Computed tomographic signs of the “possible” aspergillosis in dynamic observation of patients with COVID-19

Abstract

Aim. Determination of CT signs of possible attachment of pulmonary aspergillosis in patients with COVID-19 during dynamic follow-up.
 Methods. The analysis of the case histories of 646 patients, in whom the results of CT monitoring of the lung condition for at least 2 months were obtained, was carried out. The total number of CT examinations is 5,279, the average number of studies per patient is 8. The main group consisted of 144 patients. The leading inclusion criterion was the presence of radiological signs atypical for COVID-19, suspected of fungal complications.
 Results. The analysis of the obtained images revealed the primary signs suspected of COVID–associated aspergillosis, which can be conditionally divided into typical bronchogenic and conditionally non-bronchogenic. Of the total number of patients in the main group, bronchogenic signs were noted in 56 patients (38.89%), and in 43 of them (76.79%), their transformation into signs characteristic of a fungal lesion was revealed. Relatively non-bronchogenic primary signs were identified in 88 patients (61.11%). In the process of studying the dynamics of signs suspected of COVID-associated aspergillosis, CT-signs typical of fungal lesions were obtained in 93 patients (64.58%). "Consolidations" as a primary sign and as a sign of transformation from foci were encountered in one time interval. This made it possible to collect all the signs of COVID-associated aspergillosis in a combined timing scheme.
 Conclusion. The features of the clinical course of the disease in patients with COVID-19 do not allow us to confidently determine the attachment of a co-infection, such as aspergillosis. There are also difficulties in isolating the culture of the pathogen. Consequently, the role of computed tomography in identifying the semiotics of "possible" aspergillosis as a complication of COVID-19 is increasing.