TIMELY INITIATION OF ANTIFUNGAL TREATMENT:
WHO AND WHEN TO TREAT
In this session, Prof Kanj presented the challenges of diagnosing and treating CAPA, Candida auris and CAM infections in patients with COVID-19. “The literature on CAPA is confusing with conflicting observations”, she explained, before reviewing the literature on the incidence, mortality, onset and diagnosis of CAPA. Due to overlapping clinical features of CAPA and COVID-19-associated acute respiratory distress syndrome (ARDS), she added, the European Confederation of Medical Mycology (ECMM) and International Society for Human and Animal Mycology (ISHAM) jointly defined the diagnostic criteria and management protocol.16
“CAPA is proposed to be defined as possible, probable or proven, and considered as invasive Aspergillosis in temporal proximity to a preceding SARS-CoV-2 infection, depending on histological, microbiological, imaging and clinical criteria.”16
She explained there was no data to suggest treatment would be different from recommendations for patients without COVID-19 except in severe cases where azoles aren’t appropriate - such as where resistance is present. Cases of azole resistance have now been reported all over the world, including several countries affected by the COVID-19 pandemic.19-21 As such, clinicians need to be aware of the drivers of resistance in Aspergillus spp and use recommended alternatives, such as liposomal amphotericin B, where appropriate.16,22,23
Prof Kanj went on to discuss reported cases of Candida auris in patients with COVID-19, stating that there is an exacerbated threat, which has infection control implications. She highlighted CAM as an emerging problem that necessitates vigilance in COVID-19 patients, closing her presentation by underlining the importance of early diagnosis and treatment of IFIs in order to improve patient outcomes.
To see the full presentation, watch the video below.