Category: COVID-19 Complications, Co-infections, and Clinical Outcomes

Poster Session: COVID-19 Complications, Co-infections, and Clinical Outcomes

356 - Clinical characteristics of critically ill patients with COVID-19 and invasive pulmonary aspergillosis: a case series from Mexico City

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Presenting Author(s)

BV

Benjamin VALENTE ACOSTA

Staff physician
The American British Cowdray Medical Center
MEXICO, Mexico City, Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

FM

Francisco Moreno-Sanchez

Internal Medicine Director
The American British Cowdray Medical Center
Mexico City, Distrito Federal, Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LE

Luis Espinosa-Aguilar

Staff physician
The American British Cowdray Medical Center
Mexico city, Distrito Federal, Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
IH

Irma Hoyo-Ulloa

Staff physician
The American British Cowdray Medical Center
Mexico city, Distrito Federal, Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RM

Raquel Mendoza-Aguilar

Staff physician
The American British Cowdray Medical Center
Mexico City, Distrito Federal, Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JG

Javier Garcia-Guerrero

Staff physician
The American British Cowdray Medical Center
Mexico city, Distrito Federal, Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DO

Diego Ontañon-Zurita

Staff physician
The American British Cowdray Medical Center
Mexico City, Distrito Federal, Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Brenda Gomez-Gomez

Staff physician
The American British Cowdray Medical Center
Álvaro Obregón, Distrito Federal, Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CO

Claudia Olvera-Guzman

Staff physician
The American British Cowdray Medical Center
Mexico City, Distrito Federal, Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MC

Margarita Cebada-López

Microbiologist
The American British Cowdray Medical Center
Mexico City, Distrito Federal, Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BZ

Beatriz Zuñiga-Mejía

Microbiologist
The American British Cowdray Medical Center
Mexico City, Distrito Federal, Mexico
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: COVID-19, caused by SARS-CoV-2, has emerged as a global public health emergency and has been the main cause of intensive care admission during the pandemic. Invasive pulmonary aspergillosis (IPA) superinfection has been reported in case series of critically ill patients. Mexico has been widely affected by SARS-CoV-2. We present a case series of COVID-19-associated IPA at a teaching hospital in Mexico City.

Methods: We performed a retrospective analysis of COVID-19 patients admitted to the ABC Medical Center from March 13 to June 1, 2020. Only those with severe or critical COVID-19 were hospitalized. Patients with a diagnosis of putative IPA were analyzed. SARS-CoV-2 was diagnosed by Real-Time PCR from nasopharyngeal swabs. Aspergillus antigen testing in tracheal aspirate and serum was done with Aspergillus-specific galactomannoprotein (GP) ELISA (Euroimmun Medizinische Labordiagnostika).The study was approved by the hospital ethics committee.

Results: Among the 47 admitted patients who required invasive mechanical ventilation (IMV), we identified seven (14.9%) cases of IPA. The mean age was 59.7 ± 17.8 years and five were male. All our patients had comorbidities, but none were under previous immunosuppressive treatment. All had critical COVID-19 pneumonia requiring IMV. All but one patient received corticosteroids, and five patients were treated with tocilizumab before IPA diagnosis. Putative IPA was diagnosed in six cases (86%) by a positive GP in tracheal aspirate, additionally in one of these, the tracheal aspirate culture also grew Aspergillus niger. The remaining one (14%) had a positive serum GP. The median time from COVID-19 to IPA diagnosis was 10 days. There were five bacterial co-infections, three with Pseudomonas aeruginosa, one with Stenotrophomonas maltophilia, and one with Mycobacterium tuberculosis. Six patients were treated with isavuconazole and one voriconazole. As of June 17, 2020, three patients had died, two patients had been discharged, and two were still in the intensive care unit receiving IMV.Aspergillus niger isolated from a tracheal aspirate of a critically-ill COVID-19 patient

Conclusion: COVID-19-associated IPA had a lower prevalence than previously reported in other series. However, it appears to be linked to high mortality and could be associated with other bacterial coinfections.