Probable CAPA
|
1 |
66/M |
A. fumigatus
Bronchoalveolar lavage
|
Blood – Non-reactive (index = 0.10); BAL – non-reactive (index = 0.17) |
SAH; Hepatic steatosis; Presumed COPD; ALC; SM |
Cough and dyspnea – non-invasive ventilation. Complications: acute kidney injury and possible viral myocarditis. Fever subsided and respiratory function improved after starting itraconazole. |
Bilateral and diffuse opacity: areas of ground-glass opacities, consolidations, emphysematous bullae, nodules, and multiple cavitations with heterogeneous content, suggesting viral pneumonitis complicated with fungal infection. |
Itraconazole PO – 400 mg/day for 6-months |
Survival, lost to follow-up after 6-months |
2 |
59/F |
A. flavus/oryzae
Tracheal aspirate
|
Blood – reactive (index = 1.45) |
SAH; Hepatic steatosis; T cell lymphoma; Febrile neutropenia; Obesity |
ARDS – Mechanical ventilation. Complications: bacterial and Candida albicans infections, acute kidney injury, cardiovascular shock, persistent hyperglycemia. |
Diffuse and bilateral interstitial opacity, numerous areas of consolidation, some resembling nodules. |
Voriconazole PO – 6 days |
Death after 11 days |
3 |
76/M |
A. flavus/ Oryzae
Tracheal aspirate (2 samples)
|
Blood – reactive (index = 5.44) |
SAH; Parkinson disease; Presumed COPD; ALC; Ex-SM |
ARDS – Mechanical ventilation. Complications: multiple bacterial and Candida albicans infections, cardiovascular shock, acute kidney injury, uncontrolled blood glucose levels. Fever and worsening ventilation on the day prior to blood collection for galactomannan testing. |
Diffuse and bilateral interstitial and alveolar opacities predominating in the lower third of the lungs. |
Not performed |
Death after 11 days (bacterial infection) |
4 |
53/F |
A. niger
Bronchoalveolar lavage
|
ND |
SAH; Interstitial pulmonary disease; Depressive state; Dyslipidemia |
ARDS – Non-invasive ventilation. Bronchoscopy – normal appearance of the bronchial tree. Regression of hypoxemia after the use of methylprednisolone. |
Bilateral diffuse septal thickening, ground-glass opacities, and numerous subpleural cysts from the apex to the lower third of the lungs. |
Not performed |
Survival – lost to follow-up |
5 |
56/M |
A. fumigatus
Bronchoalveolar lavage and Tracheal aspirate
|
Bronchoalveolar lavage – non-reactive (index = 0.83) |
SAH; DM; Previous brain stroke; Dyslipidemia; SM |
ARDS – Mechanical ventilation. Complications: bacterial and Candida albicans infections, cardiovascular shock, acute kidney injury, persistent hyperglycemia, Pulmonary embolism. Bronchoscopy: Bronchial mucosa with exophytic black lesions. Partial regression of fungal lesions after the use of micafungin. |
Reticular opacities and micronodules distributed in both lungs and consolidation of the left lower third of the lung. |
Micafungin IV – 10 days → Liposomal amphotericin B – 20 days (8700 mg) + Itraconazole PO – 20 days |
Death after 32 days (bacterial infection) |
Clinically suspected CAPA
|
6 |
78/M |
A. tamari
Tracheal aspirate 60,000 CFU/mL
|
Blood – Non-reactive (index = 0.44) |
SAH; DM; Chronic arterial disease; Hypothyroidism; Ex-SM |
ARDS – Mechanical ventilation. Complications: bacterial and Candida albicans infections, acute kidney injury, enterorrhagia, hyperglycemia, acute sinusitis. |
Bilateral diffuse interstitial opacity, multiple scattered nodules, and cavities in pulmonary segments ID and HID, the largest measuring [MATH] and with heterogeneous content surrounded by ground-glass opacity. |
Voriconazole PO – 18 days |
Survival, death after 52 days (bacterial infection) |
7 |
68/M |
A. terreus
Tracheal aspirate
|
Blood – Non-reactive (index = 0.19) |
SAH; Coronary disease; cardiac insufficiency; Ex-SM |
ARDS – Mechanical ventilation. Complications: bacterial infections, acute kidney injury, persistent hyperglycemia, polyneuropathy. |
Peripheral ground-glass opacities in both lungs, consolidations in the lower lobes, and several nodules bilaterally, the largest measuring 15 mm and some with cavitation. |
Voriconazole IV → PO 16 days |
Death after 46 days (bacterial infection) |
8 |
26/M |
A. fumigatus
Sputum (2 samples)
|
Blood – Non-reactive (index = 0.1) |
Tuberculosis; Obesity; Bipolar disorder; Ex-SM |
ARDS – Non-invasive ventilation. Complications: bacterial infections, pulmonary embolism, pneumothorax, hematuria. |
Consolidations and ground-glass opacities in all lung lobes, scattered nodules, some of which are cavitated; the largest cavity measures [MATH]. |
Liposomal amphotericin B (12 days; 3600 mg) → Voriconazole PO – 7 days |
Survival |
9 |
49/M |
A. flavus/oryzae
Tracheal aspirate
|
ND |
Peripheral venous insufficiency; Ex-ALC; Ex-SM |
ARDS – Mechanical ventilation. Complications: bacterial and Candida spp. infections, bronchiolitis obliterans, acute kidney injury, persistent hyperglycemia, and refractory hypoxemia. |
Bilateral diffuse interstitial opacity and areas of alveolar consolidation. |
Voriconazole PO – 5 days |
Death after 18 days |
10 |
65/M |
A. tamarii
Tracheal aspirate 45,000 CFU/mL
|
ND |
DM; HIV infection |
ARDS – Mechanical ventilation. Complications: bacterial and Candida albicans infections, acute kidney injury, bronchospasm, uncontrolled hyperglycemia, cardiovascular shock. |
Bilateral diffuse interstitial opacity and areas of consolidation in the lung bases. |
Micafungin – 1 day |
Death after 10 days |
11 |
79/M |
A. flavus/oryzae
Tracheal aspirate
|
ND |
SAH; DM; Chronic arterial disease; Presumed COPD; Ex-SM |
ARDS – Mechanical ventilation. Complications: multiple bacterial and Candida albicans infections, cardiovascular shock, acute kidney injury. |
Diffuse and bilateral interstitial and alveolar opacity with areas of consolidation in the lung bases. |
Voriconazole IV → PO – 14 days |
Death after 23 days (bacterial infection) |
12 |
60/M |
A. fumigatus
Tracheal aspirate
|
ND |
Systemic sclerosis; Rituximab therapy; Ex-ALC |
ARDS – Mechanical ventilation. Complications: bacterial infections, acute kidney injury, pneumothorax, persistent hyperglycemia. |
Diffuse and bilateral interstitial opacity and extensive areas of consolidation in the lower half of both lungs. |
Not performed |
Death after 7 days |
Non-presumed CAPA
|
13 |
58/M |
A. fumigatus Tracheal aspirate |
Blood – Non-reactive (index = 0.09) |
SAH; DM; Obesity; Ex-SM |
ARDS – Mechanical ventilation. Complications: multiple infections, acute kidney injury, persistent hyperglycemia. It progressed in the following months to fibrotic lung disease. |
Diffuse bilateral interstitial and alveolar opacity. |
Not performed |
Survival |
14 |
33/M |
A. flavus/oryzae
Tracheal aspirate 50,000 CFU/mL
|
ND |
Obesity |
ARDS – Mechanical ventilation. Complications: persistent hypoxemia, hyperglycemia. |
Bilateral diffuse interstitial opacity and areas of consolidation in the lower third of the lungs. |
Not performed |
Death after 5 days |
15 |
77/F |
A. fumigatus
Tracheal aspirate
|
ND |
SAH; HIV infection; Parkinson disease |
ARDS – Mechanical ventilation. Complications: hemodynamic instability, cardiovascular shock, persistent hyperglycemia. |
Bilateral and multifocal consolidations and ground-glass opacities. |
Not performed |
Death after 4 days |