Abstract
Patients with coronavirus disease 19 (COVID-19) have increased susceptibility to secondary respiratory infections including invasive pulmonary aspergillosis (IPA). COVID-19-associated pulmonary aspergillosis (CAPA) is difficult to diagnose and can be associated with increased mortality especially in severe immunodeficiency such as hematological malignancies. Our study evaluates IPA in COVID-19 patients defined as COVID-19-CAPA among patients with acute leukemia (AL). A retrospective single-center study analyzed 46 patients with COVID-19 infection and acute leukemia, admitted to the Clinic for Haematology, Clinical Center of Serbia, Belgrade between the 2 April 2020 and 15 May 2021. During hospitalization, all participants were diagnosed with probable IPA according to the previous consensus definitions. Positive serology and galactomannan (GM) detection values in bronchoalveolar lavage (BAL) and serum were used as microbiological criteria. COVID-19 associated probable IPA was found in 22% (9/41) tested patients, where serum GM and IgM anti-Aspergillus antibodies were positive in 12% (5/41) and 10% (4/41) had positive serology for aspergillosis. One patient died while eight recovered during follow-up. Our study showed that COVID-19 might be a risk factor for IPA development in patients with AL. Early diagnosis and prompt treatment are required as reported mortality rates are high.
Highlights
Patients with primary COVID-19 have increased susceptibility to secondary respiratory infections which may lead to greater severity of illness and may complicate treatments [1]
We aim to report a series of co-infection of COVID-19 and COVID-19-associated pulmonary aspergillosis (CAPA) in patients with acute leukemia (AL)
Inclusion criteria were: (1) patients with acute leukemia admitted to the Clinic for Heamatologyin Belgrade between 2 April 2020 and 15 May 2021; (2) positive result in the reverse transcription-polymerase chain reaction (RT-PCR) assay for SARS-CoV-2 in respiratory samples; (3) and with suspicion of CAPA based on clinical features, thoracic computed tomography (CT) scan, serology and galactomannan testing
Summary
Patients with primary COVID-19 have increased susceptibility to secondary respiratory infections which may lead to greater severity of illness and may complicate treatments [1]. Diagnosis of CAPA is crucial for successful treatment, yet conventional microscopy and culture of respiratory tract sample has only low sensitivity and specificity of around 50% [4]. There are insufficient data on the specific types of hematological malignancies in published studies, including the incidence of CAPA in such conditions. CAPA typically involves the lung, and chest computed tomography (CT) may detect lung involvement at an early stage of infection [9]. CT has a significant role in the very early stages of the COVID-19 infection, when the nasopharyngeal swab may still be negative, to eventually place the diagnosis of COVID-19 in patients highly suspicious (i.e., clinical features and exposure history) and set up a prognosis, as well as over the course of the disease for evaluating changes in severity requiring treatment adjustments [10]. We aim to report a series of co-infection of COVID-19 and CAPA in patients with acute leukemia (AL)
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