COVID-19 Associated Pulmonary Aspergillosis: Diagnostic Performance, Fungal Epidemiology and Antifungal Susceptibility.

Nina Lackner,Dietmar Öfner,Claudius Thomé,Timo Mayerhöfer,Rohit Arora,Eldina Samardzic,Michael Joannidis,Robert Breitkopf,Cornelia Lass-Flörl,Wilfried Posch

doi:10.3390/jof8020093

Nina Lackner, Dietmar Öfner + Show 8 more

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https://doi.org/10.3390/jof8020093

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Abstract

Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) raises concerns as to whether it contributes to an increased mortality. The incidence of CAPA varies widely within hospitals and countries, partly because of difficulties in obtaining a reliable diagnosis. We implemented a routine screening of respiratory specimens in COVID-19 ICU patients for Aspergillus species using culture and galactomannan (GM) detection from serum and/or bronchoalveolar lavages (BAL). Out of 329 ICU patients treated during March 2020 and April 2021, 23 (7%) suffered from CAPA, 13 of probable, and 10 of possible. In the majority of cases, culture, microscopy, and GM testing were in accordance with CAPA definition. However, we saw that the current definitions underscore to pay attention for fungal microscopy and GM detection in BALs, categorizing definitive CAPA diagnosis based on culture positive samples only. The spectrum of Aspergillus species involved Aspergillus fumigatus, followed by Aspergillus flavus, Aspergillus niger, and Aspergillus nidulans. We noticed changes in fungal epidemiology, but antifungal resistance was not an issue in our cohort. The study highlights that the diagnosis and incidence of CAPA is influenced by the application of laboratory-based diagnostic tests. Culture positivity as a single microbiological marker for probable definitions may overestimate CAPA cases and thus may trigger unnecessary antifungal treatment.

Highlights

Several reports of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) [5,6,7] have raised concerns that this superinfection contributes to an increased mortality [8,9]
Our retrospective case study included 329 intensive care units (ICU) patients diagnosed with SARS-CoV-2 included in the COVID-19 ICU registry [13], 23 of these patients (7%) revealed Aspergillus positive culture during hospitalization at the University Hospital Innsbruck, Innsbruck
Microbiological details of culture, microscopy and GM testing are given in Tables 1 and 2

Summary

Introduction

The outbreak of the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic led to an increase of intensive care patients with severe pulmonary disorders [4]. Cases of CAPA were found to vary widely between hospitals and countries, intensive care units (ICU) reported rates from 3% to 33% [10]. These differences might be partly caused by difficulties in obtaining a reliable diagnosis and the lack of a specific clinical presentation; radiological features are not distinctive and diagnostic bronchoscopy is less frequently used in COVID-19 patients due to the risk of infectious aerosols [5]. A low sensitivity for circulating galactomannan (GM) in serum complicates any diagnostic evaluation, and the detection of Aspergillus species (sp.) in upper respiratory specimens does not distinguish fungal colonization from infection [5,10,11]

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