Clinical characteristics of invasive pulmonary aspergillosis in patients with COVID-19 in Zhejiang, China: a retrospective case series

Wang, Jie; Yang, Qing; Zhang, Piaopiao; Sheng, Jifang; Zhou, Jianying; Qu, Tingting

doi:10.1186/s13054-020-03046-7

Cited by 96 publications

(118 citation statements)

References 3 publications

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“…Four case series were excluded, one where the authors reported isolation of Aspergillus from respiratory samples of patients with COVID-19, but did not specify whether these represented cases of IPA or colonization, and the data were inadequate to make that distinction [ 5 ]. Another study was excluded because of missing individual patient data [ 6 ]. The third one was an autopsy study where there was no evidence of IPA in any of the patients that met diagnostic criteria ante-mortem [ 7 ].…”

Section: Cases Retrievedmentioning

confidence: 99%

Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

et al. 2020

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In this systematic review, we investigate the epidemiology, pathogenesis, risk factors, clinical manifestations, diagnosis and treatment of COVID-19-associated pulmonary aspergillosis (CAPA). We identified 85 cases from 22 studies. The frequency of CAPA is currently unknown but ranges between <5% to >30% in different case series; the possibility of colonization rather than invasive disease is the most important confounder. The vast majority of patients with CAPA did not have any of the classic host risk factors, such as immunosuppression from organ transplant or neutropenia, although a significant proportion (46%) had received corticosteroids. Age, pulmonary comorbidities and male sex were associated with higher mortality. Patients treated with voriconazole had numerically lower case-fatality rate. Clinical vigilance for CAPA is advisable in critically ill patients with COVID-19 who are not improving, even those who do not meet classic host criteria for invasive mycoses, especially if they are receiving corticosteroids. A thorough, multi-faceted diagnostic work-up and early initiation of a mold-active triazole may be lifesaving. Further research studies using standardized, uniform definitions of invasive disease and colonization are urgently needed.

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Section: Cases Retrievedmentioning

confidence: 99%

Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

et al. 2020

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“…The disease spectrum in COVID-19 ranges from asymptomatic infection to severe illness with acute respiratory distress syndrome (ARDS) requiring critical care, with 20-40% of hospitalised symptomatic patients developing ARDS (10)(11)(12). An increasing number of anecdotal case reports and case series have identified COVID-19 associated pulmonary aspergillosis (CAPA) as an additional infective complication of COVID-19 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Depending on the study and the region of origin, reported incidence rates for CAPA ranged from approximately 5% (14) to 20-35% (17)(18)(19)(20)(21).…”

Section: Downloaded Frommentioning

confidence: 99%

COVID-19-Associated Invasive Aspergillosis: Data from the UK National Mycology Reference Laboratory

et al. 2020

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COVID-19 associated pulmonary aspergillosis (CAPA) was recently reported as a potential infective complication affecting critically ill patients with acute respiratory distress syndrome following SARS-CoV-2 infection, with incidence rates varying from 8 to 33% depending on the study. However, definitive diagnosis of CAPA is challenging. Standardised diagnostic algorithms and definitions are lacking, clinicians are reticent to perform aerosol-generating bronchoalveolar lavages for galactomannan testing and microscopic and cultural examination, and questions surround the diagnostic sensitivity of different serum biomarkers. Between 11th March and 14th July 2020, the UK National Mycology Reference Laboratory received 1267 serum and respiratory samples from 719 critically ill UK patients with COVID-19 and suspected pulmonary aspergillosis. The laboratory also received 46 isolates of Aspergillus fumigatus from COVID-19 patients (including three that exhibited environmental triazole resistance). Diagnostic tests performed included 1000 (1-3)-β-d-glucan and 516 galactomannan tests on serum samples. The results of this extensive testing are presented here. For a subset of 61 patients, respiratory specimens (bronchoalveolar lavages, tracheal aspirates, sputum samples) in addition to serum samples were submitted and subjected to galactomannan testing, Aspergillus-specific PCR and microscopy and culture. The incidence of probable/proven and possible CAPA in this subset of patients was approximately 5% and 15%, respectively. Overall, our results highlight the challenges in biomarker-driven diagnosis of CAPA especially when only limited clinical samples are available for testing, and the importance of a multi-modal diagnostic approach involving regular and repeat testing of both serum and respiratory samples.

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“…Fungal infections associated to COVID-19 have been reported since the pandemic originated, especially in ICU stay patients [1][2][3][4][5][6][7] and similarly to secondary infections associated to Influenza viruses. Most of the risk factors previously mentioned for IPA are common in both virus.…”

Section: Discussionmentioning

confidence: 99%

Isolation of Aspergillus spp. in respiratory samples of patients with COVID‐19 in a Spanish Tertiary Care Hospital

Falces‐Romero

Ruiz-Bastián

Díaz-Pollán

et al. 2020

Mycoses

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Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has emerged from Wuhan City (Hubei, China) and has become pandemic across the world. 1 This infection can cause severe respiratory disease with important rate of intensive care unit (ICU) admissions. 2 Bacterial and fungal infections are complications of this viral pneumonia 3,4 due to the severe damage of lung tissue, cytokine storm and immune-paralysis caused by viral infection-induced acute respiratory distress syndrome (ARDS). 1,5 Invasive pulmonary aspergillosis (IPA) has been reported in other respiratory virus such as Influenza viruses. 6 In this case, risk factors are haematological malignancies, solid transplant recipients, ICU stay, diabetes, chronic obstructive pulmonary disease (COPD), systemic corticosteroid administration or chronic kidney disease, among others. 5,7 It is essential to study if these factors or similar are related to the risk of developing COVID-19 associated pulmonary aspergillosis (CAPA), as well as to clarify clinical significance of isolation of Aspergillus spp. in respiratory samples in these patients.

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Clinical characteristics of invasive pulmonary aspergillosis in patients with COVID-19 in Zhejiang, China: a retrospective case series

Cited by 96 publications

References 3 publications

Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

COVID-19-Associated Invasive Aspergillosis: Data from the UK National Mycology Reference Laboratory

Isolation of Aspergillus spp. in respiratory samples of patients with COVID‐19 in a Spanish Tertiary Care Hospital

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