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COVID‐19‐associated pulmonary aspergillosis (CAPA) remains a high mortality mycotic infection throughout the pandemic, and glucocorticoids (GC) may be its root cause. Our aim was to evaluate the effect of systemic GC treatment on the development of CAPA. We systematically searched the PubMed, Google Scholar, Scopus and Embase databases to collect eligible studies published until 31 December 2022. The pooled outcome of CAPA development was calculated as the log odds ratio (LOR) with 95% confidence intervals (CI) using a random effect model. A total of 21 studies with 5174 patients were included. Of these, 20 studies with 4675 patients consisting of 2565 treated with GC but without other immunomodulators (GC group) and 2110 treated without GC or other immunomodulators (controls) were analysed. The pooled LOR of CAPA development was higher for the GC group than for the controls (0.54; 95% CI: 0.22, 0.86; p <.01). In the subgroups, the pooled LOR was higher for high‐dose GC (0.90; 95% CI: 0.17, 1.62: p =.01) and dexamethasone (0.71; 95% CI: 0.35, 1.07; p <.01) but had no significant difference for low‐dose GC (0.41; 95% CI: −0.07, 0.89; p =.09), and non‐dexamethasone GC (0.21; 95% CI: −0.36, 0.79; p =.47), treated patients versus controls. GC treatment increases the risk of CAPA development, and this risk is particularly associated with the use of high‐dose GC or dexamethasone treatment. [ABSTRACT FROM AUTHOR]

Background: COVID‐19‐associated pulmonary aspergillosis (CAPA) has been widely reported but homogenous large cohort studies are needed to gain real‐world insights about the disease. Methods: We collected clinical and laboratory data of 1161 patients hospitalised at our Institute from March 2020 to August 2021, defined their CAPA pathology, and analysed the data of CAPA/non‐CAPA and deceased/survived CAPA patients using univariable and multivariable models. Results: The overall prevalence and mortality of CAPA in our homogenous cohort of 1161 patients were 6.4% and 47.3%, respectively. The mortality of CAPA was higher than that of non‐CAPA patients (hazard ratio: 1.8 [95% confidence interval: 1.1–2.8]). Diabetes (odds ratio [OR] 1.92 [1.15–3.21]); persistent fever (2.54 [1.17–5.53]); hemoptysis (7.91 [4.45–14.06]); and lung lesions of cavitation (8.78 [2.27–34.03]), consolidation (9.06 [2.03–40.39]), and nodules (8.26 [2.39–28.58]) were associated with development of CAPA by multivariable analysis. Acute respiratory distress syndrome (ARDS) (2.68 [1.09–6.55]), a high computed tomography score index (OR 1.18 [1.08–1.29]; p <.001), and pulse glucocorticoid treatment (HR 4.0 [1.3–9.2]) were associated with mortality of the disease. Whereas neutrophilic leukocytosis (development: 1.09 [1.03–1.15] and mortality: 1.17 [1.08–1.28]) and lymphopenia (development: 0.68 [0.51–0.91] and mortality: 0.40 [0.20–0.83]) were associated with the development as well as mortality of CAPA. Conclusion: We observed a low but likely underestimated prevalence of CAPA in our study. CAPA is a disease with high mortality and diabetes is a significant factor for its development while ARDS and pulse glucocorticoid treatment are significant factors for its mortality. Cellular immune dysregulation may have a central role in CAPA from its development to mortality. [ABSTRACT FROM AUTHOR]

Introduction: Ten to 15% of patients with sarcoidosis have associated arthritis. Chronic arthritis is fairly uncommon. There is a paucity of data on articular manifestations of the disease from India. Methods: Case records of adult patients with sarcoidosis presenting to 11 rheumatology centers from 2005 to 2017 were retrospectively reviewed. Joint involvement was assessed clinically, classified as acute or chronic depending on duration of symptoms less or greater than 6 months, respectively. Results: A total of 117 patients with sarcoid arthritis were reviewed. Forty‐five patients were classified as having Lofgren's syndrome. The pattern of joint involvement revealed the ankle to be most commonly affected in both the groups. Shoulder, wrist, metacarpophalangeal, proximal interphalangeal joints of hands and knee joint involvement were significantly more common in chronic sarcoid arthritis. Peripheral lymphadenopathy and uveitis were significantly more frequent in chronic sarcoid arthritis. Forty out of 49 patients with acute arthritis followed up over a median of 1.8 years had achieved complete remission. Twelve out of 16 chronic sarcoid arthritis (median follow up 2.5 years) had achieved complete remission with 15, 12 and five patients on steroids, methotrexate and hydroxychloroquine, respectively. One patient with acute sarcoid arthritis with concomitant interstitial lung disease had died due to lung infection. Conclusion: Acute oligoarthritis was the commonest presentation with the ankle being the most commonly affected joint. Upper limb joint (predominantly distal) and knee involvement were more common as reported in our largest series worldwide of chronic sarcoid arthritis in adults. Hilar adenopathy and erythema nodosum were common extra‐articular features in both acute and chronic sarcoid arthritis. A limitation of the study was the retrospective nature of the analysis. [ABSTRACT FROM AUTHOR]

The prevalence of allergic bronchopulmonary aspergillosis (ABPA) in chronic asthma has been reported in various studies. However, no study has systematically evaluated the occurrence of Aspergillus hypersensitivity (AH) and ABPA in acute severe asthma (ASA). The aim of this study was to investigate the occurrence of AH and ABPA in patients with ASA. All patients with ASA admitted to the respiratory intensive care unit (ICU) of this institute underwent a prospective evaluation for ABPA using Aspergillus skin test (AST) as a screening tool. Patients with positive AST were labelled as AH and were further investigated for ABPA. Patients with ASA were compared with historical control group of 755 outpatient bronchial asthma patients previously reported. Of the 357 ICU admissions, 57 (43 females, 14 males; mean age 43.5 years) patients were admitted with a diagnosis of ASA. The occurrence of AH was 50.9% [95% confidence interval (CI) 38.3–63.4; 29/57 patients] whereas the prevalence of ABPA was 38.6% (95% CI 27.1–51.6; 22/57 patients) in patients with ASA. The occurrence of AH and ABPA was significantly higher in the ASA group compared with the outpatient bronchial asthma group (38.5% and 20.5%, respectively). The prevalence of serological ABPA (ABPA without central bronchiectasis) was also higher in the ASA group compared with the outpatient bronchial asthma group (45.4% vs. 23.9%). The occurrence of AH and ABPA is very high in patients with acute asthma admitted to a respiratory ICU. Furthermore, the occurrence of high percentage of serological ABPA calls for the use of AST as a routine screening tool for ABPA in all patients with acute asthma at discharge. [ABSTRACT FROM AUTHOR]

Background and objectives: Glucocorticoids have been shown to improve survival when used in patients with septic shock. The aim of this study was to analyse the role of glucocorticoids in decreasing mortality in acute respiratory distress syndrome (ARDS) both in the acute and the fibroproliferative phases. Methods: We searched the MEDLINE database for relevant studies published between 1980 and 2006, and included studies if the study design was a randomized controlled trial or observational study (comparing historical controls). The study population included patients with ARDS treated with glucocorticoids. We calculated the odds ratio and 95% confidence intervals (CI) for the outcome of mortality. Results: Six trials met the inclusion criteria; three investigated the role of steroids in early stage disease ( n = 300) and three investigated the role of steroids in late stage disease ( n = 235). The odds of glucocorticoids decreasing mortality in patients with early ARDS were 0.57 (95% CI: 0.25–1.32) with a number needed to treat of 10 for benefit (818 harm to 5 benefit) whereas the odds of glucocorticoids decreasing mortality in patients with late ARDS was 0.58 (95% CI: 0.22–1.53) with a number needed to treat of 15 for harm (6 harm to 21 benefit). However, there was significant heterogeneity. Conclusions: Current evidence does not support a role for corticosteroids in the management of ARDS in either the early or late stages of the disease. More research is required to establish the role of steroids in specific subgroups of patients with severe sepsis and early ARDS who have relative adrenal insufficiency and patients with late ARDS 7–14 days after the onset of disease. [ABSTRACT FROM AUTHOR]

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