COVID-19-Associated Invasive Aspergillosis: Data from the UK National Mycology Reference Laboratory.
COVID-19-Associated Invasive Aspergillosis: Data from the UK National Mycology Reference Laboratory.
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DOI：
10.1128/jcm.02136-20
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发表时间：
2020-12-17
影响因子：
9.4
通讯作者：
Johnson EM
中科院分区：
文献类型：
--
作者：
Borman AM;Palmer MD;Fraser M;Patterson Z;Mann C;Oliver D;Linton CJ;Gough M;Brown P;Dzietczyk A;Hedley M;McLachlan S;King J;Johnson EM
covid -19相关肺曲霉病（CAPA）最近被报道为严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）感染后急性呼吸窘迫综合征危重患者的潜在感染并发症，发病率从8%到33%不等，具体取决于研究。然而，CAPA的明确诊断是具有挑战性的。缺乏标准化的诊断算法和定义，临床医生不愿进行产生气溶胶的支气管肺泡灌洗以进行半乳甘露聚糖检测和显微镜和培养检查，并且围绕不同血清生物标志物的诊断敏感性存在问题。covid -19相关肺曲霉病（CAPA）最近被报道为严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）感染后急性呼吸窘迫综合征危重患者的潜在感染并发症，发病率从8%到33%不等，具体取决于研究。然而，CAPA的明确诊断是具有挑战性的。缺乏标准化的诊断算法和定义，临床医生不愿进行产生气溶胶的支气管肺泡灌洗以进行半乳甘露聚糖检测和显微镜和培养检查，并且围绕不同血清生物标志物的诊断敏感性存在问题。2020年3月11日至7月14日期间，英国国家真菌学参考实验室收到了719名英国COVID-19危重患者和疑似肺曲霉病的1267份血清和呼吸道样本。实验室还收到来自COVID-19患者的46株烟曲霉（其中3株表现出环境三唑耐药性）。诊断试验包括对血清样本进行1,000 (1-3)-β-d-葡聚糖和516次半乳甘露聚糖试验。这里给出了这个广泛测试的结果。对于61例患者，除了血清样本外，还提交了呼吸道样本（支气管肺泡灌洗样本、气管吸入样本和痰样本），并进行了半乳甘露聚糖检测、曲霉特异性PCR、显微镜和培养。在这部分患者中，可能/已证实和可能发生CAPA的发生率分别约为5%和15%。总的来说，我们的研究结果强调了生物标志物驱动的CAPA诊断的挑战，特别是当只有有限的临床样本可用于测试时，以及多模式诊断方法的重要性，包括定期和重复测试血清和呼吸样本。
COVID-19-associated pulmonary aspergillosis (CAPA) was recently reported as a potential infective complication affecting critically ill patients with acute respiratory distress syndrome following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with incidence rates varying from 8 to 33% depending on the study. However, definitive diagnosis of CAPA is challenging. Standardized diagnostic algorithms and definitions are lacking, clinicians are reticent to perform aerosol-generating bronchoalveolar lavages for galactomannan testing and microscopic and cultural examination, and questions surround the diagnostic sensitivity of different serum biomarkers. COVID-19-associated pulmonary aspergillosis (CAPA) was recently reported as a potential infective complication affecting critically ill patients with acute respiratory distress syndrome following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with incidence rates varying from 8 to 33% depending on the study. However, definitive diagnosis of CAPA is challenging. Standardized diagnostic algorithms and definitions are lacking, clinicians are reticent to perform aerosol-generating bronchoalveolar lavages for galactomannan testing and microscopic and cultural examination, and questions surround the diagnostic sensitivity of different serum biomarkers. Between 11 March and 14 July 2020, the UK National Mycology Reference Laboratory received 1,267 serum and respiratory samples from 719 critically ill UK patients with COVID-19 and suspected pulmonary aspergillosis. The laboratory also received 46 isolates of Aspergillus fumigatus from COVID-19 patients (including three that exhibited environmental triazole resistance). Diagnostic tests performed included 1,000 (1-3)-β-d-glucan and 516 galactomannan tests on serum samples. The results of this extensive testing are presented here. For a subset of 61 patients, respiratory specimens (bronchoalveolar lavage specimens, tracheal aspirates, and sputum samples) in addition to serum samples were submitted and subjected to galactomannan testing, Aspergillus-specific PCR, and microscopy and culture. The incidence of probable/proven and possible CAPA in this subset of patients was approximately 5% and 15%, respectively. Overall, our results highlight the challenges in biomarker-driven diagnosis of CAPA, especially when only limited clinical samples are available for testing, and the importance of a multimodal diagnostic approach involving regular and repeat testing of both serum and respiratory samples.