COVID-19-Associated Pulmonary Aspergillosis at an Academic Medical Center in the Midwestern United States

Wasylyshyn, Anastasia; Wasylyshyn, G Rostyslaw; Linder, Kathleen A.; Miceli, Marisa H.

doi:10.1007/s11046-021-00564-y

Cited by 12 publications

(26 citation statements)

References 29 publications

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“…To review the incidence of CAPA in severe COVID-19, we used data reported by 41 studies with observational data, with a total number of 6193 included patients (Table 1 and Table S1). The reported CAPA incidence is widely variable among purely observational studies, ranging from 0.7 to 34.4% among patients with severe COVID-19 [25,31]. Overall, we found a CAPA incidence (proven, probable or putative) of 10.9% among 6193 COVID-19 patients in observational studies (11.1% among 5904 patients in ICU-only trials) (Table 1 and Table S1).…”

Section: Incidencementioning

confidence: 73%

“…The maps on the right show the pooled CAPA incidence per country in studies with observational data. Only studies with exact information on the countries where patients were recruited were included in this figure [2,9,15,16,18,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][35][36][37][38]40,41,[43][44][45][47][48][49][51][52][53][54][55][56][57][58][59]. CAPA incidence is calculated per study for the combination of proven, probable, putative and possible CAPA cases.…”

Section: Incidencementioning

confidence: 99%

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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: 73%

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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“…[ 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 main diagnostic criteria used were AspICU [103] (seven studies) and modified AspICU (eight studies) [104]. The patients were predominantly male (49, 66.2%) and had a median age of 69 years (inter-quartile range (IQR) [57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74]. The reported major co-morbidities were arterial hypertension (37 patients, 50%), diabetes mellitus (26, 35.1%), chronic pulmonary disease (13, 17.5%), cardiovascular disease (9, 12.2%), and obesity (4, 5.4%).…”

Section: Case Reports and Case Seriesmentioning

confidence: 99%

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

Casalini

Giacomelli

Ridolfo

et al. 2021

JoF

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Invasive fungal infections (IFIs) can complicate the clinical course of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients admitted to an intensive care unit (ICU). This narrative review concerns 4099 cases of IFIs in 58,784 COVID-19 patients involved in 168 studies. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is a diagnostic challenge because its non-specific clinical/imaging features and the fact that the proposed clinically diagnostic algorithms do not really apply to COVID-19 patients. Forty-seven observational studies and 41 case reports have described a total of 478 CAPA cases that were mainly diagnosed on the basis of cultured respiratory specimens and/or biomarkers/molecular biology, usually without histopathological confirmation. Candidemia is a widely described secondary infection in critically ill patients undergoing prolonged hospitalisation, and the case reports and observational studies of 401 cases indicate high crude mortality rates of 56.1% and 74.8%, respectively. COVID-19 patients are often characterised by the presence of known risk factors for candidemia such as in-dwelling vascular catheters, mechanical ventilation, and broad-spectrum antibiotics. We also describe 3185 cases of mucormycosis (including 1549 cases of rhino-orbital mucormycosis (48.6%)), for which the main risk factor is a history of poorly controlled diabetes mellitus (>76%). Its diagnosis involves a histopathological examination of tissue biopsies, and its treatment requires anti-fungal therapy combined with aggressive surgical resection/debridement, but crude mortality rates are again high: 50.8% in case reports and 16% in observational studies. The presence of other secondary IFIs usually diagnosed in severely immunocompromised patients show that SARS-CoV-2 is capable of stunning the host immune system: 20 cases of Pneumocystis jirovecii pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to Fusarium spp., and 1 case of pulmonary infection due to Scedosporium.

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COVID-19-Associated Pulmonary Aspergillosis at an Academic Medical Center in the Midwestern United States

Cited by 12 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

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

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