Proven Aspergillus flavus pulmonary aspergillosis in a COVID‐19 patient: A case report and review of the literature

Abstract

Severe COVID‐19 patients complicated with aspergillosis are increasingly reported. We present a histopathological proven case of fatal COVID‐19–associated pulmonary aspergillosis (CAPA), due to Aspergillus flavus . This report and existing published literature indicate diagnostic challenges and poor outcomes of CAPA in ICU patients.

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

“…Only 62% of the CAPA cases had a positive respiratory culture, and the specimen was BAL in 45% of cases, which means that a large proportion of the diagnoses were based on cultures of less informative respiratory specimens. Only a few studies provided data concerning direct microscopic examinations of respiratory samples, and a positive result (septate branching hyphae suggesting Aspergillus) was reported in only 24 cases (7.4% of the positive cultures: 16 BAL, 5 TA, 1 BAS, and 2 unspecified respiratory specimens) [24,33,35,43,47,52,54,[65][66][67]71,76,[86][87][88][89]92,96,102]. According to Blot et al, positive direct examination of BAL is a crucial criterion for a diagnosis of putative IPA in ICU patients without host risk factors [103].…”

“…The most frequently isolated Aspergillus species were A. fumigatus (43 cultures, 67.2%) and A. niger (8 cultures, 12.5%), and the most frequent diagnostic samples were bronchoalveolar lavage (BAL) samples (25, 40.3%). Direct examination of respiratory samples showing septate branching hyphae was reported in 11 cases (17.7% of positive cultures) [65][66][67]71,76,[86][87][88][89]92,96,102]. Proven CAPA was reported in five studies: in three cases, the diagnosis was made post portem [69,72,95]; in the remaining two cases, the diagnosis was made using pulmonary tissue (biopsy in one case, lobectomy in the other) [89,92].…”

“…Direct examination of respiratory samples showing septate branching hyphae was reported in 11 cases (17.7% of positive cultures) [65][66][67]71,76,[86][87][88][89]92,96,102]. Proven CAPA was reported in five studies: in three cases, the diagnosis was made post portem [69,72,95]; in the remaining two cases, the diagnosis was made using pulmonary tissue (biopsy in one case, lobectomy in the other) [89,92]. Serum galactomannan (GM) was positive (optical density index [ODI] > 0.5) in 25/47 cases (53.2%) with a median value of 1.7 (IQR 1.1-3.1) (ODI index available in 21 cases).…”

COVID-19-associated Aspergillus tracheobronchitis: the interplay between viral tropism, host defence, and fungal invasion

“…Aspergillus species that can be involved in CAPA include Aspergillus flavus, Aspergillus niger, Aspergillus terreus, and Aspergillus calidoustus, but cases of confirmed IATB due to species other than A fumigatus have not yet been reported. 36 Although virulence traits have been identified in A fumigatus, which enable the fungus to better resist environmental stress factors, there is no evidence to support that specific Aspergillus genotypes cause invasive aspergillosis or IATB. 1 More than the fungus itself, the effects of the virus infection (eg, local cell lysis and subsequent effects on the host, including NADPH oxidase complex suppression in influenza) that are caused by the initial viral infection are likely to determine the ability of the host to resist fungal invasion.…”

COVID19 associated pulmonary aspergillosis

“…Одной из серьезных проблем, ассоциированных с COVID19 тяжелого течения, является инвазивный ас пергиллез (ИА) -САРА (COVID19 associated pulmonary aspergillosis). Об этом свидетельствует растущее число сообщений о САРА, что вызывает опасения по поводу этой суперинфекции как дополнительного фактора смертности [6][7][8][9].…”