LitCovid-sentences  

PMC:7265874 / 54-8711 JSONTXT 11 Projects

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Id Subject Object Predicate Lexical cue
T2 0-14 Sentence denotes To the Editor:
T3 15-151 Sentence denotes Since March 2020, following in the footsteps of China, Europe has been facing the COVID-19 pandemic, caused by the SARS-COV-2 virus [1].
T4 152-341 Sentence denotes Increasing numbers of patients are being admitted to intensive care units (ICU) throughout the world, imposing multiple diagnostic and therapeutic challenges on stressed healthcare systems.
T5 342-483 Sentence denotes In our 24-bedded mixed ICU, we have encountered an unexpectedly high number of COVID-19 patients developing invasive pulmonary aspergillosis.
T6 484-701 Sentence denotes Through our case series, we aim to raise awareness of this severe complication in the critical care community, point out different diagnostic obstacles and share our approach to the management of this complex problem.
T7 702-899 Sentence denotes Invasive pulmonary aspergillosis (IPA) is a well-known complication in immunocompromised patients and is encountered frequently in haematopoietic stem cell or solid organ transplant recipients [2].
T8 900-1047 Sentence denotes Continued improvement in diagnostics has revealed that half of the cases of IPA occur in the ICU, in patients who are often non-neutropenic [3, 4].
T9 1048-1216 Sentence denotes Severe influenza infection is a well-known risk factor for developing IPA in non-neutropenic patients; a syndrome termed influenza-associated aspergillosis (IAA) [4–6].
T10 1217-1375 Sentence denotes A damaged respiratory epithelium, dysfunctional mucociliary clearance and a local immune paralysis were demonstrated to be key pathophysiological factors [4].
T11 1376-1552 Sentence denotes Supported by the hypothesis that alveolar damage facilitates fungal invasion, acute respiratory distress syndrome (ARDS) has frequently been associated with IPA in the ICU [6].
T12 1553-1650 Sentence denotes With this in mind, the existence of COVID-19-associated pulmonary aspergillosis is deemed likely.
T13 1651-1796 Sentence denotes Between March 12th and April 25th 2020, 34 COVID-19 patients were admitted to our ICU, of whom 20 (59%) required invasive mechanical ventilation.
T14 1797-1870 Sentence denotes Seven of these ventilated patients (35%) were suspected of IPA (Table 1).
T15 1871-1945 Sentence denotes Median age in our patient cohort was 66 (interquartile range 56–77) years.
T16 1946-2001 Sentence denotes Underlying comorbidities were primarily cardiovascular.
T17 2002-2045 Sentence denotes Only three patients were immunocompromised.
T18 2046-2376 Sentence denotes One patient received chronic corticosteroid treatment for pemphigus foliaceous, one patient was HIV-positive (CD4 count > 250; viral load < 20 copies, treated with antiretrovirals [lamivudine/tenofovir/nevirapine]) and one patient had been treated for acute myeloid leukaemia 8 years ago and had developed IPA during chemotherapy.
T19 2377-2466 Sentence denotes All patients were intubated and mechanically ventilated due to severe COVID-19 pneumonia.
T20 2467-2502 Sentence denotes Table 1 Patients with suspected IPA
T21 2503-2830 Sentence denotes Patient ID Sex (M/F) Age Medical history Time between COVID-19 symptoms and ICU admission (days) Time between COVID-19 symptoms and intubation (days) Time between intubation and first finding of IPA (days) First BAL galactomannan index Peak BAL galactomannan index First serum galactomannan index Peak serum galactomannan index
T22 2831-2871 Sentence denotes 1 M 86 Hyperchol 7 7 9 N/A N/A 0.10 0.10
T23 2872-2925 Sentence denotes 2 M 38 Obesity, hyperchol 9 9 6 2.40 > 2.80 0.30 0.30
T24 2926-2962 Sentence denotes 3 M 62 DM 7 7 16 0.72 2.00 0.20 0.20
T25 2963-3026 Sentence denotes 4 M 73 DM, obesity, AHT, hyperchol 9 10 5 2.65 > 2.80 0.10 0.10
T26 3027-3094 Sentence denotes 5 M 77 DM, CKD, AHT, pemphigus foliaceus 9 10 2 2.79 2.79 0.10 0.10
T27 3095-3148 Sentence denotes 6 M 55 HIV, AHT, hyperchol 8 9 13 0.69 0.69 0.18 0.80
T28 3149-3195 Sentence denotes 7 M 75 AML, IPA (2012) 3 3 8 2.63 2.63 N/A N/A
T29 3196-3351 Sentence denotes Patient ID Sex (M/F) Age Medical history First positive culture CT scan Histological examinationa IPA diagnosis AspICU algorithm Antifungal therapy Outcome
T30 3352-3432 Sentence denotes 1 M 86 Hyperchol A. flavus (ETA) No scan available N/A – – None Died, ICU day 10
T31 3433-3557 Sentence denotes 2 M 38 Obesity, hyperchol A. fumigatus (BAL) + Positive Proven Absolute Voriconazole, isavuconazole Alive on MV, ICU day 28b
T32 3558-3659 Sentence denotes 3 M 62 DM A. fumigatus (BAL) No scan available Positive Proven Absolute Voriconazole Died, ICU day 20
T33 3660-3794 Sentence denotes 4 M 73 DM, obesity, AHT, hyperchol A. fumigatus (BAL) No scan available Positive Proven Absolute Voriconazole Alive on MV, ICU day 24b
T34 3795-3935 Sentence denotes 5 M 77 DM, CKD, AHT, pemphigus foliaceus A. fumigatus (BAL) No scan available Positive Proven Absolute Voriconazole Alive on MV, ICU day 21b
T35 3936-4045 Sentence denotes 6 M 55 HIV, AHT, hyperchol Negative No scan available Negative – Voriconazole, isavuconazole Died, ICU day 27
T36 4046-4140 Sentence denotes 7 M 75 AML, IPA (2012) A. fumigatus (BAL) No scan available N/A – Voriconazole Died, ICU day 8
T37 4141-4235 Sentence denotes CKD chronic kidney disease, AML acute myeloid leukaemia, IPA invasive pulmonary aspergillosis.
T38 4236-4445 Sentence denotes N/A no sample available, Hyperchol hypercholesterolaemia, AHT arterial hypertension, DM diabetes mellitus, BAL bronchoalveolar lavage, ETA endotracheal aspirate, MV mechanical ventilation arterial hypertension
T39 4446-4522 Sentence denotes aAnatomopathological examination of tissue samples obtained via bronchoscopy
T40 4523-4546 Sentence denotes bAt the time of writing
T41 4547-4699 Sentence denotes Our suspicion was raised initially through an unusually rapid growth (< 48 h) of Aspergillus species in bronchial aspirates of three different patients.
T42 4700-4848 Sentence denotes All samples were obtained during routine bronchoscopies, performed for atelectasis, respiratory deterioration or increasing inflammatory parameters.
T43 4849-5071 Sentence denotes From that moment, routine galactomannan assays on serum and bronchoalveolar lavage (BAL) fluid were assessed regularly and bronchoscopy-guided biopsies of suspicious tracheobronchial lesions were obtained whenever present.
T44 5072-5315 Sentence denotes Unfortunately, computed tomography (CT) scanning was deemed unfeasible in some patients due to extreme hypoxia or difficult mechanical ventilation and whenever performed, the distinction between COVID-19 and Aspergillus lesions proved complex.
T45 5316-5403 Sentence denotes Table 1 shows the timing and results of the microbiological testing in our case series.
T46 5404-5509 Sentence denotes Differentiating between Aspergillus colonization and IPA is notoriously difficult, especially in the ICU.
T47 5510-5749 Sentence denotes In the absence of host factors, as defined by the European Organisation for Research and Treatment of Cancer (EORTC) diagnostic criteria, invasive or high-risk diagnostics (biopsy, CT scan) are required to support the diagnosis of IPA [7].
T48 5750-5839 Sentence denotes The AspICU algorithm was designed to partially deal with the absence of host factors [6].
T49 5840-5963 Sentence denotes Based on this algorithm, four patients (No 2, 3, 4, 5) were diagnosed with proven IPA, based on histopathological evidence.
T50 5964-6037 Sentence denotes All of these patients showed positive galactomannan indices on BAL fluid.
T51 6038-6195 Sentence denotes In two patients, cultures and/or galactomannan BAL only became positive post mortem (No 1, 7), before CT scan or histopathological samples could be obtained.
T52 6196-6353 Sentence denotes In one patient (No 6), histopathological sampling was negative and galactomannan BAL only mildly raised, but a raised serum galactomannan was later detected.
T53 6354-6437 Sentence denotes In the remaining patients, the serum galactomannan index remained negative (< 0.5).
T54 6438-6549 Sentence denotes The mean time between intubation date and the first microbiological signs of IPA was a striking 8 (SD 5) days. 
T55 6550-6731 Sentence denotes ICU physicians often have to weigh the risks of further diagnostic tests against a delayed initiation of antifungal treatment, which is associated with mortality rates over 65% [6].
T56 6732-6958 Sentence denotes Because all patients with clinical features of possible IPA were suffering from severe respiratory failure and hemodynamic instability, we initiated antifungal therapy as soon as cultures or galactomannan assays were positive.
T57 6959-7002 Sentence denotes Five patients were started on voriconazole.
T58 7003-7173 Sentence denotes In two of these patients, the treatment was escalated to isavuconazole due to pancytopenia or undetectable voriconazole levels under continuous renal replacement therapy.
T59 7174-7205 Sentence denotes Two patients died on treatment.
T60 7206-7313 Sentence denotes To confirm and control this alarming incidence of COVID-19-associated IPA, a number of measures were taken.
T61 7314-7443 Sentence denotes Firstly, we ruled out an environmental source, by sampling room air and the oxygen and pressurized air supplies (MAS 100, Merck).
T62 7444-7512 Sentence denotes Prior to COVID-19, the incidence of IPA in our ICU was not elevated.
T63 7513-7632 Sentence denotes Nonetheless, high-efficiency particulate air filters (HEPA) (Halton Vita, Helsinki, Finland) were installed in the ICU.
T64 7633-7772 Sentence denotes Secondly, all mechanically ventilated COVID-19 patients were screened systematically by performing serum galactomannan assays twice weekly.
T65 7773-7916 Sentence denotes Whenever a bronchoscopy was needed, BAL galactomannan indices and mould cultures were requested, regardless of the indication for bronchoscopy.
T66 7917-8127 Sentence denotes Finally, we initiated prophylactic nebulization of 12.5 mg of liposomal amphotericin B (Ambisome®, Gilead, Foster City, USA) in every mechanically ventilated patient without an established diagnosis of IPA [8].
T67 8128-8240 Sentence denotes Since the implementation of these measures, we have not encountered any new cases of IPA at the time of writing.
T68 8242-8252 Sentence denotes Conclusion
T69 8253-8406 Sentence denotes Using this case series, we would like to raise awareness about COVID-19-associated pulmonary aspergillosis, in view of its potential detrimental outcome.
T70 8407-8657 Sentence denotes We believe that a low threshold for screening, prophylaxis and early antifungal treatment is of paramount importance, especially since different immunosuppressive therapies have been suggested to treat patients suffering from this alarming condition.