Abstract
(1) Background: The diagnosis of invasive aspergillosis (IA) in an intensive care unit (ICU) remains a challenge and the COVID-19 epidemic makes it even harder. Here, we evaluated Aspergillus PCR input to help classifying IA in SARS-CoV-2-infected patients. (2) Methods: 45 COVID-19 patients were prospectively monitored twice weekly for Aspergillus markers and anti-Aspergillus serology. We evaluated the concordance between (I) Aspergillus PCR and culture in respiratory samples, and (II) blood PCR and serum galactomannan. Patients were classified as putative/proven/colonized using AspICU algorithm and two other methods. (3) Results: The concordance of techniques applied on respiratory and blood samples was moderate (kappa = 0.58 and kappa = 0.63, respectively), with a higher sensitivity of PCR. According to AspICU, 9/45 patients were classified as putative IA. When incorporating PCR results, 15 were putative IA because they met all criteria, probably with a lack of specificity in the context of COVID-19. Using a modified AspICU algorithm, eight patients were classified as colonized and seven as putative IA. (4) Conclusion: An appreciation of the fungal burden using PCR and Aspergillus serology was added to propose a modified AspICU algorithm. This proof of concept seemed relevant, as it was in agreement with the outcome of patients, but will need validation in larger cohorts.
Highlights
Molecular tools as diagnostic criteria for invasive fungal diseases (IFD) has long been questioned because of a lack of reproducibility and insufficient standardization of protocols
The mean number of respiratory samples until patient discharge from intensive care units (ICU) was 3.8. We categorized these 45 patients according to the AspICU algorithm and propose two alternative classification methods presented in Table 1: the AspICU algorithm associated to PCR results in respiratory and serum samples, and a modified AspICU proposal
According to the AspICU classification incorporating PCR detection, 15 were classified as having putative aspergillosis because they met all criteria reported by Blot et al, i.e., compatible clinical signs, abnormal thoracic medical imaging on CT scan and positive screening for Aspergillus on respiratory samples
Summary
Molecular tools as diagnostic criteria for invasive fungal diseases (IFD) has long been questioned because of a lack of reproducibility and insufficient standardization of protocols. One algorithm has emerged as a valuable tool to classify invasive aspergillosis (IA) in ICU patients: the AspICU algorithm [3] This classification is considered as robust because it has been evaluated in patients for whom autopsy results were available, but it is quite awkward to use in routine practice, in COVID-19 patients with clinical and CT-scan signs hard to interpret [4]. It does not include molecular markers, which are used routinely [5]
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