Diagnosis and Antifungal Prophylaxis for COVID-19 Associated Pulmonary Aspergillosis.
Armani M HawesNitipong PermpalungPublished in: Antibiotics (Basel, Switzerland) (2022)
The COVID-19 pandemic has redemonstrated the importance of the fungal-after-viral phenomenon, and the question of whether prophylaxis should be used to prevent COVID-19-associated pulmonary aspergillosis (CAPA). A distinct pathophysiology from invasive pulmonary aspergillosis (IPA), CAPA has an incidence that ranges from 5% to 30%, with significant mortality. The aim of this work was to describe the current diagnostic landscape of CAPA and review the existing literature on antifungal prophylaxis. A variety of definitions for CAPA have been described in the literature and the performance of the diagnostic tests for CAPA is limited, making diagnosis a challenge. There are only six studies that have investigated antifungal prophylaxis for CAPA. The two studied drugs have been posaconazole, either a liquid formulation via an oral gastric tube or an intravenous formulation, and inhaled amphotericin. While some studies have revealed promising results, they are limited by small sample sizes and bias inherent to retrospective studies. Additionally, as the COVID-19 pandemic changes and we see fewer intubated and critically ill patients, it will be more important to recognize these fungal-after-viral complications among non-critically ill, immunocompromised patients. Randomized controlled trials are needed to better understand the role of antifungal prophylaxis.
Keyphrases
- sars cov
- candida albicans
- pulmonary hypertension
- coronavirus disease
- systematic review
- risk factors
- randomized controlled trial
- end stage renal disease
- drug delivery
- newly diagnosed
- ejection fraction
- case control
- cystic fibrosis
- clinical trial
- peritoneal dialysis
- low dose
- mass spectrometry
- type diabetes
- ionic liquid
- coronary artery disease
- extracorporeal membrane oxygenation
- meta analyses
- drug induced
- respiratory failure
- patient reported