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Características clínicas de la aspergilosis pulmonar asociada a Covid 19: una serie de casos

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dc.contributor.advisorGuevara, Freddy
dc.contributor.advisorAmaya, Javier
dc.creatorPolanía Tovar, Valentina
dc.creator.OrganizationalUniversidad del Rosario
dc.creator.degreeEspecialista en Medicina Crítica y Cuidado Intensivo
dc.creator.degreeLevelMaestría
dc.date.accessioned2025-03-28T16:05:59Z
dc.date.available2025-03-28T16:05:59Z
dc.date.created2025-03-27
dc.descriptionAntecedentes: La infección por COVID 19 se ha asociado con un mayor riesgo de infecciones secundarias, incluyendo infecciones fúngicas oportunistas como la aspergilosis pulmonar asociada a COVID-19 (CAPA). Esta infección oportunista se ha vinculado con un aumento de la morbilidad y mortalidad en pacientes críticamente enfermos, especialmente aquellos que requieren ventilación mecánica prolongada y terapia con corticosteroides. Sin embargo, los datos epidemiológicos sobre CAPA en América Latina son escasos, lo que hace crucial estudiar sus características clínicas, diagnósticas y terapéuticas Objetivo: Describir las características clínicas, diagnósticas y terapéuticas de pacientes adultos críticamente enfermos con aspergilosis pulmonar asociada a COVID-19, ingresados en la unidad de cuidados intensivos de la Fundación Santa Fe de Bogotá entre el 1 de abril de 2020 y el 1 de abril de 2022. Métodos: Se realizó un estudio descriptivo de serie de casos que incluyó a pacientes adultos diagnosticados con CAPA según los criterios de EORTC/MSG y CAPA-European Excellence Centre for Medical Mycology. Se analizaron variables demográficas, clínicas, microbiológicas y terapéuticas. Los datos se recopilaron de historias clínicas y se analizaron utilizando estadísticas descriptivas. Resultados: El estudio encontró una alta tasa de mortalidad (75%) entre los pacientes diagnosticados con CAPA. La mayoría de los pacientes presentaban múltiples comorbilidades y requirieron estancias prolongadas en la UCI, ventilación mecánica y soporte con vasopresor. El diagnóstico se basó principalmente en evidencia microbiológica obtenida de cultivos de secreciones del tracto respiratorio y pruebas de galactomanano. Se observaron retrasos en el inicio del tratamiento antifúngico, lo que resalta los desafíos diagnósticos asociados con CAPA. La infección por COVID 19 por sí misma, el uso de corticosteroides, el uso de ventilación mecánica prolongada y estancia hospitalaria prolongada en la unidad de cuidado intensivo pudieron haber contribuido a una mayor susceptibilidad para CAPA Conclusión: El diagnóstico de CAPA se asocia con una alta mortalidad y estancias prolongadas en la UCI en pacientes críticamente enfermos con COVID 19. El diagnóstico temprano sigue siendo un desafío debido a hallazgos clínicos y radiológicos no específicos, lo que requiere estrategias diagnósticas mejoradas y una mayor conciencia en el profesional de salud. Los hallazgos de este estudio enfatizan la necesidad de una mejor vigilancia epidemiológica, terapia antifúngica oportuna y la realización de estudios epidemiológicos más robustos para optimizar el manejo de CAPA en pacientes críticamente enfermos.
dc.description.abstractBackground: COVID-19 has been associated with an increased risk of secondary infections, including opportunistic fungal infections such as COVID-19-associated pulmonary aspergillosis (CAPA). This opportunistic infection has been linked to increased morbidity and mortality in critically ill patients, particularly those requiring prolonged mechanical ventilation and corticosteroid therapy. However, epidemiological data on CAPA in Latin America are scarce, making it crucial to study its clinical and diagnostic characteristics. Objective: To describe the clinical, diagnostic, and therapeutic characteristics of critically ill adult patients with COVID-19-associated pulmonary aspergillosis admitted to the intensive care unit of Fundación Santa Fe de Bogotá between April 1, 2020, and April 1, 2022. Methods: The present study is a descriptive case series study that included adult patients diagnosed with CAPA based on EORTC/MSG and CAPA-European Excellence Centre for Medical Mycology criteria. Demographic, clinical, microbiological, and therapeutic variables were analyzed. Data were collected from electronic medical records and analyzed using descriptive statistics. Results: The study found a high mortality rate (75%) among patients diagnosed with CAPA. Most patients had multiple comorbidities and required prolonged ICU stays, mechanical ventilation and vasopressor support. Diagnosis was based primarily on microbiological evidence obtained from cultures of respiratory tract secretions and galactomannan testing. Delays in initiating antifungal therapy were observed, highlighting the diagnostic challenges associated with CAPA. COVID 19 infection itself, corticosteroid use, use of prolonged mechanical ventilation, and prolonged hospital stay in the intensive care unit may have contributed to increased susceptibility to CAPA. Conclusion: The diagnosis of CAPA is associated with high mortality and prolonged ICU stays in critically ill patients with COVID 19. Early diagnosis remains a challenge due to non-specific clinical and radiological findings, requiring improved diagnostic strategies and increased healthcare professional awareness. The findings of this study emphasize the need for improved epidemiologic surveillance, timely antifungal therapy, and more robust epidemiologic studies to optimize the management of CAPA in critically ill patients.
dc.format.extent95 pp
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.48713/10336_45169
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/45169
dc.language.isospa
dc.publisherUniversidad del Rosario
dc.publisher.departmentEscuela de Medicina y Ciencias de la Salud
dc.publisher.programEspecialización en Medicina Crítica y Cuidado Intensivo
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)
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dc.source.instnameinstname:Universidad del Rosario
dc.source.reponamereponame:Repositorio Institucional EdocUR
dc.subjectCOVID-19
dc.subjectAspergilosis pulmonar
dc.subjectCAPA
dc.subjectUnidad de cuidado intensivo
dc.subjectInfecciones fúngicas
dc.subjectCuidados críticos
dc.subjectTerapia antifúngica
dc.subject.keywordCOVID-19
dc.subject.keywordPulmonary aspergillosis
dc.subject.keywordCAPA
dc.subject.keywordIntensive care unit
dc.subject.keywordFungi infections
dc.subject.keywordCritical care
dc.subject.keywordAntigungal therapy
dc.titleCaracterísticas clínicas de la aspergilosis pulmonar asociada a Covid 19: una serie de casos
dc.title.TranslatedTitleClinica features of COVID 19-associated pulmonary aspegillosis: a case series
dc.typemasterThesis
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de grado
local.department.reportEscuela de Medicina y Ciencias de la Salud
local.regionesBogotá
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