Association of Tocilizumab and Invasive Aspergillosis in Critically Ill Patients with Severe COVID-19 Pneumonia and Acute Respiratory Distress Syndrome

Coronavirus disease-2019 (COVID-19) causes severe pneumonia and acute respiratory distress syndrome. According to the current consensus, immunosuppressants, such as dexamethasone and anti-interleukin-6 receptor monoclonal antibodies, are therapeutic medications in the early stages of infection. Howe...

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Bibliographic Details
Published in:Journal of fungi (Basel) 2022-03, Vol.8 (4), p.339
Main Authors: Wu, Kuo-Lun, Chang, Chia-Yuan, Sung, Heng-You, Hu, Ting-Yu, Kuo, Li-Kuo
Format: Article
Language:English
Subjects:
acute respiratory distress syndrome
Antibiotics
Antifungal agents
Antigens
Aspergillosis
Bronchus
Case Report
Chronic obstructive pulmonary disease
Coronaviruses
COVID-19
COVID-19-associated pulmonary aspergillosis
Cytokines
Dexamethasone
Diabetes
Dyspnea
Extubation
Hypoxia
Immunosuppressive agents
Intensive care
Interleukin 6
Intubation
Laboratories
Lavage
Literature reviews
Monoclonal antibodies
Mortality
Nosocomial infections
Oxygen saturation
Patients
Pneumonia
Radiography
Respiratory distress syndrome
Severe acute respiratory syndrome coronavirus 2
tocilizumab
Ventilators
X-rays
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Summary:Coronavirus disease-2019 (COVID-19) causes severe pneumonia and acute respiratory distress syndrome. According to the current consensus, immunosuppressants, such as dexamethasone and anti-interleukin-6 receptor monoclonal antibodies, are therapeutic medications in the early stages of infection. However, in critically ill patients, viral, fungal, and bacterial coinfection results in higher mortality. We conducted a single-center, retrospective analysis of 29 mechanically ventilated patients with artificial airways. Patients were adults with confirmed COVID-19 infection and severe pneumonia. Acute respiratory distress syndrome was diagnosed according to the Kigali modification of the Berlin definition. Six patients had invasive pulmonary aspergillosis coinfection based on elevated serum galactomannan levels and/or bronchoalveolar lavage fluid. We present two cases with brief histories and available clinical data. We also conducted a literature review to determine whether immunosuppressants, such as tocilizumab, increase infection risk or invasive aspergillosis in patients with COVID-19. There is no conclusive evidence to suggest that tocilizumab increases coinfection risk. However, further studies are needed to determine the optimal dose, between-dose interval, and timing of tocilizumab administration in patients with COVID-19.
ISSN:2309-608X
2309-608X
DOI:10.3390/jof8040339