A fatal case report of invasive pulmonary aspergillosis and mucormycosis coinfection in an immunocompetent patient with coronavirus disease 2019 in Korea

Systemic glucocorticoid treatment is highly recommended in critically ill coronavirus disease 2019 (COVID-19) patients. However, secondary fungal infections are of concern in such patients. Here, we describe the first case of COVID-19-associated invasive pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) coinfection in a COVID-19 positive immunocompetent patient in Korea. A 69-year-old man was admitted to our hospital with COVID-19 pneumonia. He had no underlying comorbidities and was not taking medications. He received remdesivir, dexamethasone, and antibiotic therapy under mechanical ventilation. Although his condition improved temporarily, multiple cavities were observed on chest computed tomography, and Aspergillus fumigatus was cultured from tracheal aspiration culture. He was diagnosed with probable CAPA and received voriconazole therapy. However, his condition was not significantly improved despite having received voriconazole therapy for 4 weeks. After release from COVID-19 quarantine, he underwent bronchoscopy examination and was then finally diagnosed with CAPA and CAM coinfection on bronchoscopic biopsy. Antifungal treatment was changed to liposomal amphotericin B. However, his progress deteriorated, and he died 4 months after admission. This case highlights that clinical suspicion and active checkups are required to diagnose secondary fungal infections in immunocompetent COVID-19 patients who receive concurrent glucocorticoid therapy

Characteristics of a new respiratory syndrome associated with the use of a humidifier disinfectant: humidifier disinfectant-related respiratory syndrome (HDRS)

ObjectivesThe purpose of this study was to characterize a new respiratory syndrome associated with exposure to a humidifier disinfectant (HD) in South Korea that is distinct from the well-known HD-related lung injury (HDLI). The authors identified this condition in 24 study subjects who were family members of patients with definite or probable HDLI (referred to as index cases), and were exposed to HD in the same room as the index cases.Material and MethodsThe authors reviewed medical records of 236 family members in 110 families who were exposed to HD in the same rooms and residences as the index cases.ResultsThey identified 24 family members who were exposed to HD in the same rooms and residences as the index cases, and who developed respiratory disorders that were distinct from HDLI. The clinical signs and symptoms of these individuals were in the upper respiratory tract, such as allergic rhinitis and croup, or in the lower respiratory tract, such as bronchitis and pneumonia. The diffusing capacity of the lung fordetermicarbon monoxide was reduced in 9 of 12 children (data not available for 1 child), and in 4 of 5 adults (data not available for 6 adults). The percent forced vital capacity and forced expiratory volume in one second/forced vital capacity ratios were within the normal ranges in most patients. The computed tomography findings, which mostly indicated non-specific inflammation, were inconsistent with the radiological diagnostic criteria for HDLI, but were abnormal in 8 of 11 adults, and in 2 of 13 children.ConclusionsThe authors propose a new condition, i.e., HD-related respiratory syndrome (HDRS), which is characterized by mild to moderate or atypical respiratory symptoms and signs, and is related to HD exposure, but is distinct from HDLI. The recognition of HDRS may provide a basis for understanding the natural history of HD-related respiratory problems, and for capturing the whole spectrum of HD-related clinical manifestations in the respiratory tract

The Effectiveness of the Use of Regdanvimab (CT-P59) in Addition to Remdesivir in Patients with Severe COVID-19: A Single Center Retrospective Study

Introduction: Coronavirus disease 2019 (COVID-19) still has a high mortality rate when it is severe. Regdanvimab (CT-P59), a neutralizing monoclonal antibody that has been proven effective against mild to moderate COVID-19, may be effective against severe COVID-19. This study was conducted to determine the effectiveness of the combined use of remdesivir and regdanvimab in patients with severe COVID-19. Methods: From March to early May 2021, 124 patients with severe COVID-19 were admitted to Ulsan University Hospital (Ulsan, Korea) and received oxygen therapy and remdesivir. Among them, 25 were also administered regdanvimab before remdesivir. We retrospectively compared the clinical outcomes between the remdesivir alone group [n = 99 (79.8%)] and the regdanvimab/remdesivir group [n = 25 (20.2%)]. Results: The oxygen-free days on day 28 (primary outcome) were significantly higher in the regdanvimab/remdesivir group [mean ± SD: 19.36 ± 7.87 vs. 22.72 ± 3.66, p = 0.003]. The oxygen-free days was also independently associated with use of regdanvimab in the multivariate analysis, after adjusting for initial pulse oximetric saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio (severity index). Further, in the regdanvimab/remdesivir group, the lowest SpO2/FiO2 ratio during treatment was significantly higher (mean ± SD: 237.05 ± 89.68 vs. 295.63 ± 72.74, p = 0.003), and the Kaplan-Meier estimates of oxygen supplementation days in surviving patients (on day 28) were significantly shorter [mean ± SD: 8.24 ± 7.43 vs. 5.28 ± 3.66, p = 0.024]. Conclusions: In patients with severe COVID-19, clinical outcomes can be improved by administering regdanvimab, in addition to remdesivir