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Updated: Sep 1, 2025
Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology
Published on: March 22, 2012
COVID-19-associated pulmonary aspergillosis: an underdiagnosed or overtreated infection?
Anahita Rouzé1, Ignacio Martin-Loeches2,3,4, Saad Nseir1
1Univ. Lille, CNRS, Inserm, CHU Lille, UMR 8576 - U1285 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Service de Médecine Intensive - Réanimation, France.
Insights
Coronavirus disease (COVID-19)-associated pulmonary aspergillosis (CAPA) affects up to one-third of intensive care unit (ICU) patients. Early diagnosis and treatment are crucial for managing this serious complication.
Area of Science:
- Critical care medicine
- Infectious diseases
- Pulmonology
Background:
- Coronavirus disease (COVID-19) patients in intensive care units (ICUs) are at risk for invasive fungal infections.
- COVID-19-associated pulmonary aspergillosis (CAPA) is a significant concern, potentially affecting up to one-third of ICU patients.
Purpose of the Study:
- To review the diagnostic criteria, pathogenesis, risk factors, incidence, and outcomes of CAPA.
- To discuss the diagnostic and therapeutic management strategies for CAPA in critically ill patients.
Main Methods:
- Systematic review of existing literature on CAPA.
- Analysis of diagnostic criteria, clinical presentation, and treatment outcomes.
Main Results:
- CAPA incidence varies (3-28%) based on definitions and screening methods.
- COVID-19-related factors like respiratory damage and immunosuppression increase Aspergillus colonization and invasion risk.
- CAPA onset typically occurs during the second week of mechanical ventilation and is linked to increased ICU mortality.
Conclusions:
- Further research is needed to validate CAPA definitions and accurately determine its incidence.
- A proactive diagnostic approach combining risk stratification, clinical assessment, and bronchoalveolar lavage is recommended for early detection and treatment.
Purpose Of Review:
Coronavirus disease (COVID-19)-associated pulmonary aspergillosis (CAPA) may concern up to one third of intensive care unit (ICU) patients. The purpose of this review is to discuss the diagnostic criteria, the pathogenesis, the risk factors, the incidence, the impact on outcome, and the diagnostic and therapeutic management of CAPA in critically ill patients.
Recent Findings:
The incidence of CAPA ranges 3--28% of critically ill patients, depending on the definition used, study design, and systematic or triggered screening. COVID-19 is associated with direct damage of the respiratory epithelium, immune dysregulation, and common use of immunosuppressive drugs which might promote Aspergillus respiratory tract colonization and invasion. Positive Aspergillus tests among COVID-19 critically patients might reflect colonization rather than invasive disease. CAPA usually appears during the second week after starting invasive mechanical ventilation and is independently associated with ICU mortality.
Summary:
Further studies are needed to validate CAPA case definitions, to determine the accurate incidence of CAPA in comparison to adequate controls, and its evolution during the pandemic. A pro-active diagnostic strategy, based on risk stratification, clinical assessment, and bronchoalveolar lavage could be recommended to provide early antifungal treatment in patients with high probability of CAPA and clinical deterioration.
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