Confronting and mitigating the risk of COVID-19 associated pulmonary aspergillosis

Armstrong‐James, Darius; Youngs, Jonathan; Bicanic, Tihana; Abdolrasouli, Alireza; Denning, David W.; Johnson, Elizabeth; Mehra, Varun; Pagliuca, T; Patel, Brijesh; Rhodes, Johanna; Schelenz, Silke; Shah, Anand; Veerdonk, Frank L. van de; Verweij, Paul E.; White, P. Lewis; Fisher, Matthew C.

doi:10.1183/13993003.02554-2020

Cited by 99 publications

(98 citation statements)

References 34 publications

(48 reference statements)

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“…The precise determination of the best testing algorithm to accurately diagnose CAPA will require further studies. However, from the results presented here, we would agree with the recent suggestion ( 35 ) that in addition to radiological imaging, serial screening for CAPA in ICU patients with deteriorating respiratory function should include (i) regular (at least weekly) Aspergillus antigen testing of serum samples, (ii) regular (at least weekly) BDG testing of serum samples, (iii) Aspergillus antigen testing of BAL fluids (where available) or nondirected lavages/tracheal aspirates, and (iv) Aspergillus PCR in conjunction with conventional mycological examination (microscopy and culture) of respiratory secretions if available.…”

Section: Discussionsupporting

confidence: 93%

COVID-19-Associated Invasive Aspergillosis: Data from the UK National Mycology Reference Laboratory

et al. 2020

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COVID-19 associated pulmonary aspergillosis (CAPA) was recently reported as a potential infective complication affecting critically ill patients with acute respiratory distress syndrome following SARS-CoV-2 infection, with incidence rates varying from 8 to 33% depending on the study. However, definitive diagnosis of CAPA is challenging. Standardised diagnostic algorithms and definitions are lacking, clinicians are reticent to perform aerosol-generating bronchoalveolar lavages for galactomannan testing and microscopic and cultural examination, and questions surround the diagnostic sensitivity of different serum biomarkers. Between 11th March and 14th July 2020, the UK National Mycology Reference Laboratory received 1267 serum and respiratory samples from 719 critically ill UK patients with COVID-19 and suspected pulmonary aspergillosis. The laboratory also received 46 isolates of Aspergillus fumigatus from COVID-19 patients (including three that exhibited environmental triazole resistance). Diagnostic tests performed included 1000 (1-3)-β-d-glucan and 516 galactomannan tests on serum samples. The results of this extensive testing are presented here. For a subset of 61 patients, respiratory specimens (bronchoalveolar lavages, tracheal aspirates, sputum samples) in addition to serum samples were submitted and subjected to galactomannan testing, Aspergillus-specific PCR and microscopy and culture. The incidence of probable/proven and possible CAPA in this subset of patients was approximately 5% and 15%, respectively. Overall, our results highlight the challenges in biomarker-driven diagnosis of CAPA especially when only limited clinical samples are available for testing, and the importance of a multi-modal diagnostic approach involving regular and repeat testing of both serum and respiratory samples.

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Section: Discussionsupporting

confidence: 93%

COVID-19-Associated Invasive Aspergillosis: Data from the UK National Mycology Reference Laboratory

et al. 2020

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“…Based on the above, we call for a more systematic forecasting and monitoring of critical weather situations-particularly thermal inversions leading to haze or fog-and high emission of combustion-generated PM2.5, as they may lead to smog and related respiratory diseases, and to vigilantly predict and track large desertic dust storms. Moreover, desert dust events likely have downwind effects on human healtheven far from their sources-through the transport of fungal diseases which have been demonstrated to exacerbate the virulence and morbidity of COVID-19 (e.g., Griffin et al 2007;Armstrong-James et al 2020;Gangneux et al 2020). In the absence of vaccines and to avoid future lockdowns, specific, short-term measures should be considered during these adverse weather situations so as to limit new blazes of COVID-19 morbidity and mortality.…”

Section: Resultsmentioning

confidence: 99%

Peaks of Fine Particulate Matter May Modulate the Spreading and Virulence of COVID-19

2020

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A probe of a patient, seeking help in an emergency ward of a French hospital in late December 2019 because of Influenza like symptoms, was retrospectively tested positive to COVID-19. Despite the early appearance of the virus in Europe, the prevalence and virulence appeared to be low for several weeks, before the spread and severity of symptoms increased exponentially, yet with marked spatial and temporal differences. Here, we compare the possible linkages between peaks of fine particulate matter (PM2.5) and the sudden, explosive increase of hospitalizations and mortality rates in the Swiss Canton of Ticino, and the Greater Paris and London regions. We argue that these peaks of fine particulate matter are primarily occurring during thermal inversion of the boundary layer of the atmosphere. We also discuss the influence of Saharan dust intrusions on the COVID-19 outbreak observed in early 2020 on the Canary Islands. We deem it both reasonable and plausible that high PM2.5 concentrations—favored by air temperature inversions or Saharan dust intrusions—are not only modulating but even more so boosting severe outbreaks of COVID-19. Moreover, desert dust events—besides enhancing PM2.5 concentrations—can be a vector for fungal diseases, thereby exacerbating COVID-19 morbidity and mortality. We conclude that the overburdening of the health services and hospitals as well as the high over-mortality observed in various regions of Europe in spring 2020 may be linked to peaks of PM2.5 and likely particular weather situations that have favored the spread and enhanced the virulence of the virus. In the future, we recommended to monitor not only the prevalence of the virus, but also to consider the occurrence of weather situations that can lead to sudden, very explosive COVID-19 outbreaks.

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“…A high rate of invasive pulmonary aspergillosis has been demonstrated among critically ill patients admitted to the ICU with severe influenza, which may contribute to their high odds of mortality [ 1 ]. In the early days of the Sars-CoV-2 pandemic, several case reports emerged from Wuhan of COVID-19-associated pulmonary aspergillosis (CAPA) [ 2 ]. Many risk factors for CAPA were recognized among critically ill COVID-19 patients, including lymphopenia, high levels of systemic pro-inflammatory cytokines, and the use of steroids [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Tocilizumab administration in COVID-19 patients: Water on the fire or gasoline?

Deana¹,

Vetrugno²,

Bassi³

et al. 2021

Medical Mycology Case Reports

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Confronting and mitigating the risk of COVID-19 associated pulmonary aspergillosis

Cited by 99 publications

References 34 publications

COVID-19-Associated Invasive Aspergillosis: Data from the UK National Mycology Reference Laboratory

COVID-19-Associated Invasive Aspergillosis: Data from the UK National Mycology Reference Laboratory

Peaks of Fine Particulate Matter May Modulate the Spreading and Virulence of COVID-19

Tocilizumab administration in COVID-19 patients: Water on the fire or gasoline?

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