Id |
Subject |
Object |
Predicate |
Lexical cue |
T59 |
0-2 |
Sentence |
denotes |
3. |
T60 |
3-46 |
Sentence |
denotes |
Risk Factors Implicated in CAPA Development |
T61 |
47-291 |
Sentence |
denotes |
Importantly, the pathogenesis of IPA differs between neutropenic and non-neutropenic patients, including those with COVID-19, impacting clinical presentation, radiological findings and diagnostic test results in the mycology laboratory [41,42]. |
T62 |
292-870 |
Sentence |
denotes |
Despite these important differences, revised European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) definitions [43] focus primarily on neutropenic patients with underlying hematological malignancies and “typical” presentation of IPA and have been shown to have limited applicability and inferior performance in non-neutropenic patients who frequently do not fulfil radiological and host criteria, including patients with COVID-19 [41,44]. |
T63 |
871-1211 |
Sentence |
denotes |
This has resulted in the creation of an alternative clinical algorithm for diagnosing IPA in the ICU setting in 2012 [41], which defines putative IPA and is now the standard of care for defining IPA in the ICU [4,45], where highly reliable definitions of IA are still missing (work on improved definitions is currently in progress [45,46]). |
T64 |
1212-1362 |
Sentence |
denotes |
Rapid development of CAPA few days following ICU admission [47] resembles the observation made for influenza-associated pulmonary aspergillosis [4,5]. |
T65 |
1363-1524 |
Sentence |
denotes |
Risk factors predisposing COVID-19 patients to develop secondary pulmonary aspergillosis are similar to those identified for influenza-IPA superinfections [4,5]. |
T66 |
1525-1826 |
Sentence |
denotes |
The most important risk factors include severe lung damage during the course of COVID-19 [48], the use of corticosteroids in those with ARDS, the widespread use of broad-spectrum antibiotics in intensive care units [49], and the presence of comorbidities such as structural lung defects [47,50,51,52]. |
T67 |
1827-2081 |
Sentence |
denotes |
There are some reports revealing that pulmonary fibrosis can be triggered by the cytokine storm activated by the viral antigens, toxicity posed by drugs, high airway pressure and hypoxia-induced acute lung injury secondary to mechanical ventilation [53]. |
T68 |
2082-2346 |
Sentence |
denotes |
While interstitial pulmonary fibrosis per se does not predispose to development of IPA, a small subset of these COVID-19 survivors may require long term corticosteroid treatment, which may predispose them to CAPA years after the acute phase of the viral infection. |
T69 |
2347-2452 |
Sentence |
denotes |
Overall, 29% of the CAPA cases published to date (10/35) had received systemic corticosteroids (Table 1). |
T70 |
2453-2672 |
Sentence |
denotes |
In those with ARDS, systemic corticosteroids are used to alleviate the immune responses and prevent cytokine storm [6,54,55,56], but may at the same time increase vulnerability for developing secondary infections [4,5]. |
T71 |
2673-2855 |
Sentence |
denotes |
Although detailed case series have not reported on antibiotic use among patients, broad-spectrum antibiotics are presumed to be used in 75% of COVID-19 patients admitted to ICU [49]. |
T72 |
2856-3231 |
Sentence |
denotes |
Since the human gut microbiome is a highly complicated structure of bacteria and fungi, although bacteria are the most diverse constituents, the administration of antibiotics results in perturbation of microbiome steady-state composition, which allows fungi to thrive, and may predispose the host to invasive fungal infections once the immune system becomes impaired [65,66]. |
T73 |
3232-3316 |
Sentence |
denotes |
Underlying medical conditions may also predispose COVID-19 patients to develop CAPA. |
T74 |
3317-3595 |
Sentence |
denotes |
Among the 35 CAPA cases published to date (Table 1), hypertension (17/35; 49%), diabetes (9/35; 26%), obesity (8/35; 23%), COPD (5/35; 14%), heart diseases (5/35; 14%), hypercholesterinemia (4/35; 11%), and asthma (3/35; 9%) were among the most prevalent comorbidities observed. |
T75 |
3596-3810 |
Sentence |
denotes |
While hypertension, coronary heart diseases, and diabetes increase the risk of infection overall [67,68,69], structural lung damage caused by COPD or asthma may particularly predispose patients to develop IPA [70]. |