COVID-19-Associated Pulmonary Aspergillosis: A Year-Long Retrospective Case Series

Abstract

COVID-19-associated pulmonary aspergillosis (CAPA) refers to co-infection with Aspergillus spp. in patients with COVID-19. It has a higher mortality rate when compared with patients only infected with COVID-19, but we still know little about the epidemiology, diagnosis, and best treatment options for patients with CAPA. We report our findings from a year-long retrospective case series of patients with CAPA in two tertiary hospitals in the United Kingdom. We included all patients admitted to critical care with CAPA between March 2020–2021. We used the European Confederation for Medical Mycology and the International Society for Human and Animal Mycology consensus criteria to categorise CAPA. Demographic data, patients’ co-morbidities, time to and method of diagnosis, COVID-19 and aspergillosis treatment, and outcomes were analysed. Thirteen patients were diagnosed with probable CAPA between October/2020–March/2021, and 54.8% also had hypertension. Diagnosis was established after a median of 18 days post-COVID-19 infection, and a median of 7 days post-intubation. All patients had received corticosteroids, as well as tocilizumab (7; 53.8%) and remdesivir (3; 23%). Eleven patients received antifungal treatment. Nine (69%) patients died by 30 days post-ICU admission, one patient died on day 32, and three (23%) patients survived. CAPA has a very high mortality rate. We also identified three areas that merit further investigation: lack of positive tests between March–October 2020; COVID-19 treatments and possible relationship with increased CAPA rates; and the rationale behind antifungal treatment in our hospitals compared to recommended treatment in the literature.

COVID-19-associated pulmonary aspergillosis (CAPA): identification of Aspergillus species and determination of antifungal susceptibility profiles

“…The incidence of possible and probable IPA in the whole population of the study was determined to be 18% and 22%, respectively. These results were found to be compatible with similar studies (Salas et al 2022 ).…”

Invasive Pulmonary Aspergillosis After Sars-CoV-2 Infection as Limitation of Contemporary Transplantology: A Case Report

“…COVID-19–associated pulmonary aspergillosis is IPA occurring during or a few days/weeks after COVID-19 infection. Infection develops, on average, 18 days after SARS-CoV-2 infection; Bhopalwala reported late manifestations of COVID-19–associated pulmonary aspergillosis within a few months after infection [ 9 , 10 ]. COVID-19–associated pulmonary aspergillosis risk factors involve old age, active smoking, chronic respiratory diseases, chronic renal failure, and chronic corticosteroids treatment.…”

Evaluation of Antifungal Properties of Titania P25

“…The impact of indoor microclimate on occupant well-being as well as the dangerous influence of mold fungi on air quality are highly important issues for modern human society [1][2][3][4]. The recent two years of the COVID-19 pandemic have revealed other aspects of superinfection associated with common indoor and outdoor molds [5,6]. For example, many people infected with COVID-19 or recovering from COVID-19 have developed Invasive Pulmonary Aspergillosis (IPA) or a similar syndrome associated with severe COVID-19-pulmonary aspergillosis (CAPA).…”