Invasive pulmonary aspergillosis in the COVID‐19 era: An expected new entity
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Open Access
- 19 November 2020
- Vol. 64 (2), 132-143
- https://doi.org/10.1111/myc.13213
Abstract
Objectives Information on the recently COVID‐19‐associated pulmonary aspergillosis (CAPA) entity is scarce. We describe eight CAPA patients, compare them to colonised ICU patients with coronavirus disease 2019 (COVID‐19), and review the published literature from Western countries. Methods Prospective study (March to May, 2020) that included all COVID‐19 patients admitted to a tertiary hospital. Modified AspICU and European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria were used. Results CAPA was diagnosed in eight patients (3.3% of 239 ICU patients). Mostly affected non‐immunocompromised patients (75%) with severe acute respiratory distress syndrome (ARDS) receiving corticosteroids. Diagnosis was established after a median of 15 days under mechanical ventilation. Bronchoalveolar lavage was performed in two patients with positive Aspergillus fumigatus cultures and galactomannan (GM) index. Serum GM was positive in 4/8 (50%). Thoracic CT‐scan findings fulfilled EORTC/MSG criteria in one case. Isavuconazole was used in 4/8 cases. CAPA‐related mortality was 100% (8/8). Compared with colonised patients, CAPA subjects were administered tocilizumab more often (100% vs. 40%, p=0.04), underwent longer courses of antibacterial therapy (13 vs. 5 days, p=0.008), and had a higher all‐cause mortality (100% vs. 40%, p=0.04). We reviewed 96 similar cases from recent publications: 59 probable CAPA (also putative according modified AspICU), 56 putative cases and 13 colonisations according AspICU algorithm; according EORTC/MSG six proven and two probable. Overall, mortality in the reviewed series was 56.3%. Conclusions CAPA must be considered a serious and potentially life‐threatening complication in patients with severe COVID‐19 receiving immunosuppressive treatment.Keywords
This publication has 41 references indexed in Scilit:
- Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort studyThe Lancet Respiratory Medicine, 2018
- Serious infection across biologic-treated patients with rheumatoid arthritis: results from the British Society for Rheumatology Biologics Register for Rheumatoid ArthritisAnnals Of The Rheumatic Diseases, 2018
- The Acute Respiratory Distress Syndrome: From Mechanism to TranslationThe Journal of Immunology, 2015
- Is Azole Resistance in Aspergillus fumigatus a Problem in Spain?Antimicrobial Agents and Chemotherapy, 2013
- Chloroquine Modulates the Fungal Immune Response in Phagocytic Cells From Patients With Chronic Granulomatous DiseaseThe Journal of Infectious Diseases, 2013
- A Clinical Algorithm to Diagnose Invasive Pulmonary Aspergillosis in Critically Ill PatientsAmerican Journal of Respiratory and Critical Care Medicine, 2012
- Acute Respiratory Distress SyndromeJAMA, 2012
- Overall survival and fungal infection-related mortality in patients with invasive fungal infection and neutropenia after myelosuppressive chemotherapy in a tertiary care centre from 1995 to 2006Journal of Antimicrobial Chemotherapy, 2010
- Proteases fromAspergillus fumigatusInduce Interleukin (IL)–6 and IL‐8 Production in Airway Epithelial Cell Lines by Transcriptional MechanismsThe Journal of Infectious Diseases, 1999
- High-resolution computed tomography and pathologic findings in pulmonary aspergillosis: a pictorial essay.1996