Invasive mould disease in fatal COVID-19: a systematic review of autopsies.
Invasive mould disease in fatal COVID-19: a systematic review of autopsies.
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DOI：
10.1016/s2666-5247(21)00091-4
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发表时间：
2021-08
期刊：
影响因子：
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通讯作者：
Schwartz IS
中科院分区：
文献类型：
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作者：
Kula BE;Clancy CJ;Hong Nguyen M;Schwartz IS
侵袭性霉菌病（IMD）可能影响多达三分之一的COVID-19重症患者。COVID-19相关的肺曲霉病（CAPA）通常根据非特异性临床、放射学和真菌学发现的组合进行诊断，但大多数病例是否代表侵袭性疾病尚未得到解决。我们系统地审查了三名或更多COVID-19死者的尸检系列，以寻找IMD的证据。我们检索了PubMed、Web of Science、奥维德（Embase）和medRxiv中2019年1月1日至2020年9月26日发表的英文或法文研究。我们确定了1070篇参考文献，其中50篇研究符合标准。这些研究描述了677名死者的尸检，其中443名死者的个人水平数据。中位年龄为70·0岁（IQR 57·0 - 79·0）。在具有个人水平数据的死亡者中，133例（30%）患有糖尿病，97例（22%）患有既存肺部疾病，27例（6%）患有免疫功能低下疾病。在548例有此类数据的死亡者中，320例（58%）接受了有创机械通气;在140例已知有创机械通气的死亡者中，通气时间中位数为9·0天（IQR 5·0 - 20·0）。治疗包括60例死者的免疫调节和50例死者的抗真菌药物。尸检证实的IMD发生在11（2%）的677名死者，包括八个CAPA，两个不明IMD，和一个播散性毛霉菌病。在320例接受机械通气的死亡者中，6例（2%）患有IMD。我们得出结论，IMD（包括CAPA）是COVID-19中不常见的尸检结果。
Invasive mould disease (IMD) might affect up to a third of critically ill patients with COVID-19. COVID-19-associated pulmonary aspergillosis (CAPA) is typically diagnosed on the basis of a combination of non-specific clinical, radiographical, and mycological findings, but whether most cases represent invasive disease is unresolved. We systematically reviewed autopsy series of three or more decedents with COVID-19 for evidence of IMD. We searched PubMed, Web of Science, OVID (Embase), and medRxiv for studies in English or French published from Jan 1, 2019, to Sept 26, 2020. We identified 1070 references, of which 50 studies met the criteria. These studies described autopsies from 677 decedents, with individual-level data for 443 decedents. The median age was 70·0 years (IQR 57·0–79·0). Of decedents with individual-level data, 133 (30%) had diabetes, 97 (22%) had pre-existing lung disease, and 27 (6%) had immunocompromising conditions. Of 548 decedents with such data, 320 (58%) received invasive mechanical ventilation; among 140 decedents for whom this was known, ventilation was for a median of 9·0 days (IQR 5·0–20·0). Treatment included immunomodulation in 60 decedents and antifungals in 50 decedents. Autopsy-proven IMD occurred in 11 (2%) of 677 decedents, including eight CAPA, two unspecified IMD, and one disseminated mucormycosis. Among 320 decedents who received mechanical ventilation, six (2%) had IMD. We conclude that IMD, including CAPA, is an uncommon autopsy finding in COVID-19.