Invasive pulmonary aspergillosis in the COVID‐19 era: An expected new entity. Issue 2 (29th November 2020)

• Record Type: Journal Article
• Authors: Machado, Marina; Valerio, Maricela; Álvarez‐Uría, Ana; Olmedo, María; Veintimilla, Cristina; Padilla, Belén; De la Villa, Sofía; Guinea, Jesús; Escribano, Pilar; Ruiz‐Serrano, María Jesús; Reigadas, Elena; Alonso, Roberto; Guerrero, José Eugenio; Hortal, Javier; Bouza, Emilio; Muñoz, Patricia
• Other Names: Alcalá Luis investigator.; Aldámiz Teresa investigator.; Álvarez Beatriz investigator.; Arias Alexi investigator.; Arroyo Luis Antonio investigator.; Bermúdez Elena investigator.; Burillo Almudena investigator.; Candela Ana investigator.; Carrillo Raquel investigator.; Catalán Pilar investigator.; Cercenado Emilia investigator.; Cobos Alejandro investigator.; Díez Cristina investigator.; Estévez Agustín investigator.; Fanciulli Chiara investigator.; Galar Alicia investigator.; García Mª Dolores investigator.; de Viedma Darío García investigator.; Gijón Paloma investigator.; González Adolfo investigator.; Guillén Helmuth investigator.; Haces Laura Vanessa investigator.; Kestler Martha investigator.; López Juan Carlos investigator.; Losada Carmen Narcisa investigator.; Marín Mercedes investigator.; Martín Pablo investigator.; Montilla Pedro investigator.; Moure Zaira investigator.; Palomo María investigator.; Parras Francisco investigator.; Pérez‐Granda María Jesús investigator.; Pérez Laura investigator.; Pérez Leire investigator.; Pescador Paula investigator.; Rincón Cristina investigator.; Rodríguez Belén investigator.; Rodríguez Sara investigator.; Rojas Adriana investigator.; Sánchez Carlos investigator.; Sánchez Mar investigator.; Serrano Julia investigator.; Tejerina Francisco investigator.; Vesperinas Lara investigator.; Vicente Teresa investigator.;
• Is Part Of: Mycoses. Volume 64:Issue 2(2021)
• Page Start: 132
• Page End: 143
• Publication Date: 2020-11-29
• Subjects: antifungal therapy -- Aspergillus infection -- COVID‐19 -- fungal diseases -- fungal infections -- intensive care -- invasive pulmonary aspergillosis -- SARS‐CoV‐2 infection; Pathogenic fungi -- Periodicals; Medical mycology -- Periodicals; 616.969
• DOI: 10.1111/myc.13213
• Languages: English
• ISSNs: 0933-7407

Abstract

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: COVID‐19‐associated pulmonary aspergillosis 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 = .04), underwent longer courses of antibacterial therapy (13 vs. 5 days, p = .008), and had a higher all‐cause mortality (100% vs. 40%, p = .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: COVID‐19‐associated pulmonary aspergillosis must be considered a serious and potentially life‐threatening complication in patients with severe COVID‐19 receiving immunosuppressive treatment.