COVID-19 associated pulmonary aspergillosis (CAPA): An Australian case report

Sharma, Avinash; Hofmeyr, Ann; Bansal, Anup; Thakkar, Devesh; Lam, Leon; Harrington, Zinta; Bhonagiri, Deepak

doi:10.1016/j.mmcr.2020.06.002

Cited by 37 publications

(30 citation statements)

References 18 publications

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“…Out of 40 CAPA cases thus far reported in the literature, 25 (62.5%) have died ( Table 1 ). [ 5 , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [16] , [17] , [18] , [19] , [20] ] Such high mortality is not surprising given that CAPA has been almost exclusively reported in critically ill COVID-19 requiring mechanical ventilation, who were mostly of older age and had significant co-existing chronic medical conditions. Delayed recognition and commencement of appropriate antifungal therapy may have also contributed to the poor outcomes associated with CAPA.…”

Section: Discussionmentioning

confidence: 99%

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Fatal Coronavirus Disease 2019-associated Pulmonary Aspergillosis; A Report of Two Cases and Review of the Literature

Abdalla

Almaslamani

Hashim

et al. 2020

IDCases

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Coronavirus Disease 2019 (COVID-19)-associated pulmonary aspergillosis is an emerging entity. We report two fatal cases of putative COVID-19-associated pulmonary aspergillosis. Both cases were diagnosed on the basis of respiratory tract cultures yielding Aspergillus species and otherwise unexplained clinical and radiological deterioration. Existing published literature on COVID-19-associated pulmonary aspergillosis indicate poor outcomes and high mortality. CAPA should be considered in patients with critical COVID-19 who have unexplained progressive respiratory failure despite optimized supportive care. Diagnostic work-up should be initiated as early as possible and should ideally include fungal cultures, galactomannan detection and Aspergillus PCR on tracheal aspirates or broncho-alveolar lavage fluid. Empiric systemic antifungal therapy may be justified in selected cases, pending diagnostic work up results. Large, multi-center studies are required to further understand the pathogenesis of invasive aspergillosis in COVID-19, and the optimal diagnostic and treatment strategies.

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Section: Discussionmentioning

confidence: 99%

“…[ 22 ] Interestingly, this geographic variation in Aspergillus species distribution is also notable in the previous CPAP report from Pakistan, compared with reports from other parts of the world ( Table 1 ). [ 5 , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [16] , [17] , [18] , [19] , [20] ].…”

Section: Discussionmentioning

confidence: 99%

Fatal Coronavirus Disease 2019-associated Pulmonary Aspergillosis; A Report of Two Cases and Review of the Literature

Abdalla

Almaslamani

Hashim

et al. 2020

IDCases

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“…The development of CAPA was fairly rapid, with a median of 6 days and range of 3-28 days after ICU admission [47,52]. Moreover, two additional CAPA cases have been reported from Germany [61] and single cases have also been reported from the Netherlands [62], Austria [60], Italy [59], Australia [63], and France [57,58] (Table 1). Among 35 CAPA cases reported to date, there were a total of 5 proven cases [52,59].…”

Section: Capa Prevalencementioning

confidence: 97%

“…In published cases and case series from Germany [50,61], France [51,57,58], Italy [59], Austria [60], Belgium [52], Australia [63], and the Netherlands [47], CAPA was most commonly mycologically diagnosed by either culture from BALF or tracheal aspirate and/or based on a positive GM or LFD from BALF or tracheal aspirate (Table 1). Across published cases, Aspergillus culture was positive in 29/35 (83%) of patients; of those with a positive culture and a reported source, 16/29 (55%) were recovered from-often undirected-BALF, 12/29 (41%) from tracheal aspirate, and 1/29 (3%) from sputum.…”

Section: Diagnostic Workup For Accurate Identification Of Capamentioning

confidence: 99%

COVID-19 Associated Pulmonary Aspergillosis (CAPA)—From Immunology to Treatment

Arastehfar

Carvalho

Veerdonk

et al. 2020

JoF

351

404

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Like severe influenza, coronavirus disease-19 (COVID-19) resulting in acute respiratory distress syndrome (ARDS) has emerged as an important disease that predisposes patients to secondary pulmonary aspergillosis, with 35 cases of COVID-19 associated pulmonary aspergillosis (CAPA) published until June 2020. The release of danger-associated molecular patterns during severe COVID-19 results in both pulmonary epithelial damage and inflammatory disease, which are predisposing risk factors for pulmonary aspergillosis. Moreover, collateral effects of host recognition pathways required for the activation of antiviral immunity may, paradoxically, contribute to a highly permissive inflammatory environment that favors fungal pathogenesis. Diagnosis of CAPA remains challenging, mainly because bronchoalveolar lavage fluid galactomannan testing and culture, which represent the most sensitive diagnostic tests for aspergillosis in the ICU, are hindered by the fact that bronchoscopies are rarely performed in COVID-19 patients due to the risk of disease transmission. Similarly, autopsies are rarely performed, which may result in an underestimation of the prevalence of CAPA. Finally, the treatment of CAPA is complicated by drug–drug interactions associated with broad spectrum azoles, renal tropism and damage caused by SARS-CoV-2, which may challenge the use of liposomal amphotericin B, as well as the emergence of azole-resistance. This clinical reality creates an urgency for new antifungal drugs currently in advanced clinical development with more promising pharmacokinetic and pharmacodynamic profiles.

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“…With the global spread of COVID-19, as of 30 June 2020, 38 cases of CAPA have been reported. [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Here, we review these cases of CAPA so as to highlight the diagnostic and therapeutic challenges posed by this novel fungal co-infection.…”

Section: Introductionmentioning

confidence: 99%

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

Mohamed

Rogers

Talento

2020

JoF

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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.

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COVID-19 associated pulmonary aspergillosis (CAPA): An Australian case report

Cited by 37 publications

References 18 publications

Fatal Coronavirus Disease 2019-associated Pulmonary Aspergillosis; A Report of Two Cases and Review of the Literature

Fatal Coronavirus Disease 2019-associated Pulmonary Aspergillosis; A Report of Two Cases and Review of the Literature

COVID-19 Associated Pulmonary Aspergillosis (CAPA)—From Immunology to Treatment

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

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