Journal Article

COVID-19–Associated Pulmonary Aspergillosis, March–August 2020

Dupont, Damien, Cornely, Oliver A., Koehler, Philipp, Seidel, Danila, Hanses, Frank, Valerio, Maricela, Salmanton-García, Jon, Schroeder, Maria, Bartoletti, Michele, Sal, Ertan, Machado, Marina, Meis, Jacques F., Ferreira-Paim, Kennio, Antinori, Spinello, Stemler, Jannik, Rodríguez-Guardado, Azucena, Sprute, Rosanne, Falces-Romero, Iker, de la Villa, Sofía, Gangneux, Jean-Pierre, Malaj, Xhorxha, Hoyo, Irma, Giacobbe, Daniele Roberto, Garcia-Vidal, Carolina

2021

Overview

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Because of the severe immunomodulation and lymphocyte depletion caused by this virus and the subsequent administration of drugs directed at the immune system, we anticipated that patients might experience fungal superinfection. We collected data from 186 patients who had coronavirus disease-associated pulmonary aspergillosis (CAPA) worldwide during March-August 2020. Overall, 182 patients were admitted to the intensive care unit (ICU), including 180 with acute respiratory distress syndrome and 175 who received mechanical ventilation. CAPA was diagnosed a median of 10 days after coronavirus disease diagnosis. Aspergillus fumigatus was identified in 80.3% of patient cultures, 4 of which were azole-resistant. Most (52.7%) patients received voriconazole. In total, 52.2% of patients died; of the deaths, 33.0% were attributed to CAPA. We found that the cumulative incidence of CAPA in the ICU ranged from 1.0% to 39.1%.

• Publisher: U.S. National Center for Infectious Diseases,Centers for Disease Control and Prevention
• Subject: Aged / Antifungal agents / Antifungal Agents - therapeutic use / Aspergillosis / Aspergillus / Aspergillus fumigatus - isolation & purification / Coronaviruses / COVID-19 / COVID-19 - complications / COVID-19 - immunology / COVID-19 - mortality / COVID-19 - therapy / Diagnosis / Female / Fungal infections / Humans / Immune system / Immunologic Factors - administration & dosage / Immunologic Factors - adverse effects / Incidence / Infectious diseases / intensive care unit / Intensive Care Units - statistics & numerical data / International Cooperation / Life Sciences / Lymphocytes / Male / Medical research / Outcome and Process Assessment, Health Care / Patients / Pulmonary aspergillosis / Pulmonary Aspergillosis - diagnosis / Pulmonary Aspergillosis - drug therapy / Pulmonary Aspergillosis - mortality / Registries / Respiration, Artificial - methods / Risk Factors / SARS-CoV-2 / SARS-CoV-2 - isolation & purification / Severe acute respiratory syndrome / Severe acute respiratory syndrome coronavirus 2 / Ventilators / voriconazole / Voriconazole - therapeutic use