RESUMO
BACKGROUND: COVID-19 patients on mechanical ventilation are at risk to develop invasive aspergillosis. To provide additional data regarding this intriguing entity, we conducted a retrospective study describing risk factors, radiology and prognosis of this emerging entity in a Brazilian referral centre. METHODS: This retrospective study included intubated (≥18 years) patients with COVID-19 admitted from April 2020 until July 2021 that had bronchoscopy to investigate pulmonary co-infections. COVID-19-associated aspergillosis (CAPA) was defined according to the 2020 European Confederation of Medical Mycology/International Society of Human and Animal Mycosis consensus criteria. The performance of tracheal aspirate (TA) cultures to diagnose CAPA were described, as well as the radiological findings, risk factors and outcomes. RESULTS: Fourteen patients (14/87, 16%) had probable CAPA (0.9 cases per 100 ICU admissions). The sensitivity, specificity, positive predictive value and negative predictive value of TA for the diagnosis of CAPA were 85.7%, 73.1%, 46.2% and 95% respectively. Most of the radiological findings of CAPA were classified as typical of invasive pulmonary aspergillosis (64.3%). The overall mortality rate of probable CAPA was 71.4%. Age was the only independent risk factor for CAPA [p = .03; odds ratio (OR) 1.072]. CAPA patients under renal replacement therapy (RRT) may have a higher risk for a fatal outcome (p = .053, hazard ratio 8.047). CONCLUSIONS: CAPA was a prevalent co-infection in our cohort of patients under mechanical ventilation. Older patients had a higher risk to develop CAPA, and a poor prognosis may be associated with RRT.
Assuntos
COVID-19 , Aspergilose Pulmonar Invasiva , Animais , Brasil/epidemiologia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/microbiologia , COVID-19/terapia , Humanos , Intubação , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/epidemiologia , Aspergilose Pulmonar Invasiva/terapia , Aspergilose Pulmonar Invasiva/virologia , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/isolamento & purificaçãoRESUMO
Os autores estiveram no Parque Ouro Branco com moradores e funcionários da Unidade Básica de Saúde local e conheceram os principais problemas relacionados à saúde da comunidade. Devido à alta incidência de parasitoses intestinais na regiäo, sobretudo em crianças, o grupo escolheu abordar esse tema, fazendo o diagnóstico, profilaxia e tratamento. Foram realizados exames parasitológicos nos quais foi constatada a grande prevalência da doença em questäo nas crianças. Os resultados foram levados até a Unidade Básica de Saúde, que se responsabilizou pela medicaçäo. Posteriormente, foi coletado material para novos exames, verificando-se que apenas algumas dessas crianças continuaram infestadas. A atuaçäo profilática do grupo deu-se por meio de palestras educativas a criança e seus pais e também com um teatro de fantoches seguido de uma gincana realizada na creche do Parque Ouro Branco