COVID-19-associated pulmonary aspergillosis (CAPA): how big a problem is it?

Abstract

An international panel of experts has recently proposed criteria for defining a new clinical entity called CAPAdcoronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosisdand has made recommendations for its management [1]. The foundation for proposing CAPA as a distinct entity was the premise that pneumonia associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection might promote fungal lung superinfections, particularly invasive pulmonary aspergillosis (IPA), as has been documented for influenza. The expert panel referred to articles that introduced the concept of CAPA, and raised concerns not only for a high incidence of this fungal superinfection but also a high rate of associated mortality. This literature included five case series [2e6] and two prospective studies [7,8] with a total of 94 CAPA cases (i.e. those considered as proven/probable or putative by the authors, according to different criteria). The overall incidence of CAPA was 22.6% (83/368). The association between CAPA and increased mortality was suggested by one study [7].

Aspergillus Lateral Flow Assay with Digital Reader for the Diagnosis of COVID-19-Associated Pulmonary Aspergillosis (CAPA): a Multicenter Study

“…Finally, the study chose a more conservative approach to CAPA classification by applying the new and more restrictive ECMM/ISHAM criteria for CAPA classification instead of the modified Blot criteria. Compared to modified Blot criteria, application of these new criteria was shown to result in a reduction of the mean incidence of probable/proven CAPA cases from 19% to 11.9% among evaluable cases, bringing the prevalence of CAPA cases closer to that suggested by autopsy studies ( 28 , 29 ).…”

Combination of Mycological Criteria: a Better Surrogate to Identify COVID-19-Associated Pulmonary Aspergillosis Patients and Evaluate Prognosis?

“…Because no host factor meeting European Organization for Research and Treatment of Cancer and Mycosis Study Group Education and Research Consortium (EORTC/MSGERC) definitions is present in most patients, alternative classifications were needed ( 1 ). Despite several attempts to clarify CAPA definition by expert panels ( 2 – 4 ), diagnosis remains arguable ( 5 – 7 ). The lack of impact of both antifungal treatment and prophylaxis in many large cohort studies and the impact of prophylaxis on the incidence of CAPA cases lead to the hypothesis that many of these cases may only be colonization rather than infection ( 8 , 9 ).…”

The Continuing Emergence of Candida blankii as a Pathogenic Fungus: A New Case of Fungemia in a Patient Infected with SARS-CoV-2

“…-Aspergillosis: COVID-19-associated pulmonary aspergillosis (CAPA) occurred in over 30% of cases admitted to intensive care units (ICUs) in some publications [10], though more robust meta-analyses suggest the true incidence being closer to 6% [11]; -Mucormycosis: as of June 2021 (latest available data), over 40,000 cases of mucormycosis complicating SARS-CoV-2 infection had been reported to the Indian government [12]. Cases have been described in over 18 countries [13]; -Candidiasis: invasive Candida infections, including those caused by C. auris, have been reported [14,15]; -Others: cases of Saccharomyces cerevisiae [16] and Trichosporon asahii fungemia [17] complicating SARS-CoV-2 infection have been reported.…”