Fatal Coronavirus Disease 2019-associated Pulmonary Aspergillosis; A Report of Two Cases and Review of the Literature. (2020)

• Record Type: Journal Article
• Authors: Abdalla, Shiema; Almaslamani, Muna A.; Hashim, Samar M.; Ibrahim, Abdulsalam S.; Omrani, Ali S.
• Is Part Of: IDCases. Volume 22(2020)
• Publication Date: 2020
• Subjects: COVID-19 -- aspergillosis -- ICU -- viral pneumonia; Communicable diseases -- Periodicals; Communicable Diseases -- Case Reports; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; 616.9
• DOI: 10.1016/j.idcr.2020.e00935
• Languages: English
• ISSNs: 2214-2509

Abstract

Abstract: Coronavirus Disease 2019 (COVID-19)-associated pulmonary aspergillosis is an emerging entity. We report two fatal cases of putative COVID-19-associated pulmonary aspergillosis. Both cases were diagnosed on the basis of respiratory tract cultures yielding Aspergillus species and otherwise unexplained clinical and radiological deterioration. Existing published literature on COVID-19-associated pulmonary aspergillosis indicate poor outcomes and high mortality. CAPA should be considered in patients with critical COVID-19 who have unexplained progressive respiratory failure despite optimized supportive care. Diagnostic work-up should be initiated as early as possible and should ideally include fungal cultures, galactomannan detection and Aspergillus PCR on tracheal aspirates or broncho-alveolar lavage fluid. Empiric systemic antifungal therapy may be justified in selected cases, pending diagnostic work up results. Large, multi-center studies are required to further understand the pathogenesis of invasive aspergillosis in COVID-19, and the optimal diagnostic and treatment strategies.