COVID-19 Associated Invasive Pulmonary Aspergillosis: Diagnostic and Therapeutic Challenges

Abstract

Aspergillus co-infection in patients with severe coronavirus disease 2019 (COVID-19) pneumonia, leading to acute respiratory distress syndrome, has recently been reported. To date, 38 cases have been reported, with other cases most likely undiagnosed mainly due to a lack of clinical awareness and diagnostic screening. Importantly, there is currently no agreed case definition of COVID-19 associated invasive pulmonary aspergillosis (CAPA) that could aid in the early detection of this co-infection. Additionally, with the global emergence of triazole resistance, we emphasize the importance of antifungal susceptibility testing in order to ensure appropriate antifungal therapy. Herein is a review of 38 published CAPA cases, which highlights the diagnostic and therapeutic challenges posed by this novel fungal co-infection.

Prevalence of opportunistic invasive aspergillosis in COVID‐19 patients with severe pneumonia

“…To our knowledge, and to this date, more than 50 published cases of IPA have been identified in patients with COVID‐19. However, the clinical characteristics and risk factors are not well defined 16–25 . It seems to exist a trend in which patients with IPA have the worst clinical prognosis and the highest mortality.…”

Fatal VAP-related pulmonary aspergillosis by Aspergillus niger in a positive COVID-19 patient

“…According to recent literature data (June 2020), about 38 cases of COVID-19 associated pulmonary aspergillosis are known [ 1 , 2 ]. Percentages are probably underestimated owing to a diagnostic delay or to the lack of clinical recognition [ 1 ]. Most COVID-related pulmonary aspergillosis cases are, in fact, belatedly diagnosed, often in post-mortem time.…”

“…IPA, caused by the Aspergillus genus, is known as a common complication in patients with severe respiratory syndromes and is also related to high mortality rates [ 1 , 2 ]. There are many predisposing factors to the development of IPA, basically recognized in prolonged treatment with corticosteroids and lung epithelial damage [ 1 ]. Several cases of IPA have been documented as super-infections in patients with severe respiratory illness such as influenza and MERS-CoV [ 1 , 3 ].…”

“…There are many predisposing factors to the development of IPA, basically recognized in prolonged treatment with corticosteroids and lung epithelial damage [ 1 ]. Several cases of IPA have been documented as super-infections in patients with severe respiratory illness such as influenza and MERS-CoV [ 1 , 3 ]. Starting in December 2019 many severe respiratory syndrome cases caused by Coronavirus-19 (SARS-CoV-2) have been diagnosed.…”

Pulmonary aspergillosis in two COVID-19 patients from Kuwait

“…This report describes two cases of pulmonary aspergillosis among COVID-19 patients from two different hospitals in Kuwait. The list of reported CAPA cases is growing rapidly worldwide [6–8]. While this clearly indicates that CAPA is not geographically restricted, epidemiology may differ across different countries due to the diverse clinical practices in ICUs and the different modalities used to treat COVID-19-infected patients.…”