{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:46:16Z","timestamp":1789055176951,"version":"build-2803163510"},"reference-count":24,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,3,24]],"date-time":"2022-03-24T00:00:00Z","timestamp":1648080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Coronavirus disease-2019 (COVID-19) causes severe pneumonia and acute respiratory distress syndrome. According to the current consensus, immunosuppressants, such as dexamethasone and anti-interleukin-6 receptor monoclonal antibodies, are therapeutic medications in the early stages of infection. However, in critically ill patients, viral, fungal, and bacterial coinfection results in higher mortality. We conducted a single-center, retrospective analysis of 29 mechanically ventilated patients with artificial airways. Patients were adults with confirmed COVID-19 infection and severe pneumonia. Acute respiratory distress syndrome was diagnosed according to the Kigali modification of the Berlin definition. Six patients had invasive pulmonary aspergillosis coinfection based on elevated serum galactomannan levels and\/or bronchoalveolar lavage fluid. We present two cases with brief histories and available clinical data. We also conducted a literature review to determine whether immunosuppressants, such as tocilizumab, increase infection risk or invasive aspergillosis in patients with COVID-19. There is no conclusive evidence to suggest that tocilizumab increases coinfection risk. However, further studies are needed to determine the optimal dose, between-dose interval, and timing of tocilizumab administration in patients with COVID-19.<\/jats:p>","DOI":"10.3390\/jof8040339","type":"journal-article","created":{"date-parts":[[2022,3,24]],"date-time":"2022-03-24T23:31:43Z","timestamp":1648164703000},"page":"339","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Association of Tocilizumab and Invasive Aspergillosis in Critically Ill Patients with Severe COVID-19 Pneumonia and Acute Respiratory Distress Syndrome"],"prefix":"10.3390","volume":"8","author":[{"given":"Kuo-Lun","family":"Wu","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Mackay Memorial Hospital, Taipei City 10449, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Yuan","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mackay Memorial Hospital, Taipei City 10449, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heng-You","family":"Sung","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Mackay Memorial Hospital, Taipei City 10449, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8251-3808","authenticated-orcid":false,"given":"Ting-Yu","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Mackay Memorial Hospital, Taipei City 10449, Taiwan"},{"name":"Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Kuo","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Mackay Memorial Hospital, Taipei City 10449, Taiwan"},{"name":"Department of Medicine, Mackay Medical College, New Taipei City 25245, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1001\/jama.2020.17021","article-title":"Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: The CoDEX randomized clinical trial","volume":"324","author":"Tomazini","year":"2020","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"102568","DOI":"10.1016\/j.autrev.2020.102568","article-title":"Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: A single center study of 100 patients in Brescia, Italy","volume":"19","author":"Toniati","year":"2020","journal-title":"Autoimmun. 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