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A Visual and Comprehensive Review on COVID-19-Associated Pulmonary Aspergillosis (CAPA)
Simon Feys1,2, Maria Panagiota Almyroudi3, Reinout Braspenning1
1Medical Intensive Care Unit, University Hospitals Leuven, 3000 Leuven, Belgium.
Abstract:
Coronavirus disease 19 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a severe fungal infection complicating critically ill COVID-19 patients. Numerous retrospective and prospective studies have been performed to get a better grasp on this lethal co-infection. We performed a qualitative review and summarized data from 48 studies in which 7047 patients had been included, of whom 820 had CAPA. The pooled incidence of proven, probable or putative CAPA was 15.1% among 2953 ICU-admitted COVID-19 patients included in 18 prospective studies. Incidences showed great variability due to multiple factors such as discrepancies in the rate and depth of the fungal work-up. The pathophysiology and risk factors for CAPA are ill-defined, but therapy with corticosteroids and anti-interleukin-6 therapy potentially confer the biggest risk. Sampling for mycological work-up using bronchoscopy is the cornerstone for diagnosis, as imaging is often aspecific. CAPA is associated with an increased mortality, but we do not have conclusive data whether therapy contributes to an increased survival in these patients. We conclude our review with a comparison between influenza-associated pulmonary aspergillosis (IAPA) and CAPA.
Insights
COVID-19-associated pulmonary aspergillosis (CAPA) affects 15.1% of ICU patients, increasing mortality. Diagnosis relies on bronchoscopy, with risk factors including corticosteroid and anti-IL-6 therapies.
Area of Science:
- Infectious Diseases
- Mycology
- Critical Care Medicine
Background:
- COVID-19-associated pulmonary aspergillosis (CAPA) is a severe fungal co-infection in critically ill COVID-19 patients.
- Understanding CAPA's incidence, risk factors, and diagnostic challenges is crucial for patient outcomes.
Purpose of the Study:
- To conduct a qualitative review of studies on CAPA.
- To summarize the incidence, risk factors, diagnostic methods, and outcomes of CAPA.
- To compare CAPA with influenza-associated pulmonary aspergillosis (IAPA).
Main Methods:
- Qualitative review of 48 studies including 7047 patients.
- Pooled incidence calculation for CAPA in 18 prospective studies of ICU-admitted COVID-19 patients.
- Analysis of risk factors, diagnostic approaches, and mortality data.
Main Results:
- The pooled incidence of CAPA was 15.1% in ICU-admitted COVID-19 patients.
- Variability in incidence was linked to differences in fungal work-up protocols.
- Corticosteroid and anti-interleukin-6 therapies are potential risk factors; bronchoscopy is key for diagnosis.
Conclusions:
- CAPA is a significant complication associated with increased mortality in COVID-19 patients.
- Further research is needed to determine the impact of CAPA therapies on survival.
- A comparison with IAPA highlights unique aspects of COVID-19-related fungal infections.
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