Does Pulmonary Aspergillosis Complicate Coronavirus Disease 2019?
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Published on: December 19, 2020
Karlyn D Beer1, Brendan R Jackson1, Tom Chiller1
1Centers for Disease Control and Prevention, Mycotic Diseases Branch, Atlanta, GA.
Objectives:
Aspergillus coinfection in coronavirus disease 2019 patients has rarely been described but may be occurring among coronavirus disease 2019 patients admitted to ICUs. Previous reports of viral coinfections with Aspergillus, including influenza-associated pulmonary aspergillosis, suggest that coronavirus disease 2019-associated aspergillosis is plausible. This report aims to summarize what is known about coronavirus disease 2019 complicated by Aspergillus, introduces coronavirus disease 2019-associated pulmonary aspergillosis as a possible clinical entity, and describes reasons clinical suspicion of Aspergillus is warranted in the critical care setting.
Data Sources:
We summarize the available evidence suggesting the existence of Aspergillus coinfection among severe coronavirus disease 2019 patients. This includes published coronavirus disease 2019 patient case series, a case description, and a review of potential biologic mechanisms.
Study Selection:
Reports of coronavirus disease 2019 patient attributes were selected if they included clinical, microbiologic, or radiologic signs of invasive fungal infection.
Data Extraction:
Data included in summary tables were identified through a literature search for coronavirus disease 2019-associated pulmonary aspergillosis.
Data Synthesis:
We present descriptive data extracted from coronavirus disease 2019-associated pulmonary aspergillosis case series current at the time of article submission.
Discussion:
Pulmonary aspergillosis is known to occur among influenza patients requiring intensive care and is associated with increased mortality. If Aspergillus coinfections are occurring among coronavirus disease 2019 patients, early clinical suspicion and testing are needed to understand the epidemiology of these infections and prevent associated mortality. As the coronavirus disease 2019 pandemic unfolds, reports on the existence of this coinfection are needed, and opportunities to contribute cases of Aspergillus coinfection among coronavirus disease 2019 patients to an ongoing registry are described.
Insights
Aspergillus coinfection in coronavirus disease 2019 patients is emerging as a critical concern. Early suspicion and testing for Aspergillus in severe COVID-19 cases are vital for understanding and preventing mortality.
Area of Science:
- Critical care medicine
- Infectious diseases
- Pulmonology
Background:
- Aspergillus coinfection is rarely reported in coronavirus disease 2019 (COVID-19) patients.
- Previous fungal coinfections in viral illnesses, like influenza-associated pulmonary aspergillosis, suggest COVID-19-associated aspergillosis is plausible.
- COVID-19 patients in intensive care units (ICUs) may be at risk for Aspergillus coinfection.
Purpose of the Study:
- To summarize current knowledge on COVID-19 complicated by Aspergillus.
- To introduce COVID-19-associated pulmonary aspergillosis as a potential clinical entity.
- To outline reasons for suspecting Aspergillus in critically ill COVID-19 patients.
Main Methods:
- Systematic review of published COVID-19 patient case series.
- Inclusion of case descriptions and review of potential biologic mechanisms.
- Selection of reports with clinical, microbiologic, or radiologic signs of invasive fungal infection.
Main Results:
- Descriptive data from available COVID-19-associated pulmonary aspergillosis case series were analyzed.
- Evidence suggests Aspergillus coinfection occurs in severe COVID-19 patients.
Conclusions:
- Pulmonary aspergillosis in critically ill influenza patients is linked to higher mortality.
- Early clinical suspicion and diagnostic testing for Aspergillus in COVID-19 patients are crucial.
- Further reports and registry contributions are needed to understand the epidemiology and impact of Aspergillus coinfection in COVID-19.
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