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Association of COVID-19-Associated Pulmonary Aspergillosis with Cytomegalovirus Replication: A Case-Control Study

Jorge Calderón-Parra1,2, Victor Moreno-Torres1,2, Patricia Mills-Sanchez1

  • 1Infectious Diseases Unit, Service of Internal Medicine, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain.

Journal of Fungi (Basel, Switzerland)
|February 25, 2022
PubMed

Insights

Cytomegalovirus (CMV) replication is linked to COVID-19-associated pulmonary aspergillosis (CAPA) in critically ill patients. CMV reactivation may precede and indicate a higher risk of developing CAPA.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Pulmonology

Background:

  • Cytomegalovirus (CMV) infection is a known risk factor for invasive aspergillosis in immunocompromised individuals.
  • The association between CMV replication and COVID-19-associated pulmonary aspergillosis (CAPA) remains underexplored.

Purpose of the Study:

  • To investigate the potential link between cytomegalovirus (CMV) replication and the occurrence of COVID-19-associated pulmonary aspergillosis (CAPA).

Main Methods:

  • Retrospective case-control study involving critically ill COVID-19 patients.
  • Cases were defined as patients diagnosed with CAPA based on 2020 ECMM/ISHAM criteria.
  • Two controls per case were selected from critically ill COVID-19 patients without CAPA.

Main Results:

  • CMV replication was significantly more frequent in CAPA cases (75.0%) compared to controls (35.4%) (p=0.002).
  • Probable CMV end-organ disease was also more prevalent in CAPA patients (20.8% vs. 4.2%, p=0.037).
  • CMV replication remained strongly associated with CAPA after adjusting for confounders (OR 8.28, p=0.005), with 81.8% of cases showing CMV replication prior to CAPA diagnosis.

Conclusions:

  • CMV replication is associated with CAPA in critically ill COVID-19 patients.
  • CMV replication may serve as an early indicator or harbinger of CAPA development.
  • Further research is warranted to confirm this association and its clinical implications.
Keywords:
CAPACOVID-associated pulmonary aspergillosiscytomegalovirus infectionprevalencerisk factors

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