Abstract
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%.
Highlights
Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019
Most (182; 97.8%) patients were admitted to the intensive care unit (ICU), most for acute respiratory distress syndrome (ARDS) (180; 96.8%) or mechanical ventilation (175; 94.1%)
We described 62 coronavirus disease–associated pulmonary aspergillosis (CAPA) cases in the literature, 45 in the FungiScope registry, and 79 in both that were diagnosed during March 1–August 31, 2020
Summary
Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Cases of pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were first described in Wuhan, China, at the end of December 2019 [1]. RESEARCH ventilation [7,17] Many of these patients lack the concurrent conditions usually associated with invasive pulmonary aspergillosis (IPA) such as malignancies, neutropenia, or history of allogeneic stem cell or solid organ transplantation [21]. Gov/EID/article/27/4/20-4895-App1.pdf) and the FungiScope registry (reference 55 in Appendix) to describe baseline conditions, clinical management, and associated deaths in CAPA patients. This analysis contextualizes the available cumulative incidences
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