Diseases, HCMC