Increased Risk of Invasive Aspergillosis in Immunocompromised Patients With Persistent SARS-CoV-2 Viral Shedding >8 Weeks, Retrospective Case-control Study

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Melenotte, Cléa | Chavarot, Nathalie | L’honneur, Anne-Sophie | Bodard, Sylvain | Cheminant, Morgane | Flahault, Adrien | Nguyen, Yann | Burgard, Marianne | Dannaoui, Eric | Bougnoux, Marie-Elisabeth | Parize, Perrine | Rouzaud, Claire | Scemla, Anne | Canouï, Etienne | Lafont, Emmanuel | Vimpere, Damien | Zuber, Julien | Charlier, Caroline | Suarez, Felipe | Anglicheau, Dany | Hermine, Olivier | Lanternier, Fanny | Mouthon, Luc | Lortholary, Olivier

Edité par CCSD ; Oxford University Press -

International audience. BackgroundImmunocompromised patients now represent the population most at risk for severe coronavirus disease 2019. Persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral shedding was reported in these patients ranging from several weeks up to 9 months. We conducted a bicentric retrospective case-control study to identify risk and prognostic factors associated with persistent viral shedding in immunocompromised patients.Material and MethodsSymptomatic immunocompromised adults with persistent SARS-CoV-2 viral shedding >8 weeks were retrospectively included between 1 March 2020 and 24 April 2022 at 2 university hospitals in Paris, France, and matched with a control group consisting of symptomatic immunocompromised patients without persistent viral shedding.ResultsTwenty-nine immunocompromised patients with persistent viral shedding were compared with 40 controls. In multivariate analysis, fever and lymphocytopenia (<0.5 G/L) were associated with an increased risk of persistent viral shedding (odds ratio [OR]: 3.3; 95% confidence interval [CI], 1.01–11.09) P = .048 and OR: 4.3; 95% CI, 1.2–14.7; P = .019, respectively). Unvaccinated patients had a 6-fold increased risk of persistent viral shedding (OR, 6.6; 95% CI, 1.7–25.1; P = .006). Patients with persistent viral shedding were at risk of hospitalization (OR: 4.8; 95 CI, 1.5–15.6; P = .008), invasive aspergillosis (OR: 10.17; 95 CI, 1.15–89.8; P = .037) and death (log-rank test <0.01).ConclusionsVaccine coverage was protective against SARS-CoV-2 persistent viral shedding in immunocompromised patients. This new group of immunocompromised patients with SARS-CoV-2 persistent viral shedding is at risk of developing invasive aspergillosis and death and should therefore be systematically screened for this fungal infection for as long as the viral shedding persists.

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