INVASIVE PULMONARY ASPERGILLOSIS AFTER CORTICOSTEROID THERAPY IN COVID 19

Yıl 2021, Cilt: 3 Sayı: 2, 48 - 59, 31.12.2021

Muhammed Emin Demirkol , Mehmet Balcı , Emine Afşin , Lütfiye Nur Uzun

Öz

Although corticosteroids are widely used in COVID-19 treatment protocols, they are discussed in terms of opportunistic infections and invasive pulmonary aspergillosis due to immune suppression. This study was conducted to present a case of invasive pulmonary aspergillosis associated with high-dose corticosteroid therapy in two cases diagnosed with COVID-19.
Both cases included in this study were young male patients who had no previous risk factor for invasive pulmonary aspergillosis, were diagnosed with hypertension, and did not have any addictions. Both cases received high-dose methylprednisolone treatment during the treatment of COVID-19 and invasive pulmonary aspergillosis infection developed in the post-covid period. One of the cases was accepted as exitus as a result of unresponsive cardiopulmonary resuscitation following the arrest that developed on the 81st day of the COVID-19 diagnosis and the 26th day of the IPA diagnosis, while the other was discharged with oxygen support on the 58th day of the COVID-19 diagnosis and the 19th day of the IPA diagnosis.
IPA should be considered as a life-threatening complication in patients diagnosed with COVID-19 and receiving immunosuppressive therapy. If long-term and high-dose corticosteroids are used in COVID-19 patients, it may be indicated to be careful in terms of IPA and to screen these patients for this purpose.

Anahtar Kelimeler

COVID-19, Invasive pulmonary aspergillosis, Corticosteroids

COVID-19’da Kortikosteroid Tedavi Sonrası Gelişen İnvazif Pulmoner Aspergilloz

Öz

COVID-19 tedavi protokollerinde kortikosteroidler yaygın olarak kullanılmasına rağmen bağışıklığın baskılaması nedeniyle fırsatçı enfeksiyonlar ve invaziv pulmoner aspergillozis yönünden tartışılmaktadır. Bu çalışma COVID-19 tanısı almış iki olguda yüksek doz kortikosteroid tedavisi ile ilişkili invaziv pulmoner aspergillozis olgusunu sunmak amacıyla yapılmıştır.
Bu çalışmada yer alan her iki olgu daha önce invaziv pulmoner aspergillozis yönünden risk faktörü olmayan, hipertansiyon tanısı almış ve herhangi bir bağımlılıkları bulunmayan genç erkek hastalardır. Her iki olguda COVID-19 tedavisi süreçlerinde yüksek doz metilprednizolon tedavisi almış ve post-covid dönemde invaziv pulmoner aspergillozis enfeksiyonu gelişmiştir. Vakaların biri COVID-19 tanısın 81. ve IPA tanısının 26. gününde gelişen arrestin ardından yanıtsız kardiyopulmoner resustasyon sonucunda exitus kabul edilirken, diğeri COVID-19 tanısının 58. ve IPA tanısının 19. gününde oksijen desteği ile taburcu edilmiştir.
IPA COVID-19 tanılı ve immünosupresif tedavi gören hastalarda yaşamı tehdit eden bir komplikasyon olarak düşünülmelidir. COVID-19 hastalarına uzun süreli ve yüksek doz kortikosteroid kullanılması halinde IPA yönünden dikkatli olunması ve bu hastaların bu amaçla taranması endike olabilir.

Anahtar Kelimeler

COVID-19, Invazif Pulmoner Aspergilloz, Kortikosteroid tedavi

Kaynakça

• Alanio, A., Dellière, S., Fodil, S., Bretagne, S. ve Mégarbane, B. (2020). Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19. The Lancet Respiratory Medicine, 8(6), e48–e49.
• Antinori, S., Rech, R., Galimberti, L., Castelli, A., Angeli, E., Fossali, T., … Torre, A. (2020). Invasive pulmonary aspergillosis complicating SARS-CoV-2 pneumonia: A diagnostic challenge. Travel medicine and infectious disease. doi: 10.1016/j.tmaid.2020.101752.
• Cano, E. J., Fonseca Fuentes, X., Corsini Campioli, C., O’Horo, J. C., Abu Saleh, O., Odeyemi, Y., … Temesgen, Z. (2020). Impact of Corticosteroids in Coronavirus Disease 2019 Outcomes: Systematic Review and Meta-analysis. Chest. doi:https://doi.org/10.1016/j.chest.2020.10.054
• Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., … Wei, Y. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet, 395(10223), 507–513.
• Erdem, İ., Doğan, M., KARAALİ, R., OMAR, Ş. E. ve ARDIÇ, E. (2018). İnvaziv Aspergilloz Tedavisi. Namık Kemal Tıp Dergisi, 6(2), 64–82.
• Falces‐Romero, I., Ruiz‐Bastián, M., Díaz‐Pollán, B., Maseda, E., García‐Rodríguez, J. ve Group, S. W. (2020). Isolation of Aspergillus spp. in respiratory samples of patients with COVID‐19 in a Spanish Tertiary Care Hospital. Mycoses, 63(11), 1144–1148.
• Fernandez, N. B., Caceres, D. H., Beer, K. D., Irrazabal, C., Delgado, G., Farias, L., … Stecher, D. (2020). Ventilator-associated pneumonia involving Aspergillus flavus in a patient with coronavirus disease 2019 (COVID-19) from Argentina. Medical Mycology Case Reports. doi:https://doi.org/10.1016/j.mmcr.2020.07.001
• Hagiya, H., Kuroe, Y., Nojima, H., Sugiyama, J., Naito, H., Hagioka, S., … Murase, T. (2013). Co-infection with invasive pulmonary aspergillosis and Pneumocystis jirovecii pneumonia after corticosteroid therapy. Journal of Infection and Chemotherapy, 19(2), 342–347.
• Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., … Gu, X. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet, 395(10223), 497–506. doi:https://doi.org/10.1016/S0140-6736(20)30183-5
• Huseynov, R., Javadov, S., Kadyrova, H., Karaltı, İ., Taqıyev, B., Asgarova, S. ve Hashımova, L. (2020). Diagnostic Significance of Aspergillus Species Isolated from Clinical Specimens. Mantar Dergisi, 11(1), 94–100.
• Klimke, A., Hefner, G., Will, B. ve Voss, U. (2020). Hydroxychloroquine as an aerosol might markedly reduce and even prevent severe clinical symptoms after SARS-CoV-2 infection. Medical hypotheses, 142, 109783.
• Koç, C., Otan, E. ve Hopoğlu, S. M. (2014). Karaciğer Nakli Sonrası Mortal Seyreden Bir Fırsatçı Enfeksiyon: İnvaziv Aspergillozis, 3, 817–820.
• Lai, C.-C. ve Yu, W.-L. (2020). COVID-19 associated with pulmonary aspergillosis: A literature review. Journal of Microbiology, Immunology and Infection, 54(1), 46-53.
• Machado, M., Valerio, M., Álvarez‐Uría, A., Olmedo, M., Veintimilla, C., Padilla, B., … Ruiz‐Serrano, M. J. (2021). Invasive pulmonary aspergillosis in the COVID‐19 era: An expected new entity. Mycoses, 64(2), 132–143.
• Mohamed, A., Rogers, T. R. ve Talento, A. F. (2020). COVID-19 associated invasive pulmonary aspergillosis: diagnostic and therapeutic challenges. Journal of Fungi, 6(3), 115.
• Ni, Y.-N., Chen, G., Sun, J., Liang, B.-M. ve Liang, Z.-A. (2019). The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis. Critical care, 23(1), 1–9.
• Prattes, J., Valentin, T., Hoenigl, M., Talakic, E., Reisinger, A. C. ve Eller, P. (2020). Invasive pulmonary aspergillosis complicating COVID-19 in the ICU - A case report. Medical Mycology Case Reports. doi:https://doi.org/10.1016/j.mmcr.2020.05.001
• Rutsaert, L., Steinfort, N., Van Hunsel, T., Bomans, P., Naesens, R., Mertes, H., … Van Regenmortel, N. (2020). COVID-19-associated invasive pulmonary aspergillosis. Annals of Intensive Care, 10, 1–4.
• Tay, M. Z., Poh, C. M., Rénia, L., MacAry, P. A. ve Ng, L. F. P. (2020). The trinity of COVID-19: immunity, inflammation and intervention. Nature Reviews Immunology, 20(6), 363–374. van Arkel, A. L. E., Rijpstra, T. A., Belderbos, H. N. A., Van Wijngaarden, P., Verweij, P. E. ve Bentvelsen, R. G. (2020). COVID-19–associated pulmonary aspergillosis. American journal of respiratory and critical care medicine, 202(1), 132–135.
• Veronese, N., Demurtas, J., Yang, L., Tonelli, R., Barbagallo, M., Lopalco, P., … Smith, L. (2020). Use of Corticosteroids in Coronavirus Disease 2019 Pneumonia: A Systematic Review of the Literature . Frontiers in Medicine . https://www.frontiersin.org/article/10.3389/fmed.2020.00170 adresinden erişildi.
• Wang, J., Yang, Q., Zhang, P., Sheng, J., Zhou, J. ve Qu, T. (2020). Clinical characteristics of invasive pulmonary aspergillosis in patients with COVID-19 in Zhejiang, China: a retrospective case series. Critical Care, 24, 1–4.