Abstract
Reports of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) have been widely published across the world since the onset of the pandemic with varying incidence rates. We retrospectively studied all patients with severe COVID-19 infection who were admitted to our tertiary care center′s intensive care units between January 2020 and March 2021, who also had respiratory cultures positive for Aspergillus species. Among a large cohort of 970 patients admitted to the ICU with severe COVID-19 infections during our study period, 48 patients had Aspergillus species growing in respiratory cultures. Based on the 2020 European Confederation of Medical Mycology and the International Society for Human and Animal Mycology (ECMM/ISHAM) consensus criteria, 2 patients in the study had proven CAPA, 9 had probable CAPA, and 37 had possible CAPA. The incidence of CAPA was 5%. The mean duration from a positive COVID-19 test to Aspergillus spp. being recovered from the respiratory cultures was 16 days, and more than half of the patients had preceding fever or worsening respiratory failure despite adequate support and management. Antifungals were given for treatment in 44% of the patients for a mean duration of 13 days. The overall mortality rate in our study population was extremely high with death occurring in 40/48 patients (83%).
Highlights
Accepted: 9 November 2021Invasive pulmonary aspergillosis (IPA) is a devastating infection associated with high morbidity and mortality
IPA in post-viral illness and critically ill patients is even more difficult to diagnose due to the absence of characteristic clinical and imaging findings
We report our experience on COVID-19-associated pulmonary aspergillosis (CAPA) among patients with severe COVID-19 infection in Fresno, Central California, from January 2020 through March 2021
Summary
Invasive pulmonary aspergillosis (IPA) is a devastating infection associated with high morbidity and mortality. IPA was traditionally encountered in the immunocompromised host, typically patients with prolonged neutropenia, hematologic malignancy, allogeneic hematopoietic stem cell or solid organ transplantation, prolonged use of high dose corticosteroids and T-cell immunosuppressive agents [1]. Evidence started to accumulate that IPA occurred in patients admitted to the intensive care unit (ICU). A cohort of these ICU patients had preceding respiratory viral illnesses such as influenza [3,4]. IPA was already a challenging diagnosis in patients with traditional risk factors due to the difficulty of obtaining tissue samples to confirm diagnosis. IPA in post-viral illness and critically ill patients is even more difficult to diagnose due to the absence of characteristic clinical and imaging findings
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