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MeSH Disease

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SARS-CoV-2 proteins

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    Invasive Mould Disease in Fatal COVID-1 19: A Systematic Review of Autopsies

    Authors: Brittany Kula; Cornelius J Clancy; Minh Hong Nguyen; Ilan S. Schwartz

    doi:10.1101/2021.01.13.21249761 Date: 2021-01-20 Source: medRxiv

    Background Invasive mould disease ( IMD MESHD) - most commonly pulmonary aspergillosis MESHD - is reported to affect up to a third of critically ill COVID-19 MESHD patients. Most reported cases are diagnosed with probable/putative COVID-19 MESHD associated pulmonary aspergillosis MESHD (CAPA) based on a combination of non-specific clinical, radiographic, and mycological findings, but the clinical significance - and whether these cases represent true invasive disease - is unresolved. Methods We performed a systematic review of autopsy series of decedents with COVID-19 MESHD for evidence of IMD MESHD. We searched PubMed, Web of Science, OVID (Embase) and MedRxiv for English- or French-language case series published between January 1, 2019 to September 26, 2020. We included series describing lung histology of [≥]3 decedents, and authors were contacted for missing information as necessary. Results We identified 51 case series describing autopsies of 702 decedents. Individual-level data was available for 430 decedents. The median age was 72 (IQR 61 to 80) years. Diabetes mellitus MESHD, pre-existing lung disease MESHD, and immunocompromising conditions were reported for 129 (32%), 95 (22%), and 25 (6%) decedents, respectively. The median hospitalization length was 10 (IQR 5-22) days. 51.6% of decedents had received mechanical ventilation for a median of nine (IQR 5-20) days. Treatment included immunomodulation in 60 (most often steroids or tocilizumab) and antifungals in 41 decedents. Eleven decedents (1.6%) had autopsy-confirmed IMD (6 with CAPA, 4 with invasive pulmonary mycosis MESHD not specified and 1 with disseminated mucormycosis). Among 173 decedents who received mechanical ventilation, 5 had IMD (2.9%). Conclusions Autopsy-proven IMD, including CAPA, is uncommon in fatal COVID-19 MESHD.

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MeSH Disease
HGNC Genes
SARS-CoV-2 Proteins


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