Putative invasive pulmonary aspergillosis in critically ill patients with COVID‐19: An observational study from New York City

Abstract

Background Critically ill patients with coronavirus disease‐2019 (COVID‐19) are at the theoretical risk of invasive pulmonary aspergillosis (IPA) due to known risk factors. Patients/Methods We aimed to describe the clinical features of COVID‐19‐associated pulmonary aspergillosis at a single centre in New York City. We performed a retrospective chart review of all patients with COVID‐19 with Aspergillus isolated from respiratory cultures. Results A total of seven patients with COVID‐19 who had one or more positive respiratory cultures for Aspergillus fumigatus were identified, all of whom were mechanically ventilated in the ICU. Four patients were classified as putative IPA. The median age was 79 years, and all patients were male. The patients had been mechanically ventilated for a mean of 6.8 days (range: 1‐14 days) before Aspergillus isolation. Serum galactomannan level was positive for only one patient. The majority of our cases received much higher doses of glucocorticoids than the dosage with a proven mortality benefit. All four patients died. Conclusions Vigilance for secondary fungal infections will be needed to reduce adverse outcomes in critically ill patients with COVID‐19.

Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis

“…BDG 1/? [ 22 ] France 19 Culture 7/9 GM 7/9 PCR – A. fumigatus (14), A. calidoustus (1), A. niger (1) Culture 9/10 GM– PCR – GM 1/12 BDG – [ 23 ] Pakistan 5 Not specified A. fumigatus (1), A. flavus (4), A. niger (1) Not specified GM 0/5 BDG 1/5 [ 24 ] USA 4 Not specified A. fumigatus (4) Not specified GM 1/3 BDG – [ 25 ] France 7 Culture not specified/5 GM 3/5 PCR 2/5 A. fumigatus (5) Not specified GM 1/7 BDG 2/7 [ 26 ] Netherlands 8 Culture 7/7 GM 2/6 PCR 4/5 A. fumigatus (7) Culture 1/1 GM 1/1 PCR 1/1 GM 0/1 [ 27 ] Netherlands 11 Culture 5/40 GM 11/37 PCR 11/40 A. fumigatus (3) Culture 3/47 GM not performed PCR 23/30 GM 0/11 [ 28 ] USA …”

Aspergillus fumigatusand aspergillosis: From basics to clinics

“…2020b , Lescure et al. 2020 , Mitaka et al. 2020 , van Arkel et al.…”

“…Additional cases of fatal CAPA were reported from Argentina, Australia, Austria, Brazil, France, Ireland, Italy, Pakistan, Switzerland, United States and many other countries ( Blaize et al. 2020 , Mitaka et al. 2020 , Prattes et al.…”

A Coronavirus Disease 2019 (COVID-19) Mystery: Persistent Fevers and Leukocytosis in a Patient With Severe COVID-19

“…Lower lobe involvement of TB has also been reported in diabetes [ 18 , 19 ] with more frequent lower lobe cavitation in diabetic patients compared with nondiabetic patients [ 19 ]. In our patient, lower lobe cavitary process initially led to an evaluation for hospital-acquired pathogens including COVID-19-associated pulmonary aspergillosis [ 20 ]. Although endobronchial specimens for galactomannan tests were not performed, serial sputum cultures and serum galactomannan tests were negative.…”