07/29/2020
Loss of smell associated with less severe COVID-19 infection, high incidence of invasive pulmonary aspergillosis in intubated patients
By Denise Baez
NEW YORK -- July 29, 2020 -- Today’s DG Alert covers the prognostic value of smell loss in coronavirus disease 2019 (COVID-19), and the incidence of invasive pulmonary aspergillosis among intubated patients with severe COVID-19.
According to a study published in the Annals of Allergy, Asthma & Immunology, loss of smell appears to be an independent positive prognostic factor of less severe COVID-19 infection.
The study, which included 949 patients with COVID-19, found anosmia was significantly associated with decreased hospitalisation (odds ratio [OR] = 0.69; 95% confidence interval [CI], 0.47-0.99), intensive care unit (ICU) admission (OR = 0.38; 95% CI, 0.20-0.70), intubation (OR = 0.43; 95% CI, 0.21-0.89), and acute respiratory distress syndrome (OR = 0.45; 95% CI, 0.23-0.89). The results remained significant after further adjustment for allergic rhinitis and chronic rhinosinusitis.
“Smell loss was also associated with less lymphopenia and higher levels of albumin, suggesting a less severe reaction to COVID-19 in patients with smell loss compared with those with intact smell,” wrote Katharine J. Foster, MD, Rush University Medical Center, Chicago, Illinois, and colleagues.
Mean lymphocyte count was 1.84 ± 3.69 among patients with anosmia compared with 1.11 ± 0.81 in those without smell loss (P = .001), and levels of albumin were 3.02 ± 0.83 versus 2.77 ± 0.83, respectively (P = .02). Other laboratory values and inflammatory markers were not associated with anosmia.
All patients in the study were evaluated at Rush University Medical Center between February 1, 2020, and April 3, 2020. Of the 949 patients, 198 (20.9%) reported loss of smell. Anosmia was significantly associated with younger age (mean age, 46 vs 49 years; P = .02), female gender (64.7% vs 52.8%; P = .003), and higher body mass index (33.6 vs 31.5; P = .001).
The study also found that a significant association between anosmia and history of pre-existing smell dysfunction (OR = 4.66; 95% CI, 2.07-10.46), allergic rhinitis (OR = 1.79; 95% CI, 1.12-2.87), and chronic rhinosinusitis (OR = 3.70; 95% CI, 1.29-10.67) compared with patients without smell loss.
“The main limitations of our study were its retrospective nature, subjective nature of smell loss, and focused nature of the data collection, which did not include subjects’ current medications,” the authors noted.
Another study, published in Clinical Infectious Diseases, found a high incidence of coronavirus-associated pulmonary aspergillosis (CAPA) among critically ill patients with COVID-19.
“We found a high incidence of invasive aspergillosis among critically ill patients with COVID-19 and that its occurrence seems to change the natural history of disease,” wrote Michele Bartoletti, MD, Policlinico Sant’Orsola, Bologna, Italy, and colleagues. “The use of CAPA criteria for diagnosis of invasive aspergillosis may provide earlier diagnosis than AspICU criteria and might prioritise prompt antifungal treatment.”
The prospective, multicentre study included 108 adults with laboratory-confirmed COVID-19 receiving mechanical ventilation. All patients underwent screening protocol for invasive pulmonary aspergillosis with bronchoalveolar lavage galactomannan (BAL GM) and cultures. Cases were classified as CAPA, according to previous consensus definitions, and the new definition was compared with putative invasive pulmonary aspergillosis (P**A). Probable CAPA was diagnosed in 30 (27.7%) patients after a median of 4 days (range, 2-8 days) from ICU admission.
Among patients with CAPA, the 30-day mortality rate from ICU admission was 44% compared with 19% among patients without aspergillosis (P = .002). The 30-day mortality rate was also significantly higher for patients with P**A (74% vs 26%; P< .001). The association remained even after adjustment for confounders with a logistic regression model.
Among the patients with CAPA, 13 received voriconazole, which was associated with a lower mortality rate (46% vs 59%; P = .30).
“Another interesting finding in our study is the correlation between the magnitude of the BAL GM index and 30-day patient mortality,” the authors noted.
The odds of death within 30 days of ICU admission increased 1.41-fold (P = .007) for each point increase in the initial BAL GM index. When adjusted for age, need for renal replacement therapy, and SOFA score at ICU admission, the initial BAL galactomannan index was still independently associated with increased odds of death within 30-days of ICU admission (OR = 1.44; 95% CI, 1.08-1.94; P = .014).
“If confirmed by further studies BAL GM may be useful to prioritise antifungal treatment to patients considered at higher risk of mortality.”
Reference: https://www.annallergy.org/article/S1081-1206(20)30514-7/fulltext
SOURCE: Annals of Allergy, Asthma & Immunology, Clinical Infectious Diseases
Coronavirus disease 2019 (COVID-19) can present with a myriad of symptoms.1 Guidelines from China, the United Kingdom and Italy had focused screening efforts on patients with fever and cough, excluding anosmia from similar scrutiny.1 However, screening of individuals with reported anosmia and dysgeu...
