COVID-19-Associated Pulmonary Aspergillosis (CAPA)

Area of Science:

• Infectious Diseases
• Pulmonology
• Mycology

Background:

• Invasive Pulmonary Aspergillosis (IPA) is an emerging secondary infection in COVID-19 patients, associated with increased mortality.
• The incidence, pathophysiology, diagnosis, and treatment of COVID-19-Associated Pulmonary Aspergillosis (CAPA) require comprehensive understanding.

Purpose of the Study:

• To review and synthesize current literature on the incidence, pathophysiology, diagnosis, and treatment of CAPA.
• To highlight diagnostic challenges and therapeutic strategies for CAPA.

Main Methods:

• Systematic review of existing studies on CAPA.
• Analysis of diagnostic criteria, including EORTC/MSG, AspICU, and IAPA criteria.
• Evaluation of diagnostic work-up methods such as BAL, galactomannan, and PCR.

Main Results:

• The incidence of CAPA is uncertain due to varied diagnostic criteria, with an estimated 8.6% of mechanically ventilated patients affected.
• Classical IPA risk factors are uncommon in CAPA patients, who are often immunocompetent with comorbidities.
• Commonly isolated pathogen is *Aspergillus fumigatus*; diagnostic tests show low sensitivity, necessitating differentiated strategies to distinguish colonization from infection.

Conclusions:

• Accurate differentiation between Aspergillus colonization and infection is critical in intubated COVID-19 patients.
• Voriconazole or isavuconazole are recommended for CAPA treatment upon confirmation.
• Further research is needed on the role of steroids and prophylactic antifungal administration.