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Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis
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Histological Quantification to Determine Lung Fungal Burden in Experimental Aspergillosis

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COVID-19-Associated Pulmonary Aspergillosis, March-August 2020

Jon Salmanton-García, Rosanne Sprute, Jannik Stemler

    Emerging Infectious Diseases
    |February 4, 2021
    PubMed

    Insights

    Severe fungal infections, known as coronavirus disease-associated pulmonary aspergillosis (CAPA), significantly impacted patients with severe acute respiratory syndrome coronavirus 2. This study highlights the high mortality rate associated with CAPA in critically ill patients.

    Area of Science:

    • Infectious Diseases
    • Pulmonology
    • Mycology

    Background:

    • Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes significant immunomodulation and lymphocyte depletion.
    • Immunosuppression in SARS-CoV-2 patients increases the risk of secondary fungal infections.
    • Anticipated fungal superinfections, particularly pulmonary aspergillosis, in critically ill COVID-19 patients.

    Purpose of the Study:

    • To investigate the incidence, characteristics, and outcomes of coronavirus disease-associated pulmonary aspergillosis (CAPA).
    • To analyze the demographic and clinical features of CAPA patients.
    • To determine the mortality attributed to CAPA in a global cohort.

    Main Methods:

    • Retrospective data collection from 186 patients with CAPA worldwide (March-August 2020).
    • Analysis of patient demographics, clinical conditions, and treatment regimens.
    • Microbiological identification of Aspergillus species and antifungal susceptibility testing.

    Main Results:

    • The majority of CAPA patients (182/186) were admitted to the ICU, with 180 having acute respiratory distress syndrome and 175 requiring mechanical ventilation.
    • Aspergillus fumigatus was the predominant pathogen (80.3%), with some azole-resistant strains identified.
    • The overall mortality rate was 52.2%, with 33.0% of deaths attributed to CAPA. ICU incidence ranged from 1.0% to 39.1%.

    Conclusions:

    • Coronavirus disease-associated pulmonary aspergillosis is a significant complication in critically ill SARS-CoV-2 patients.
    • CAPA contributes substantially to the high mortality observed in these patients.
    • Further research is needed to optimize the diagnosis and management of CAPA.
    Keywords:
    AspergillusCOVID-19SARS-CoV-2aspergillosiscoronavirus diseasecoronavirusesfungiintensive care unitrespiratory infectionssevere acute respiratory syndrome coronavirus 2virusesvoriconazolezoonoses

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