Incidence, diagnosis and outcomes of COVID-19-associated pulmonary aspergillosis (CAPA): a systematic review

Abstract

Background COVID-19-associated pulmonary aspergillosis (CAPA) is defined as invasive pulmonary aspergillosis occurring in COVID-19 patients. Objective The purpose of this review is to discuss the incidence, characteristics, diagnostic criteria, biomarkers, and outcomes of hospitalized patients diagnosed with CAPA. Methods A literature search was performed through Pubmed and Web of Science databases for articles published up to March 20th, 2021. Results In 1,421 COVID-19 patients, the overall CAPA incidence was 13.5% (ranging 2.5-35.0%). The majority required invasive mechanical ventilation (IMV). The time to CAPA diagnosis from illness onset varied between 8.0-16.0 days. However, the time to CAPA diagnosis from ICU admission and IMV initiation ranged between 4.0-15.0 days and 3.0-8.0 days. The most common diagnostic criteria were the modified AspICU-Dutch/Belgian Mycosis Study Group and IAPA-Verweij et al. 77.6% of patients had positive lower respiratory tract cultures, other fungal biomarkers of BAL and serum galactomannan were positive in 45.3% and 18.2% of patients. The CAPA mortality rate was high at 48.4%, despite the widespread use of antifungals. Lengthy hospital and ICU LOS ranging between 16.0-37.5 days and 10.5-37.0 days were observed. CAPA patients had prolonged IMV duration of 13.0-20.0 days. Conclusion The true incidence of CAPA likely remains unknown as the diagnosis is limited by the lack of standardized diagnostic criteria that rely solely on microbiological data with direct or indirect detection of Aspergillus in respiratory specimens, particularly in clinical conditions with a low pretest probability. A well-designed, multi-center study to determine the optimal diagnostic approach for CAPA is required.

Aspergillus in Critically Ill COVID-19 Patients: A Scoping Review

“…in COVID-19 patients were interpreted, and whether it was associated with increased mortality. This scoping review differs from the published systematic reviews [ 6 , 7 ] that used an entity COVID-19-associated pulmonary aspergillosis as starting point.…”

COVID-19-associated mucormycosis: Case report and systematic review

“…The exact incidence of fungal involvement is not yet known due to the incapability of common bronchoscopy diagnosis in COVID-19 patients [ 5 ]. Since the clinical and radiological findings of secondary fungal infections are not distinguishable from varying COVID-19 pneumonia and pneumonitis, the identification of pathogenic fungi is mainly dependent on the positivity in lower respiratory tract specimen tests, such as the bronchoalveolar lavage, sputum or endotracheal aspirate [ [5] , [6] , [7] ].…”

Comparing the clinical characteristics and outcomes of COVID-19-associate pulmonary aspergillosis (CAPA): a systematic review and meta-analysis

“…The diagnosis of invasive pulmonary aspergillosis is made based on the positive results of lower respiratory tract (LRT) cultures or polymerase chain reaction (PCR) for Aspergillus species, or using galactomannan (GM) biomarker obtained from serum or bronchoalveolar lavage (BAL) in COVID-19 patients, termed COVID-19-associated pulmonary aspergillosis (CAPA) [ 3 – 6 ]. Multiple diagnostic criteria have been used to define and identify patients with CAPA across many observational studies [ 7 ]. Although the incidence of fungal infection is 6.3% in hospitalized COVID-19 patients and is frequently seen in those who are critically ill, the actual risk factors and outcomes of CAPA remain unknown [ 1 ].…”