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ANTONIO CASCIO

Invasive cryptococcal disease in COVID-19: systematic review of the literature and analysis

  • Authors: Pipitone G.; Spicola D.; Abbott M.; Sanfilippo A.; Onorato F.; Di Lorenzo F.; Ficalora A.; Buscemi C.; Alongi I.; Imburgia C.; Ciusa G.; Agrenzano S.; Gizzi A.; Marascia F.G.; Granata G.; Cimo F.; Verde M.S.; Di Bernardo F.; Scafidi A.; Mazzarese V.; Sagnelli C.; Petrosillo N.; Cascio A.; Iaria C.
  • Publication year: 2023
  • Type: Review essay (rassegna critica)
  • OA Link: http://hdl.handle.net/10447/620284

Abstract

During the Coronavirus Disease 2019 (COVID-19) pandemic, an increasing number of fungal infections associated with SARS-CoV-2 infection have been reported. Among them, cryptococcosis could be a lifethreatening disease. We performed a Systematic Review (PRISMA Statement) of cryptococcosis and COVID-19 co-infection, case report/series were included: a total of 34 cases were found, then we added our case report. We collected patients’ data and performed a statistical analysis comparing two groups of patients sorted by outcome: “dead” and “alive”. Three cases were excluded for lack of information. To compare categorical data, we used a Fisher-exact test (a=0.05). To compare quantitative variables a U Mann-Whitney test was used (a=0.05), with a 95% Confidence Interval. A total of 32 co-infected patients were included in the statistical analysis. Mortality rate was 17/32 (53.1%): these patients were included in “dead” group, and 15/32 (46.9%) patients survived and were included in “alive” group. Overall, males were 25/32 (78.1%), the median age was 60 years (IQR 53-70) with non-statistically significant difference between groups (p=0.149 and p=0.911, respectively). Three variables were associated with mortality: ARDS, ICU admission and inadequate treatment. Overall, 21 out of 24 (87.5%) patients were in ARDS with a statistically significant difference among two groups (p=0.028). ICU admission for COVID-19 was observed in 18/26 (69.2%), more frequently among dead group (p=0.034). Finally, 15/32 (46.9%) patients had adequate treatment (amphotericin B + flucytosine for invasive cryptococcosis) mostly among alive patients (p=0.039). In conclusion, mortality due to cryptococcal infection among COVID-19 patients remains high but an early diagnosis and appropriate treatment could reduce mortality.