Prevalence, Risk Factors, Treatment, Outcome, and Diagnosis of COVID-19-Associated Pulmonary Aspergillosis Using a Serum Galactomannan Assay

Abstract

Background: Coronavirus-associated pulmonary aspergillosis (CAPA) is defined as invasive pulmonary aspergillosis (IPA) occurring in patients with COVID-19 infection. Objectives: This study aimed to identify CAPA patients and describe their clinical-epidemiological characteristics in Ahvaz, Iran, from the third to the fifth COVID-19 waves. Methods: The serum galactomannan (GM) antigen assay was used to detect CAPA in 257 COVID-19 hospitalized patients according to the EORTC/MSGERC (European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium) 2020 criteria. The demographic and clinical data, host risk factors, lung radiographic imaging, laboratory findings, antifungal agents used, and the outcomes of the patients were extracted in cases that were available. All findings were statistically analyzed. Results: Of the 257 patients, 114 (44.35%) were positive for GM levels (CAPA cases). The demographic and clinical information of 51 cases showed that diabetes mellitus (25.5%) was the most common underlying condition, followed by oropharyngeal candidiasis (22%) and hypertension (21.6%). In both surviving and deceased patients, the frequency of CAPA in older ages was statistically significant (r = 0.519; P < 0.0001). In surviving individuals, GM had a significant relationship with age (r = 0.520; P = 0.032), blood glucose (BS; r = 0.497; P = 0.043), diagnosis of hyperglycemia during hospitalization (P = 0.039), and diabetes mellitus (P = 0.039). In deceased patients, the frequency of CAPA in older ages was statistically significant (r = 0.503; P = 0.002). Galactomannan had a significant association with the variables of age (r = 0.503; P = 0.002) and suspicion of fungal infection (P = 0.003). Conclusions: The prevalence of CAPA was high in critically ill patients with COVID-19. Diabetes mellitus, hyperglycemia, and old age are the main factors that predispose COVID-19 patients to IPA.