COVID‐19‐associated subacute invasive pulmonary aspergillosis

Abstract

Background Though invasive pulmonary aspergillosis is a well known complication of COVID‐19 pneumonia, indolent forms of aspergillosis have been rarely described. Methods We prospectively collected the clinico‐radio‐microbiological data of 10 patients of subacute invasive pulmonary aspergillosis (SAIA), who presented to our hospital with recent history of COVID‐19 pneumonia along with cavitary lung disease, positive IgG (against Aspergillus) with or without positive respiratory samples for Aspergillus spp. Result The mean age of presentation of SAIA was 50.7 ± 11.8 years. All the patients had recently recovered from severe COVID‐19 illness with a mean duration of 29.2 ± 12 days from COVID‐19 positivity. Cough was the predominant symptom seen in 8/10 (80%) patients followed by haemoptysis. 7/10 (70%) patients were known diabetic. While serum galactomannan was positive in 5/9 patients (55.5%), fungal culture was positive in 2/7 patients (28.5%) and polymerase chain reaction (PCR) for Aspergillus was positive in three patients. Eight (80%) patients presented with a single cavitary lesion; pseudoaneurysm of pulmonary artery was seen in two patients and post‐COVID‐19 changes were seen in all patients. All patients were treated with voriconazole, out of which four (40%) patients died during the follow‐up period. Conclusion SAIA should be considered in the differential diagnosis of cavitating lung lesions in patients with recent history of COVID‐19 in the background of steroid use with or without pre‐existing diabetes.

Incidencia De Infecciones Fúngicas Invasivas Asociadas a Covid-19

“…El rango de edad en el que se presenta esta coinfección en pacientes con COVID-19 se encuentra entre los 55 a 74 años (Kariyawasam et al, 2022). La sintomatología incluye tos, seguida de hemoptisis, lo cual se ha observado en un gran porcentaje de pacientes diabéticos (Swain et al, 2022). En pacientes sin neutropenia, la causa más frecuente de infección es la invasión de vías respiratorias, aunque puede ocurrir por angioinvasión en pacientes neutropénicos (Egger et al, 2022).…”

Post-COVID-19-Invasive Pulmonary Mycosis

“…Swain et al in a recent prospective study have described 10 patients with COVID-19-associated SAIA. 2 SAIA (previously known as chronic necrotizing or semi-invasive pulmonary aspergillosis) is a slowly progressive form of invasive aspergillosis typically seen in mildly immunocompromised conditions, which progress over 1 to 3 months. The immunocompromising conditions include diabetes mellitus, chronic obstructive lung disease (COPD), radiation therapy, HIV infection, non-tuberculous mycobacterial infection (NTM), connective tissue disorder, and low-dose corticosteroid therapy (5–20 mg every other day).…”

A study on the morbid histopathological changes in COVID‐19 patients with or without comorbidities using minimally invasive tissue sampling

“… 23 Patients with severe COVID‐19 are at an increased risk to develop secondary fungal infections with aspergillus or mucor. 24 , 25 , 26 , 27 A review showed the prevalence of COVID‐19 associated pulmonary aspergillosis (CAPA) to be around 8.6%. Destruction of the bronchial mucosa and alveolar injury, COVID‐19 associated immune‐dysregulation, and immunosuppressive treatment is thought to create favorable conditions for fungal growth.…”