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INTRODUCTION: Probiotics provide therapeutic benefits not only in the gut but also other mucosal organs, including the lungs. OBJECTIVE AND DESIGN: To evaluate the effects of the probiotic strain L. delbrueckii UFV-H2b20 oral administration in an experimental murine model of A. fumigatus pulmonary infection. BALB/c mice were associated with L. delbrueckii and infected with Aspergillus fumigatus and compared with non-associated group. METHODS: We investigated survival, respiratory mechanics, histopathology, colony forming units, cytokines in bronchoalveolar lavage, IgA in feces, efferocytosis, production of reactive oxygen species and the cell population in the mesenteric lymph nodes. RESULTS: L. delbrueckii induces tolerogenic dendritic cells, IL-10+macrophages and FoxP3+regulatory T cells in mesenteric lymph nodes and increased IgA levels in feces; after infection with A. fumigatus, increased survival and decreased fungal burden. There was decreased lung vascular permeability without changes in the leukocyte profile. There was enhanced neutrophilic response and increased macrophage efferocytosis. L. delbrueckii-treated mice displayed more of FoxP3+Treg cells, TGF-ß and IL-10 levels in lungs, and concomitant decreased IL-1ß, IL-17 A, and CXCL1 production. CONCLUSION: Uur results indicate that L. delbrueckii UFV H2b20 ingestion improves immune responses, controlling pulmonary A. fumigatus infection. L. delbrueckii seems to play a role in pathogenesis control by promoting immune regulation.
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Aspergillus fumigatus , Citocinas , Lactobacillus delbrueckii , Pulmón , Ratones Endogámicos BALB C , Probióticos , Animales , Probióticos/administración & dosificación , Aspergillus fumigatus/inmunología , Pulmón/inmunología , Pulmón/patología , Pulmón/microbiología , Administración Oral , Lactobacillus delbrueckii/inmunología , Citocinas/inmunología , Citocinas/metabolismo , Ratones , Aspergilosis/inmunología , Aspergilosis/prevención & control , Linfocitos T Reguladores/inmunología , Inmunoglobulina A/inmunología , Femenino , Líquido del Lavado Bronquioalveolar/inmunología , Aspergilosis Pulmonar/inmunología , Heces/microbiología , MasculinoRESUMEN
During the COVID-19 pandemic, many patients in intensive care units (ICUs) were affected by invasive fungal infections, including aspergillosis, contributing to a high mortality rate. Diagnosing proven COVID-19-associated pulmonary aspergillosis (CAPA) requires clinical and radiological evaluations, along with laboratory testing of bronchoalveolar lavage samples or lung biopsies. However, these procedures and equipment are often inaccessible in developing countries or regions with limited resources, including Brazil. Consequently, alternative diagnostic methods, such as measuring Aspergillus galactomannan (GM) in tracheal aspirate (TA), have been explored for CAPA diagnosis. Nonetheless, research on the efficacy of TA-based diagnostic tests is limited. This study aimed to assess the performance of the IMMY® Sona Aspergillus lateral flow assay (LFA) for GM detection in TA samples from 60 ICU patients with suspected CAPA at two tertiary hospitals in Campo Grande, Brazil. The ELISA method (Platelia Aspergillus AG, Bio-Rad®) was used to detect Aspergillus GM in TA samples, serving as the microbiological criterion and reference test. Fifteen patients (12.4%) were identified as having possible CAPA. The overall accuracy of LFA was 94%, and the tests demonstrated an agreement of 93.1% (Cohen's kappa of 0.83). Based on our findings, the LFA for Aspergillus GM detection in TA samples exhibited excellent performance, proving to be a valuable diagnostic tool for potential CAPA. In a systematic review, two studies were included, and the meta-analysis revealed pooled estimates provided a sensitivity of 86% (95% CI, 80%-91%) and specificity of 93% (95% CI, 86%-97%). The diagnostic odds ratio (DOR) for identification of Aspergillus using LFA was 103.38 (95% CI, 38.03-281.03). Despite its lower sensitivity compared to our study, the LFA appears to be a promising diagnostic option for CAPA, particularly in suspected cases that have not received antifungal therapy. This enables timely antifungal treatment and could reduce mortality rates in regions where bronchoscopy is unavailable or limited.
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Aspergillus , COVID-19 , Galactosa , Mananos , Sensibilidad y Especificidad , Tráquea , Humanos , Galactosa/análogos & derivados , Mananos/análisis , Brasil , COVID-19/complicaciones , COVID-19/diagnóstico , Aspergillus/aislamiento & purificación , Tráquea/microbiología , Persona de Mediana Edad , Estudios Transversales , Masculino , Femenino , Aspergilosis Pulmonar/diagnóstico , Anciano , Adulto , SARS-CoV-2/aislamiento & purificación , Unidades de Cuidados IntensivosRESUMEN
Introducción: La enfermedad por el nuevo coronavirus SARS-CoV-2 (COVID-19) se extendió rápidamente por todo el mundo y generó un gran desafío. La aparición de coinfecciones se encuentra entre las complicaciones más graves que pueden desarrollar los enfermos. La aspergilosis pulmonar se ha identificado como una complicación de la neumonía por la COVID-19 en los pacientes ventilados en las unidades de cuidados intensivos. Objetivo: Presentar un caso clínico poco común de aspergilosis pulmonar. Caso clínico: Se presenta el caso de una paciente con historia reciente de la COVID-19, con un cuadro clínico enteral dado por diarreas, vómitos e insuficiencia respiratoria en el que concomitan la evolución de un cáncer de colon y neumonía asociada a la ventilación provocada por Aspergillus niger. Conclusiones: La aspergilosis pulmonar asociada a la COVID-19 es una complicación que debe considerarse y buscarse en pacientes con historia reciente de esta enfermedad(AU)
Introduction: The new SARS-CoV-2 coronavirus disease (COVID-19) spread rapidly throughout the world, which created a great challenge. The appearance of coinfections is among the most serious complications that these patients can develop. Pulmonary aspergillosis has been identified as a complication of COVID-19 pneumonia among ventilated patients in intensive care. Objective: To present an unusual clinical case of pulmonary aspergillosis. Clinical case: It is presented the case of a patient with a recent history of COVID-19, with an enteral clinical picture of diarrhea and vomiting plus respiratory failure, in which the evolution of colon cancer and ventilator-associated pneumonia caused by Aspergillus niger are concomitant. Conclusions: Pulmonary aspergillosis associated with COVID-19 is a complication that should be considered and sought in patients with a recent history of this disease(AU)
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Humanos , Femenino , Anciano , Aspergilosis/etiología , Infecciones del Sistema Respiratorio , Neumonía Asociada al Ventilador/etiología , Aspergilosis Pulmonar/complicaciones , COVID-19/etiología , Unidades de Cuidados IntensivosRESUMEN
Data published on Panamanian fungal disease are scarce, mostly case reports. To date, there is no paper that compiles the burden of fungal disease Here we estimate for the first time the incidence and prevalence of fungal diseases in Panama. Data on fungal disease were obtained from different search engines: PubMed, Google Scholar, Scielo and Lilacs. For population and at risk diseases, we used statistics from worldometer, UNAIDS, and WHO. Incidence, prevalence, and absolute numbers were calculated based on the population at risk. Panamanian population in 2022 was 4,429,739. We estimated that 85,530 (1.93 %) people suffer from fungal diseases. The most frequent fungal infection was recurrent Candida vaginitis (3285/100,000). There are 31,000 HIV-infected people in Panama and based on the number of cases not receiving anti-retroviral therapy (14,570), and previous reports of prevalence of opportunistic infections, we estimated annual incidences of 4.0/100,000 for cryptococcal meningitis, 29.5/100,000 for oral candidiasis, 23.1/100,000 for esophageal candidiasis, 29.5/100,000 for Pneumocystis pneumonia, 15.1/100,000, and for histoplasmosis. For chronic pulmonary aspergillosis (CPA) and fungal asthma we used data from Guatemala and Colombia to estimate COPD and asthma prevalence and WHO report for tuberculosis. We estimated annual incidences of 6.1/100,000 for invasive aspergillosis and prevalence of 31.5/100,000 for CPA, 60.2/100,000 for allergic bronchopulmonary aspergillosis, and 79.5/100,000 for severe asthma with fungal sensitisation. Other incidence estimates were 5.0/100,000 for candidaemia, 0.20/100,000 for mucormycosis, and 4.97/100,000 for fungal keratitis. Even though this report on burden of fungal disease is a forward step, more epidemiological studies to validate these estimates are needed.
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Infecciones Oportunistas Relacionadas con el SIDA , Aspergilosis , Asma , Candidemia , Candidiasis , Aspergilosis Pulmonar , Femenino , Humanos , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Aspergilosis/microbiología , Candidiasis/microbiología , Aspergilosis Pulmonar/microbiología , Asma/epidemiología , Candidemia/epidemiología , Incidencia , PrevalenciaRESUMEN
BACKGROUND: Damage due to respiratory viruses increases the risk of bacterial and fungal coinfections and superinfections. High rates of invasive aspergillosis are seen in severe influenza and COVID-19. This report describes CAPA cases diagnosed during the first wave in the biggest reference centre for severe COVID-19 in Mexico. OBJECTIVES: To describe the clinical, microbiological and radiological characteristics of patients with invasive pulmonary aspergillosis associated with critical COVID-19, as well as to describe the variables associated with mortality. METHODS: This retrospective study identified CAPA cases among individuals with COVID-19 and ARDS, hospitalised from 1 March 2020 to 31 March 2021. CAPA was defined according to ECMM/ISHAM consensus criteria. Prevalence was estimated. Clinical and microbiological characteristics including bacterial superinfections, antifungal susceptibility testing and outcomes were documented. RESULTS: Possible CAPA was diagnosed in 86 patients among 2080 individuals with severe COVID-19, representing 4.13% prevalence. All CAPA cases had a positive respiratory culture for Aspergillus species. Aspergillus fumigatus was the most frequent isolate (64%, n = 55/86). Seven isolates (9%, n = 7/80) were resistant to amphotericin B (A. fumigatus n = 5/55, 9%; A. niger, n = 2/7, 28%), two A. fumigatus isolates were resistant to itraconazole (3.6%, n = 2/55). Tracheal galactomannan values ranged between 1.2 and 4.05, while serum galactomannan was positive only in 11% (n = 3/26). Bacterial coinfection were documented in 46% (n = 40/86). Gram negatives were the most frequent cause (77%, n = 31/40 isolates), from which 13% (n = 4/31) were reported as multidrug-resistant bacteria. Mortality rate was 60% and worse prognosis was seen in older persons, high tracheal galactomannan index and high HbA1c level. CONCLUSIONS: One in 10 individuals with CAPA carry a resistant Aspergillus isolate and/or will be affected by a MDR bacteria. High mortality rates are seen in this population.
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COVID-19 , Coinfección , Aspergilosis Pulmonar Invasiva , Aspergilosis Pulmonar , Sobreinfección , Humanos , Anciano , Anciano de 80 o más Años , México/epidemiología , Estudios Retrospectivos , COVID-19/complicaciones , Aspergilosis Pulmonar Invasiva/complicaciones , Aspergilosis Pulmonar Invasiva/tratamiento farmacológico , Aspergilosis Pulmonar Invasiva/epidemiología , Bacterias , HospitalesRESUMEN
La aspergilosis es una infección fúngica causada por el microorganismo Aspergillus spp. Las manifestaciones clínicas dependen del estado inmunológico del paciente y de las alteraciones estructurales del parénquima pulmonar. Pese a su baja incidencia, siempre se debe considerar como diagnóstico diferencial en el contexto de pacientes con enfermedades pulmonares de base. Se presenta un caso de hombre de 66 años, agricultor, con antecedente de tuberculosis pulmonar y enfermedad pulmonar obstructiva crónica, quien consultó por cuadro de 5 meses de disnea progresiva, fiebre, tos, hemoptisis y pérdida de peso. Los hallazgos imagenológicos fueron sugestivos de tuberculosis pulmonar asociado a aspergiloma, lo que fue confirmado por tinción de hidróxido de potasio (KOH) y cultivo de hongos positivo para Aspergillus fumigatus. El Gene Xpert fue positivo para Mycobacterium tuberculosis demostrando coinfección activa.
Aspergillosis is a fungal infection caused by the microorganism Aspergillus spp. Clinical manifestations depend on the patient's immune status and structural alterations of the lung parenchyma. Despite its low incidence, it should always be considered as a differential diagnosis in the context of patients with underlying lung diseases. We present the case of a 66-year-old male farmer, with a history of pulmonary tuberculosis and chronic obstructive pulmonary disease, who presented with progressive dyspnea months, fever, cough, hemoptysis and weight loss for 5 months. Imaging findings were suggestive of aspergiloma- associated pulmonary tuberculosis, which was confirmed by potassium hydroxide (KOH) staining and positive fungal culture for Aspergillus fumigatus. Gene Xpert was positive for Mycobacterium tuberculosis showing active co-infection.
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Humanos , Masculino , Anciano , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico , Aspergilosis Pulmonar/complicaciones , Aspergilosis Pulmonar/diagnóstico , Aspergillus fumigatus/aislamiento & purificación , Tuberculosis Pulmonar/microbiología , Enfermedad Crónica , Enfermedad Pulmonar Obstructiva Crónica , Diagnóstico Diferencial , Aspergilosis Pulmonar/microbiología , Coinfección , Mycobacterium tuberculosis/aislamiento & purificaciónRESUMEN
INTRODUCCIÓN: Desde el inicio de la pandemia por COVID-19 se han registrado casos de infecciones de aspergilosis pulmonar asociada a esta infección, la cual tiene características diferentes a la aspergilosis pulmonar clásica y, por lo tanto, han significado un desafío diagnóstico. OBJETIVO: Validar una reacción de polimerasa en cadena (RPC) en tiempo real (sigla en inglés RT-PCR) comercial, como herramienta diagnóstica alternativa a la técnica de galactomanano (GM) en el diagnóstico de aspergilosis pulmonar asociada a COVID-19 (sigla en inglés CAPA). PACIENTES Y MÉTODO: Se analizaron resultados de RT-PCR de Aspergillus spp y GM en lavado bronco-alveolar (LBA) de 72 pacientes, hospitalizados por COVID-19 de Clínica Dávila entre los años 2020 y 2021. De estos pacientes, 33 presentaron CAPA. RESULTADOS: La RT-PCR de Aspergillus y GM presentaron una correlación positiva (r = 0,6351, valor p < 0,0001). La técnica de RT-PCR presentó una sensibilidad (S), especificidad (E), valor predictor positivo (VPP) y valor predictor negativo (VPN) de 100, 44, 66 y 100%, respectivamente, mientras que en GM fueron de 64, 89, 84 y 73%, respectivamente para LBA. Al utilizar ambas técnicas en combinación se obtuvo una S, E, VPP y VPN de 100, 82, 88 y 100%, respectivamente. CONCLUSIÓN: Este estudio concluyó que usar una técnica de RT-PCR de Aspergillus y GM en conjunto en LBA mejoraron los parámetros de desempeño de ambas técnicas usadas de manera individual para diagnosticar CAPA. Se requieren más estudios para evaluar el desempeño de técnicas combinadas en otros tipos de aspergilosis.
BACKGROUND: Since the beginning of the COVID-19 pandemic, there have been cases of pulmonary aspergillosis infections associated with this infection, which has different characteristics from classical pulmonary aspergillosis and therefore, have been diagnostic challenges. AIM: To validate a commercial real-time PCR (RT-PCR) method as an alternative diagnostic tool to the galactomannan (GM) technique in the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA). METHODS: Results of RT-PCR of Aspergillus spp and GM in broncho-alveolar lavage (BAL) of 72 patients hospitalized for COVID-19 at Clínica Dávila between 2020 and 2021 were analyzed. Of these patients, 33 presented CAPA. RESULTS: The RT-PCR for Aspergillus and GM showed a positive correlation (r = 0.6351, p-value < 0.0001). The RT-PCR for Aspergillus technique presented a sensitivity (S), specificity (S), positive predictive value (PPV) and negative predictive value (NPV) of 100, 44, 66 and 100% respectively, while the GM technique presented 64, 89, 84 and 73%, respectively for BAL. Using both techniques in combination a S, E, PPV and NPV of 100, 82, 88 and 100% were obtained respectively. CONCLUSION: This study concluded that using RT-PCR and GM techniques in combination in BAL improved the performance parameters of both techniques from those used individually to diagnose CAPA. Further studies are required to evaluate the performance of combined techniques in other aspergillosis focus.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Aspergilosis Pulmonar/diagnóstico , Reacción en Cadena en Tiempo Real de la Polimerasa , COVID-19/complicaciones , Aspergillus/aislamiento & purificación , Ensayo de Inmunoadsorción Enzimática , Líquido del Lavado Bronquioalveolar/microbiología , Chile , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Aspergilosis Pulmonar/complicaciones , Galactosa/análogos & derivados , Mananos/análisisRESUMEN
BACKGROUND: A clear cutoff value of galactomannan (GM) has not been established for chronic pulmonary aspergillosis (CPA) and is frequently extrapolated from invasive pulmonary aspergillosis. We performed a systematic review and meta-analysis to evaluate the diagnostic performance of serum and bronchoalveolar lavage (BAL) GM, and to propose a cutoff. METHODS: We extracted from the studies the cutoff of serum or/and BAL GM associated with true positives, false positives, true negatives, and false negatives. We performed a multi-cutoff model and a non-parametric random effect model. We estimated the optimal cutoff and the area under the curve (AUC) for GM in serum and BAL samples. RESULTS: Nine studies from 1999 to 2021 were included. Overall, the optimal cutoff of serum GM was 0.96 with a sensitivity of 0.29 (95%CI: 0.14-0.51); specificity of 0.88 (95%CI: 0.73-0.95); and AUC of 0.529 (with a CI: [0.415-0.682] [0.307-0.713]). The AUC for the non-parametric ROC model was 0.631. For BAL GM the cutoff was 0.67 with a sensitivity of 0.68 (95%CI: 0.51-0.82), specificity of 0.84 (95%CI: 0.70-0.92), and AUC of 0.814 (with a CI: [0.696-0.895] [0.733-0.881]). The AUC for the non-parametric model was 0.789. CONCLUSION: The diagnosis of CPA requires the assessment of a combination of mycological and serological factors, as no single serum and/or BAL GM antigen test is adequate. BAL GM performed better than serum, with better sensitivity and excellent accuracy.
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Aspergilosis Pulmonar , Humanos , Sensibilidad y Especificidad , Líquido del Lavado Bronquioalveolar/microbiología , Aspergilosis Pulmonar/diagnóstico , Lavado Broncoalveolar , Mananos/análisisRESUMEN
COVID-19-Associated Pulmonary Aspergillosis (CAPA) is a relatively common complication in patients with severe forms of the disease caused by the SARS-CoV-2 virus. Diagnosing and confirming CAPA is challenging. In this study, Aspergillus spp. isolation in respiratory specimens from patients with COVID-19 was evaluated for identifying cases of CAPA. In 2020â2021, 17 Aspergillus spp. were isolated from 15 COVID-19 patients admitted to a university hospital in Brazil. Patient records were retrospectively reviewed to obtain clinical-epidemiological data and other markers of Aspergillus spp. infection and then compared with the ECMM/ISHAM criteria for defining CAPA. Probable CAPA was defined in 5/10 patients, who had Aspergillus spp. isolated from Bronchoalveolar Lavage (BAL) or a positive galactomannan blood test. Additionally, anti-Aspergillus antibodies were detected in two of these patients, during active or follow-up phases of CAPA. In another seven patients with Aspergillus spp. isolated from tracheobronchial aspirate or sputum, CAPA was presumed, mainly due to deterioration of clinical conditions and new lung imaging suggestive of fungal infection. Antifungal agents to control CAPA, particularly voriconazole, were used in 9/15 cases. In cases of probable CAPA and remaining patients, clinical conditions and comorbidities were similar, with lethality being high, at 60% and 71%, respectively. The number of CAPA cases defined by scientific criteria was lower than that assumed in the clinical context. This was largely due to the lack of BAL collection for fungal culture and the non-intensive use of other markers of invasive aspergillosis. The isolation of Aspergillus spp. in different respiratory specimens should alert clinicians to the diagnosis of CAPA.
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Aspergilosis , COVID-19 , Aspergilosis Pulmonar , Humanos , Estudios Retrospectivos , SARS-CoV-2 , Aspergillus , Aspergilosis Pulmonar/diagnóstico , DimercaprolRESUMEN
BACKGROUND: Untreated HIV infection can lead to profound immunosuppression and increase susceptibility of people living with HIV/AIDS (PLHA) to aspergillosis. OBJECTIVES: Reporting the burden and natural history of aspergillosis documented in PLHA admitted in five medical centres in Brazil. PATIENTS AND METHODS: Clinical, epidemiological and laboratory data were collected in all sequential cases of proven or probable aspergillosis documented in PLHA hospitalised in five medical centres between 2012 and 2020. RESULTS: We enrolled 25 patients ageing between 23 and 58 years (mean = 39) including 11 patients with invasive aspergillosis (IA) and 14 with chronic pulmonary aspergillosis (CPA). The prevalence rate of aspergillosis was 0.1% of 19.616 PLHA. Overall, 72.7% of patients with IA exhibited CD4 < 100 cells/mL and 42.8% of patients with CPA exhibited CD4 count >200 cells/mL. Most patients had a history of tuberculosis, especially those with CPA (85.7%). IA was documented after a mean of 16.5 days of hospitalisation, mainly in critically ill patients exposed to corticosteroids and broad-spectrum antibiotics. In the CPA group, a positive culture (71.4%) and radiological alterations were the most frequent findings supporting their diagnosis. Episodes of IA were mostly documented by tissue biopsies. Crude mortality rates were 72.7% and 42.8% in patients with IA and CPA, respectively. CONCLUSIONS: Despite being considered an unusual complication in PLHA (0.1%), IA should be considered in patients with profound immunosuppression and pneumonia refractory to conventional therapy. CPA should be investigated in PLHA with chronic deterioration of pulmonary function and previous diagnosis of tuberculosis.
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Aspergilosis , Infecciones por VIH , Aspergilosis Pulmonar , Humanos , Infecciones por VIH/complicaciones , Aspergilosis/tratamiento farmacológico , Aspergilosis Pulmonar/complicaciones , Brasil/epidemiologíaRESUMEN
Chronic pulmonary aspergillosis (CPA) is divided into five subtypes. The diagnosis of CPA is complicated due to poor sensitivity of the laboratory tests. Diagnostic performance of different antigen, serological, and microbiological methods in subtypes of CPA is unknown. The purpose of this study was to evaluate the diagnostic performance in different subtypes of CPA. A total of 91 participants with CPA were included, and the study was performed at Hospital das Clínicas of University of São Paulo. Bronchoalveolar lavage galactomannan (73%, 11/15), serology by immunodiffusion test (81%, 61/75), and histology (78%, 39/50) had the best sensitivity. The counterimmunoelectrophoresis (CIE) titers had a significant statistical difference between the CPA subtypes (P < 0.001), in which the forms chronic fibrosing pulmonary aspergillosis (CFPA) and subacute invasive aspergillosis (SAIA) had higher titers: 1/64 (interquartile range [IQR]: 1/32-1/256) and 1/64 (1/32-1/128). C-reactive protein generally presented lower values (median 15 mg/L, IQR: 6-33), with higher values in SAIA and lower values for Aspergillus nodule. Overall, we found a low diagnostic sensitivity of current tests. Regarding the CPA subtypes, we did not find great differences in the performance of the tests, but it is observed that the inflammatory markers and CIE titers tend to be higher in forms of the more extensive lung parenchyma involvement, such as SAIA and CFPA.
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Aspergilosis Pulmonar , Humanos , Brasil/epidemiología , Aspergilosis Pulmonar/diagnóstico , Aspergillus , Pulmón , Hospitales de Enseñanza , Enfermedad CrónicaRESUMEN
OBJECTIVES: Chronic pulmonary aspergillosis (CPA) is a research priority in fungal diseases with a need for new studies to reduce misdiagnosis with more common diseases, discuss improvement in diagnostic methods and better characterize gaps in antifungal and surgical treatments to improve clinical outcomes. METHODS: In this retrospective study, we reviewed medical records of patients diagnosed with CPA from January 2010 to June 2021 at University of São Paulo, São Paulo, Brazil. We evaluated clinical characteristics, radiological findings, serology, treatment, and outcomes. RESULTS: The study included 91 participants, with 43 (47.3%) patients who underwent surgery and 69 (75.8%) received antifungal therapy. We found a predominance of middle-aged adults (median 51 years), males (n = 58, 64%) with lower BMI (median 21.3 kg/m2). The most common underlying lung disease was pulmonary tuberculosis (n = 70, 76.9%). The commonest symptoms were cough (n = 67, 74%), haemoptysis, and dyspnea (n = 63, 70%). The most common chest computerized tomography abnormalities were cavity (n = 86, 94.5%), with a predominance of mycetomas (n = 78, 91%). The serology was positive in 81% (61/75). The one-year mortality was low (3.3%). Clinical improvement and stability occurred in 89% of participants for constitucional symptoms and 86% for pulmonary symptoms. While serological improvement and stability occurred in 71%. Radiological improvement and stability occurred in 75%. CONCLUSION: We observed a good outcome after 1-year follow-up, in which the majority had improvement or stability of pulmonary and constitutional symptoms, decrease in CIE titers and low mortality.
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Antifúngicos , Aspergilosis Pulmonar , Adulto , Masculino , Persona de Mediana Edad , Humanos , Antifúngicos/uso terapéutico , Estudios Retrospectivos , Brasil/epidemiología , Aspergilosis Pulmonar/diagnóstico , Aspergilosis Pulmonar/tratamiento farmacológico , Aspergilosis Pulmonar/epidemiología , Pulmón , Enfermedad CrónicaRESUMEN
Aspergillus fumigatus is a ubiquitous and saprophytic filamentous fungus and the main etiologic agent of aspergillosis. Infections caused by A. fumigatus culminate in a strong inflammatory response that can evolve into respiratory failure and may be lethal in immunocompromised individuals. In the last decades, it has been demonstrated that extracellular vesicles (EVs) elicit a notable biological response in immune cells. EVs carry a variety of biomolecules, therefore are considered potential antigen delivery vehicles. The role of EVs as a strategy for modulating an effective response against infections caused by A. fumigatus remains unexplored. Here we investigate the use of EVs derived from A. fumigatus as an immunization tool to induce a more robust immune response to A. fumigatus pulmonary infection. In order to investigate that, male C57BL/6 mice were immunized with two doses of EVs and infected with A. fumigatus. Pre-exposure of mice to EVs was able to induce the production of specific IgG serum for fungal antigens. Besides that, the immunization with EVs reduced the neutrophilic infiltrate into the alveoli, as well as the extravasation of total proteins and the production of proinflammatory mediators IL-1ß, IL-6, and CXCL-1. In addition, immunization prevented extensive lung tissue damage and also improved phagocytosis and fungus clearance. Noteworthy, immunization with EVs, associated with subclinical doses of Amphotericin B (AmB) treatment, rescued 50% of mice infected with A. fumigatus from lethal fungal pneumonia. Therefore, the present study shows a new role for A. fumigatus EVs as host inflammatory response modulators, suggesting their use as immunizing agents.
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Aspergilosis , Vesículas Extracelulares , Aspergilosis Pulmonar , Animales , Aspergillus fumigatus , Modelos Animales de Enfermedad , Masculino , Ratones , Ratones Endogámicos C57BLAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Manejo de la Enfermedad , Aspergilosis Pulmonar/diagnóstico , Aspergilosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/complicaciones , Tomografía Computarizada por Rayos X , Prevalencia , Aspergilosis Pulmonar/mortalidad , Aspergilosis Pulmonar/epidemiologíaRESUMEN
El síndrome del edificio enfermo, se refiere a un conjunto de síntomas generales en mucosa (ocular y/o respiratoria) y piel que presentan los ocupantes de edificaciones con calidad ambiental deficientes, exponiendo a sus ocupantes a factores de riesgos físicos, mecánicos, químicos, biológicos y psicosociales, que puede afectar negativamente la salud y productividad de las personas. Con el propósito de determinar la frecuencia de los síntomas de los ocupantes de una industria manufacturera del Perú, se realizó estudio transversal aplicándose a 237 trabajadores, estratificados por áreas laborales, el cuestionario sugerido por el Instituto Nacional de Higiene y Seguridad en el Trabajo, además de evaluar la condición ambiental mediante la determinación de bioaerosoles cultivables y contables. Los resultados mostraron prevalencia superior al 20% en síntomas como: sequedad en ojos y garganta, picor en garganta congestión nasal, dolor de cabeza y debilidad general. Se tomaron, cuantificaron y caracterizaron 164 muestras de bioaerosoles, los microrganismos encontrados con mayor porcentaje fueron, Aspergillus sp. 54,68% (68) en el área administrativa, mientras que en las áreas de producción y almacén predomino Penicillium sp. con 87,10% (108) y 62,21% (77) respectivamente. Otros géneros encontrados en mayor porcentajes, en las tres áreas fueron: Trichoderma, Acremonium, Monilia, Cladosporium, entre otros. Los hallazgos se correlacionan con lo reportado en diversas investigaciones, la presencia de mencionados hongos, sugiere que existe una inadecuada calidad ambiental y aunada a la prevalencia obtenida en cuanto a sintomatología, se puede clasificar la edificación objeto de estudio con el Síndrome del edificio enfermo(AU)
Sick building syndrome refers to a set of general mucosal (ocular and/or respiratory) and skin symptoms presented by occupants of buildings with poor environmental quality, exposing their occupants to physical, mechanical, chemical, biological and psychosocial, which can negatively affect the health and productivity of people. In order to determine the frequency of the symptoms of the occupants of a manufacturing industry in Peru, a cross-sectional study was carried out, applying to 237 workers, stratified by work areas, the questionnaire suggested by the National Institute of Hygiene and Safety at Work, in addition to to evaluate the environmental condition by determining cultivable and countable bioaerosols. The results showed a prevalence greater than 20% in symptoms such as: dry eyes and throat, itchy throat, nasal congestion, headache and general weakness. 164 samples of bioaerosols were taken, quantified and characterized, the microorganisms found with the highest percentage were Aspergillus sp. 54.68% (68) in the administrative area, while in the production and storage areas, Penicillium sp. with 87.10% (108) and 62.21% (77) respectively. Other genera found in higher percentages in the three areas were: Trichoderma, Acremonium, Monilia, Cladosporium, among others. The findings correlate with what has been reported in various investigations, the presence of these fungi suggests that there is an inadequate environmental quality and, together with the prevalence obtained in terms of symptoms, the building under study can be classified with the Sick Building Syndrome(AU)
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Humanos , Masculino , Adulto , Persona de Mediana Edad , Estudios Transversales , Síndrome del Edificio Enfermo/etiología , Síndrome del Edificio Enfermo/epidemiología , Contaminación del Aire/efectos adversos , Aspergilosis Pulmonar/epidemiología , Perú/epidemiología , Asma , Rinitis , Trastornos de Cefalalgia , Otomicosis , Industria ManufactureraRESUMEN
BACKGROUND: Data on the prevalence of chronic pulmonary aspergillosis (CPA) in patients with active or cured tuberculosis (TB) are scarce, mainly due to diagnostic difficulties. The diagnosis of CPA is based on pulmonary symptoms and chest computed tomography (CT) scans and is considered confirmed when there is microbiological or serological evidence of Aspergillus spp. OBJECTIVES: To estimate the prevalence of CPA in patients treated or undergoing treatment for PTB, seen in two referral hospitals in Mato Grosso do Sul, Brazil. PATIENTS AND METHODS: A total of 193 consecutive patients who were treated or previously treated for pulmonary tuberculosis underwent prospective evaluation: (a) clinical evaluation; (b) chest CT scan; (c) sputum examination-culture for fungi and smears for direct mycology; (d) detection of anti-Aspergillus fumigatus antibodies using an enzyme-linked immunosorbent assay Platelia® test; and (e) anti-Aspergillus spp. antibodies were assessed via a DID test. RESULTS: The global prevalence of CPA was 10.9% (95% confidence interval, 7.2%-16.1%), but it increased with the time of TB diagnosis. The variables independently associated with CPA were previous pulmonary tuberculosis over 4 years ago and haemoptysis. Cavities, pleural thickening and the presence of a fungal ball were the most frequent tomographic findings in patients with CPA. CONCLUSIONS: The high prevalence observed and its increase over time suggest the need for continuous surveillance of CPA in patients with active or previous pulmonary tuberculosis and throughout life, with clinical, tomographic and serological evaluations (ELISA) for a timely diagnosis and a better prognosis.
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Aspergilosis Pulmonar , Tuberculosis Pulmonar , Tuberculosis , Aspergillus , Brasil/epidemiología , Enfermedad Crónica , Humanos , Infección Persistente , Prevalencia , Estudios Prospectivos , Aspergilosis Pulmonar/complicaciones , Aspergilosis Pulmonar/diagnóstico , Aspergilosis Pulmonar/epidemiología , Tuberculosis/complicaciones , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/epidemiologíaRESUMEN
COVID-19-associated pulmonary aspergillosis (CAPA) incidence varies depending on the country. Serum galactomannan quantification is a promising diagnostic tool since samples are easy to obtain with low biosafety issues. A multicenter prospective study was performed to evaluate the CAPA incidence in Argentina and to assess the performance of the lateral flow assay with digital readout (Sona Aspergillus LFA) as a CAPA diagnostic and screening tool. The correlation between the values obtained with Sona Aspergillus LFA and Platelia® EIA was evaluated. In total, 578 serum samples were obtained from 185 critically ill COVID patients. CAPA screening was done weekly starting from the first week of ICU stay. Probable CAPA incidence in critically ill patients was 10.27% (19/185 patients when LFA was used as mycological criteria) and 9% (9/100 patients when EIA was used as mycological criteria). We found a very good correlation between the two evaluated galactomannan quantification methods (overall agreement of 92.16% with a Kappa statistic value of 0.721). CAPA diagnosis (>0.5 readouts in LFA) were done during the first week of ICU stay in 94.7% of the probable CAPA patients. The overall mortality was 36.21%. CAPA patients' mortality and length of ICU stay were not statistically different from for COVID (non-CAPA) patients (42.11 vs 33.13% and 29 vs 24 days, respectively). These indicators were lower than in other reports. LFA-IMMY with digital readout is a reliable tool for early diagnosis of CAPA using serum samples in critically ill COVID patients. It has a good agreement with Platelia® EIA. LAY SUMMARY: The incidence of COVID-associated pulmonary aspergillosis (CAPA) in critically-ill Argentinian patients was established (10.27%). Serum galactomannan quantification was useful as a screening tool for this mycosis. A good agreement between Platelia® EIA and Sona Aspergillus LFA is reported.
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COVID-19 , Aspergilosis Pulmonar Invasiva , Aspergilosis Pulmonar , Animales , Argentina/epidemiología , Aspergillus , COVID-19/diagnóstico , COVID-19/veterinaria , Enfermedad Crítica , Galactosa/análogos & derivados , Humanos , Aspergilosis Pulmonar Invasiva/diagnóstico , Aspergilosis Pulmonar Invasiva/veterinaria , Mananos , Estudios Prospectivos , Aspergilosis Pulmonar/diagnóstico , Aspergilosis Pulmonar/veterinaria , Sensibilidad y EspecificidadRESUMEN
A 52-year-old female was admitted to our hospital in April 2021 with dyspnea. She was discharged from the hospital 3 weeks ago due to the diagnosis of pneumonia caused by coronavirus disease 2019 (COVID-19). Physical examination revealed an oxygen desaturation of 82%. The patient underwent computed tomography angiography (CTA) that showed a ground-glass pattern and a giant left atrial appendage ( Figure 1A ). Film array respiratory panel was negative, and pulmonary aspergillosis was diagnosed after bronchoscopy. Cardiac magnetic resonance corroborated the huge left atrial appendage ( Figure 1B ). No other structural or functional heart abnormalities were diagnosed. A giant left atrial appendage is a rare cardiac anomaly that can be congenital or acquired. In the literature, it is called a left atrial appendage aneurysm. The dilatation can be generalized or focused. Although it can occur in all age groups, it is predominant in patients in their 30s to 50s and most common in females.1 Patients can be asymptomatic or present with symptoms such as palpitations, chest pain, or dyspnea. A number of recent cases in the literature have highlighted the diagnostic utility of CTA.2 While there is no standard treatment for this condition, surgical resection is the most frequent therapy. Another option reported in the literature is anticoagulant treatment for select cases.3 Closure of the left atrial appendage is a more recent and emerging intervention that can be considered. In our patient, we initiated anticoagulant therapy to reduce the risk of thromboembolic events; however, we recommended left atrial appendage occlusion or surgical resection after completing the treatment for pulmonary aspergillosis.
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Apéndice Atrial , COVID-19 , Aneurisma Cardíaco , Cardiopatías Congénitas , Aspergilosis Pulmonar , Anticoagulantes , Apéndice Atrial/diagnóstico por imagen , Disnea/etiología , Femenino , Aneurisma Cardíaco/cirugía , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnóstico por imagen , Cardiopatías Congénitas/cirugía , Humanos , Persona de Mediana Edad , Aspergilosis Pulmonar/patologíaRESUMEN
INTRODUCTION: Pulmonary aspergilloma is commonly associated with comorbidities that cause immunodeficiency such as diabetes mellitus, tuberculosis, human immunodeficiency virus/acquired immunodeficiency syndrome and/or a pre-existing parenchymal lung disease such as chronic obstructive pulmonary disease. Predisposing factors can further increase the risk of acquiring this mycosis. Our objective was to determine the frequency, clinical and microbiological characteristics of pulmonary aspergilloma in immunocompromised patients. METHODOLOGY: Retrospective case series of patients diagnosed with pulmonary aspergilloma in a respiratory care unit in Mexico City from 2000 to 2019 was studied. Bronchoalveolar lavage cultures on Sabouraud-dextrose agar and serum galactomannan determination were performed on each patient. RESULTS: We identified twenty-four patients with pulmonary aspergilloma (sixteen male and eight female), thirteen had a history of tuberculosis (54%), seven of diabetes mellitus (29%), three of human immunodeficiency virus/acquired immunodeficiency syndrome (13%) and one of chronic obstructive pulmonary disease (4%). The most commonly reported symptoms were hemoptysis in eighteen patients (75%), dyspnea in sixteen patients (67%) and chest pain in thirteen patients (54%). Aspergillus fumigatus was identified in all cultures and galactomannan was positive in 21 serum samples (87%). CONCLUSIONS: Coexistence of diseases that could suppress the immune system predispose to pulmonary aspergilloma; clinical presentation is often confused with other systemic diseases. A high degree of clinical suspicion is important for early detection.