COVID-19 Associated Pulmonary Aspergillosis: Diagnostic Performance, Fungal Epidemiology and Antifungal Susceptibility

Abstract

Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) raises concerns as to whether it contributes to an increased mortality. The incidence of CAPA varies widely within hospitals and countries, partly because of difficulties in obtaining a reliable diagnosis. We implemented a routine screening of respiratory specimens in COVID-19 ICU patients for Aspergillus species using culture and galactomannan (GM) detection from serum and/or bronchoalveolar lavages (BAL). Out of 329 ICU patients treated during March 2020 and April 2021, 23 (7%) suffered from CAPA, 13 of probable, and 10 of possible. In the majority of cases, culture, microscopy, and GM testing were in accordance with CAPA definition. However, we saw that the current definitions underscore to pay attention for fungal microscopy and GM detection in BALs, categorizing definitive CAPA diagnosis based on culture positive samples only. The spectrum of Aspergillus species involved Aspergillus fumigatus, followed by Aspergillus flavus, Aspergillus niger, and Aspergillus nidulans. We noticed changes in fungal epidemiology, but antifungal resistance was not an issue in our cohort. The study highlights that the diagnosis and incidence of CAPA is influenced by the application of laboratory-based diagnostic tests. Culture positivity as a single microbiological marker for probable definitions may overestimate CAPA cases and thus may trigger unnecessary antifungal treatment.

Incidencia De Infecciones Fúngicas Invasivas Asociadas a Covid-19

“…En el metaanálisis más reciente, realizado por Kariyawasam et al (2022) se concluyó que la prevalencia de la aspergilosis en pacientes con COVID-19 fue de 10%; 313 pacientes de 3297 fueron diagnosticados con aspergilosis pulmonar asociada a COVID-19 (CAPA). Esta coinfección genera una tasa de mortalidad del 59.2%, que se considera alta, y es común que se presente en pacientes inmunocompetentes, aunque las condiciones de inmunosupresión por el uso de corticoesteroides pueden aumentar 3 veces el riesgo de desarrollar CAPA (Kariyawasam et al, 2022;Lackner et al, 2022). Otros autores, mencionan que la mortalidad de la coinfección SARS-CoV-2 y especies de Aspergillus puede ser de 43-52% y llegar hasta el 80% (Egger et al, 2022y Janssen et al, 2021.…”

The breathtaking world of human respiratory in vitro models: Investigating lung diseases and infections in 3D models, organoids, and lung‐on‐chip

“…Thus, several reports of CAPA have raised concerns that this superinfection contributes to increased mortality [62]. Since reports from CAPA varied among hospitals and countries with incidences between 3% and 33% [63, 64], a laboratory‐based study on multiple biomarker testing in the diagnosis of CAPA was performed by Lass‐Flörl et al. [60].…”

Possibilities of CT in the diagnosis of pulmonary aspergillosis in patients with COVID-19 (literature review)

“…Аспергиллез легких (АЛ) -одно из наиболее распространенных жизнеугрожающих грибковых заболеваний, поражает все отделы дыхательной системы, вызывается вдыханием спор плесени Aspergillus spp., которые являются наиболее распространенными грибковыми микроорганизмами, ответственными за вторичные легочные инфекции [4,5]. Недавно опубликованные данные свидетельствуют о том, что АЛ развивается как осложнение после перенесенного COVID-19, особенно у пациентов, находящихся в ОИТ, способствуя повышению смертности [6,7]. Частота встречаемости АЛ у пациентов с COVID-19 варьирует от 3,3 до 34,4%, летальность составляет от 42,6 до 74% [6][7][8][9][10].…”