Invasive pulmonary aspergillosis complicating COVID-19 in the ICU - A case report

Prattes, Juergen; Valentin, Thomas; Hoenigl, Martin; Talakić, Emina; Reisinger, Alexander Christian; Eller, Philipp

doi:10.1016/j.mmcr.2020.05.001

Cited by 90 publications

(104 citation statements)

References 17 publications

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“…New point-of-care tests for the detection of the Aspergillus -specific antigen or for GM from serum or BALF may also be useful as early evidence of CAPA in critically ill COVID-19 patients [ 43 , 44 , 45 , 46 , 47 ]. One patient with CAPA was reported to have the Aspergillus specific antigen detected from an ETA utilizing a lateral flow device [ 20 ]. The diagnostic performance of this lateral flow assay in the early diagnosis of IA in patients with severe influenza and/or COVID-19 is currently being investigated (ISRCTN51287266) [ 48 ].…”

Section: Diagnosis Of Capamentioning

confidence: 99%

“…High resolution computed tomography (CT) is preferred to other imaging, such as chest radiographs [ 37 , 50 ]. Of the 38 reported CAPA cases, CT was performed in 15, where one patient was noted to have a reverse halo sign [ 20 ], six patients had ground glass opacities and varying sizes and numbers of nodules noted [ 11 ], while the others had findings “typical” of COVID-19 pneumonia. Patients with severe COVID-19 pneumonia in critical care are often clinically unfit for additional imaging, adding to the difficulty in interpreting the significance of the isolation of an Aspergillus sp.…”

Section: Diagnosis Of Capamentioning

confidence: 99%

“…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%

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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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Section: Diagnosis Of Capamentioning

confidence: 99%

Section: Diagnosis Of Capamentioning

confidence: 99%

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

Mohamed

Rogers

Talento

2020

JoF

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“…A total of 77 patients with CAPA (all with available data) required admission to the ICU, whereas this information was not available in one study [ 35 ]. Acute Respiratory Distress Syndrome (ARDS), which is the main complication associated with multi-organ failure in COVID-19, was reported in 21/85 cases (25%).…”

Section: Clinical Presentationmentioning

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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“…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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Invasive pulmonary aspergillosis complicating COVID-19 in the ICU - A case report

Cited by 90 publications

References 17 publications

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

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

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

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

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