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      Azole-Resistant COVID-19-Associated Pulmonary Aspergillosis in an Immunocompetent Host: A Case Report

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          Abstract

          COVID-19-associated pulmonary aspergillosis (CAPA) is a recently described disease entity affecting patients with severe pulmonary abnormalities treated in intensive care units. Delays in diagnosis contribute to a delayed start of antifungal therapy. In addition, the emergence of resistance to triazole antifungal agents puts emphasis on early surveillance for azole-resistant Aspergillus species. We present a patient with putative CAPA due to Aspergillus fumigatus with identification of a triazole-resistant isolate during therapy. We underline the challenges faced in the management of these cases, the importance of early diagnosis and need for surveillance given the emergence of triazole resistance.

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          Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR

          Victor M Corman, Olfert Landt, Marco Kaiser … (2020)
          Background The ongoing outbreak of the recently emerged novel coronavirus (2019-nCoV) poses a challenge for public health laboratories as virus isolates are unavailable while there is growing evidence that the outbreak is more widespread than initially thought, and international spread through travellers does already occur. Aim We aimed to develop and deploy robust diagnostic methodology for use in public health laboratory settings without having virus material available. Methods Here we present a validated diagnostic workflow for 2019-nCoV, its design relying on close genetic relatedness of 2019-nCoV with SARS coronavirus, making use of synthetic nucleic acid technology. Results The workflow reliably detects 2019-nCoV, and further discriminates 2019-nCoV from SARS-CoV. Through coordination between academic and public laboratories, we confirmed assay exclusivity based on 297 original clinical specimens containing a full spectrum of human respiratory viruses. Control material is made available through European Virus Archive – Global (EVAg), a European Union infrastructure project. Conclusion The present study demonstrates the enormous response capacity achieved through coordination of academic and public laboratories in national and European research networks.
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            Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium

            J. Peter Donnelly, Sharon C-J Chen, Carol A Kauffman … (2020)
            Abstract Background Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. Methods To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups’ findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. Results There is no change in the classifications of “proven,” “probable,” and “possible” IFD, although the definition of “probable” has been expanded and the scope of the category “possible” has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. Conclusions These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk.
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              CO-RADS – A categorical CT assessment scheme for patients with suspected COVID-19: definition and evaluation

              Mathias Prokop, Wouter van Everdingen, Tjalco van Rees Vellinga … (2020)
              Purpose To introduce the COVID-19 Reporting and Data System (CO-RADS) for standardized assessment of pulmonary involvement of COVID-19 on non-enhanced chest CT and report its initial interobserver agreement and performance. Methods The Dutch Radiological Society (NVvR) developed CO-RADS based on other efforts for standardization, such as Lung-RADS or BI-RADS. CO-RADS assesses the suspicion for pulmonary involvement of COVID-19 on a scale from 1 (very low) to 5 (very high). The system is meant to be used in patients presenting with moderate to severe symptoms of COVID-19. The system was evaluated using 105 chest CTs of patients admitted to the hospital with clinical suspicion of COVID-19 in whom RT-PCR was performed (62 +/- 16 years, 61 men, 53 with positive RT-PCR). Eight observers assessed the scans using CO-RADS. Fleiss’ kappa was calculated, and scores of individual observers were compared to the median of the remaining seven observers. The resulting area under the receiver operating characteristics curve (AUC) was compared to results from RT-PCR and clinical diagnosis of COVID-19. Results There was absolute agreement among observers in 573 (68.2%) of 840 observations. Fleiss’ kappa was 0.47 (95% confidence interval (CI) 0.45-0.47), with the highest kappa for CO-RADS categories 1 (0.58, 95% CI 0.54-0.62) and 5 (0.68, 95% CI 0.65-0.72). The average AUC was 0.91 (95% CI 0.85-0.97) for predicting RT-PCR outcome and 0.95 (95% CI 0.91-0.99) for clinical diagnosis. The false negative rate for CO-RADS 1 was 9/161 (5.6%, 95% CI 1.0-10%), and the false positive rate for CO-RADS 5 was 1/286 (0.3%, 95% CI 0-1.0%). Conclusions CO-RADS is a categorical assessment scheme for pulmonary involvement of COVID-19 on non-enhanced chest CT providing very good performance for predicting COVID-19 in patients with moderate to severe symptoms and has a substantial interobserver agreement, especially for categories 1 and 5.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Fungi (Basel)
                Journal ID (iso-abbrev): J Fungi (Basel)
                Journal ID (publisher-id): jof
                Title: Journal of Fungi
                Publisher: MDPI
                ISSN (Electronic): 2309-608X
                Publication date (Electronic): 06 June 2020
                Publication date Collection: June 2020
                Volume: 6
                Issue: 2
                Electronic Location Identifier: 79
                Affiliations
                [1 ]Department of Medical Microbiology, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands; Eelco.Meijer@ 123456radboudumc.nl (E.F.J.M.); Jochem.Buil@ 123456radboudumc.nl (J.B.B.)
                [2 ]Center of Expertise in Mycology Radboudumc/CWZ, 6532 SZ Nijmegen, The Netherlands
                [3 ]Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital (CWZ), 6532 SZ Nijmegen, The Netherlands; A.Dofferhoff@ 123456cwz.nl
                [4 ]Department of Internal Medicine, Canisius Wilhelmina Hospital (CWZ), 6532 SZ Nijmegen, The Netherlands
                [5 ]Department of Intensive Care Medicine, Canisius Wilhelmina Hospital (CWZ), 6532 SZ Nijmegen, The Netherlands; O.Hoiting@ 123456cwz.nl
                [6 ]Bioprocess Engineering and Biotechnology Graduate Program, Federal University of Paraná, Curitiba 81531-970, PR, Brazil
                Author notes
                [* ]Correspondence: jacques.meis@ 123456gmail.com ; Tel.: +31-24-365-7514
                Author information
                https://orcid.org/0000-0002-0226-024X
                https://orcid.org/0000-0003-4031-0778
                https://orcid.org/0000-0003-3253-6080
                Article
                Publisher ID: jof-06-00079
                DOI: 10.3390/jof6020079
                PMC ID: 7344504
                PubMed ID: 32517166
                SO-VID: 85adb5a3-e269-4dbf-b412-807a5e6c1589
                Copyright © © 2020 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 26 May 2020
                Date accepted : 04 June 2020
                Categories
                Subject: Case Report

                Keywords: sars-cov-2,co-infection,pulmonary aspergillosis,icu,azole-resistant aspergillus,aspergillus fumigatus,capa,tr34l98h
                Data availability:
                Keywords: sars-cov-2, co-infection, pulmonary aspergillosis, icu, azole-resistant aspergillus, aspergillus fumigatus, capa, tr34l98h

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