Epidemiology and Incidence of COVID-19-Associated Pulmonary Aspergillosis (CAPA) in a Greek Tertiary Care Academic Reference Hospital

Paramythiotou, Elisabeth; Dimοpoulos, George; Koliakos, Nikolaos; Siopi, Maria; Vourli, Sophia; Pournaras, Spyros; Meletiadis, Joseph

doi:10.1007/s40121-021-00486-8

Cited by 23 publications

(31 citation statements)

References 29 publications

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“…Several factors caused a wide variability in the incidence of CAPA in retrospective (and to a lesser extent prospective) observational trials. The first factor is a regional difference in CAPA incidence, e.g., reported incidences have been as low as 3.3% in Greece and as high as 38.7% in Germany (Figure 2) [2,18,22,31]. Whether this is solely caused by regional differences in test strategies (further discussed below), or also by other regional factors, such as differences in circulating SARS-CoV2 strains, deserves further investigation.…”

Section: Incidencementioning

confidence: 99%

A Visual and Comprehensive Review on COVID-19-Associated Pulmonary Aspergillosis (CAPA)

Feys

Almyroudi

Braspenning

et al. 2021

JoF

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Coronavirus disease 19 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a severe fungal infection complicating critically ill COVID-19 patients. Numerous retrospective and prospective studies have been performed to get a better grasp on this lethal co-infection. We performed a qualitative review and summarized data from 48 studies in which 7047 patients had been included, of whom 820 had CAPA. The pooled incidence of proven, probable or putative CAPA was 15.1% among 2953 ICU-admitted COVID-19 patients included in 18 prospective studies. Incidences showed great variability due to multiple factors such as discrepancies in the rate and depth of the fungal work-up. The pathophysiology and risk factors for CAPA are ill-defined, but therapy with corticosteroids and anti-interleukin-6 therapy potentially confer the biggest risk. Sampling for mycological work-up using bronchoscopy is the cornerstone for diagnosis, as imaging is often aspecific. CAPA is associated with an increased mortality, but we do not have conclusive data whether therapy contributes to an increased survival in these patients. We conclude our review with a comparison between influenza-associated pulmonary aspergillosis (IAPA) and CAPA.

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Section: Incidencementioning

confidence: 99%

A Visual and Comprehensive Review on COVID-19-Associated Pulmonary Aspergillosis (CAPA)

Feys

Almyroudi

Braspenning

et al. 2021

JoF

Self Cite

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“…[ 23 ]; [ 24 ]; [ 25 ]; [ 26 ]; [ 27 ]; [ 28 ]; [ 29 ]; [ 30 ]; [ 31 ]; [ 32 ]; [ 33 ]; [ 34 ]; [ 35 ]; [ 36 ]; [ 37 ]; [ 38 ]; [ 39 ]; [ 40 ]; [ 41 ]; [ 42 ]; [ 43 ]; [ 44 ]; [ 45 ]; [ 46 ]; [ 47 ]; [ 48 ]; [ 49 ]; [ 50 ]; [ 51 ]; [ 52 ]; [ 53 ]; [ 54 ]; [ 55 ]; [ 56 ]; [ 57 ]; [ 58 ]; [ 59 ]; [ 60 ]; [ 61 ]; [ 62 ]; [ 63 ]; [ 64 ]; [ 65 ]; [ 66 ]; [ 67 ]; [ 68 ]; [ 69 ].…”

Section: Uncited Referencesunclassified

Defining COVID-19–associated pulmonary aspergillosis: systematic review and meta-analysis

Kariyawasam

Dingle

Kula

et al. 2022

Clinical Microbiology and Infection

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Background Pulmonary aspergillosis may complicate COVID-19 and contribute to excess mortality in intensive care unit (ICU) patients. The disease is poorly understood, in part due to discordant definitions across studies. Objectives We sought to review the prevalence, diagnosis, treatment, and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA) and compare research definitions. Methods . Data Sources PubMed, Embase, Web of Science, and MedRxiv were searched from inception to October 12, 2021. Study eligibility criteria ICU cohort studies and CAPA case series including ≥3 patients were included. Participants Adult patients in ICUs with COVID-19. Definitions Patients were reclassified according to 4 research definitions (respectively described by Verweij et al, White et al, Koehler et al, and Bassetti et al). Assessment of risk of bias We assessed risk of bias with an adaptation of the Joanna Briggs Institute cohort checklist tool for systematic reviews. Methods of data synthesis We calculated CAPA prevalence using Freeman-Tukey random effects method. Correlations between definitions were assessed with Spearman’s rank test. Associations between antifungals and outcome were assessed with random effects meta-analysis. Results 51 studies were included. Among 3,297 COVID-19 patients in ICU cohort studies, 313 were diagnosed with CAPA (prevalence 10%, 95% confidence interval 8-13%). 277 patients had patient-level data allowing reclassification. Definitions had limited correlation with one another (ρ=0.268 to 0.447, p<0.001) with the exception of Koehler and Verweij (ρ=0.893, p<0.001). 33.9% of patients reported to have CAPA did not fulfill any research definitions. Patients were diagnosed after a median of 8 days (interquartile range 5-14) in ICUs. Tracheobronchitis occurred in 3% of patients examined with bronchoscopy. The mortality rate was high (59.2%). Applying CAPA research definitions did not strengthen the association between mould-active antifungals and survival. Conclusions The reported prevalence of CAPA is significant, but may be exaggerated by non-standard definitions.

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“…The incidence of CAPA in our study was around 5%. Previous studies have shown incidences varying from 3 to 34% [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Practices in obtaining specimens such as tracheal or endotracheal aspirates, bronchoscopy specimens, fungal biomarkers as well local geographic variations in the incidence of Aspergillus likely contributed to these variations.…”

Section: Discussionmentioning

confidence: 99%

“…Since the onset of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)associated pandemic, multiple reports of IPA have emerged in critically ill patients with severe pneumonia [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The incidence of COVID-19-associated pulmonary aspergillosis (CAPA) in these studies has been variable, ranging from 3 to 34% largely due to differences in diagnostic criteria as well as regional differences in obtaining culture specimens and bronchoscopies [14,26].…”

Section: Introductionmentioning

confidence: 99%

COVID-19-Associated Pulmonary Aspergillosis: A Single-Center Experience in Central Valley, California, January 2020–March 2021

Sivasubramanian

Ghanem

Maison-Fomotar

et al. 2021

JoF

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Reports of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) have been widely published across the world since the onset of the pandemic with varying incidence rates. We retrospectively studied all patients with severe COVID-19 infection who were admitted to our tertiary care center′s intensive care units between January 2020 and March 2021, who also had respiratory cultures positive for Aspergillus species. Among a large cohort of 970 patients admitted to the ICU with severe COVID-19 infections during our study period, 48 patients had Aspergillus species growing in respiratory cultures. Based on the 2020 European Confederation of Medical Mycology and the International Society for Human and Animal Mycology (ECMM/ISHAM) consensus criteria, 2 patients in the study had proven CAPA, 9 had probable CAPA, and 37 had possible CAPA. The incidence of CAPA was 5%. The mean duration from a positive COVID-19 test to Aspergillus spp. being recovered from the respiratory cultures was 16 days, and more than half of the patients had preceding fever or worsening respiratory failure despite adequate support and management. Antifungals were given for treatment in 44% of the patients for a mean duration of 13 days. The overall mortality rate in our study population was extremely high with death occurring in 40/48 patients (83%).

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Epidemiology and Incidence of COVID-19-Associated Pulmonary Aspergillosis (CAPA) in a Greek Tertiary Care Academic Reference Hospital

Cited by 23 publications

References 29 publications

A Visual and Comprehensive Review on COVID-19-Associated Pulmonary Aspergillosis (CAPA)

A Visual and Comprehensive Review on COVID-19-Associated Pulmonary Aspergillosis (CAPA)

Defining COVID-19–associated pulmonary aspergillosis: systematic review and meta-analysis

COVID-19-Associated Pulmonary Aspergillosis: A Single-Center Experience in Central Valley, California, January 2020–March 2021

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