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. 2022 May 11;12(5):1201.
doi: 10.3390/diagnostics12051201.

Clinical and Imaging Features of COVID-19-Associated Pulmonary Aspergillosis

Tim Fischer  1 , Yassir El Baz  1 , Nicole Graf  2 , Simon Wildermuth  1 , Sebastian Leschka  1 , Gian-Reto Kleger  3 , Urs Pietsch  4 , Manuel Frischknecht  5 , Giulia Scanferla  5 , Carol Strahm  5 , Stephan Wälti  1 , Tobias Johannes Dietrich  1 , Werner C Albrich  5
Affiliations

Clinical and Imaging Features of COVID-19-Associated Pulmonary Aspergillosis

Tim Fischer et al. Diagnostics (Basel). .

Abstract

Background: COVID-19 superinfection by Aspergillus (COVID-19-associated aspergillosis, CAPA) is increasingly observed due to increased awareness and use of corticosteroids. The aim of this study is to compare clinical and imaging features between COVID-19 patients with and without associated pulmonary aspergillosis.

Material and methods: In this case-control study, hospitalized patients between March 2020 and March 2021 were evaluated. Two observers independently compared 105 chest CTs of 52 COVID-19 patients without pulmonary aspergillosis to 40 chest CTs of 13 CAPA patients. The following features were evaluated: lung involvement, predominant main pattern (ground glass opacity, crazy paving, consolidation) and additional lung and chest findings. Chronological changes in the abnormal extent upon CT and chronological changes in the main patterns were compared with mixed models. Patient-wise comparisons of additional features and demographic and clinical data were performed using Student's t-test, Chi-squared test, Fisher's exact tests and Wilcoxon rank-sum tests.

Results: Compared to COVID-19 patients without pulmonary aspergillosis, CAPA patients were older (mean age (±SD): 70.3 (±7.8) versus 63.5 (±9.5) years (p = 0.01). The time-dependent evolution rates for consolidation (p = 0.02) and ground glass (p = 0.006) differed. In early COVID-19 disease, consolidation was associated with CAPA, whereas ground glass was less common. Chronological changes in the abnormal extent upon CT did not differ (p = 0.29). Regardless of the time point, bronchial wall thickening was observed more frequently in CAPA patients (p = 0.03).

Conclusions: CAPA patients showed a tendency for consolidation in early COVID-19 disease. Bronchial wall thickening and higher patient age were associated with CAPA. The overall lung involvement was similar between both groups.

Keywords: COVID-19; COVID-19-associated pulmonary aspergillosis; chest CT.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Total lung involvement (A,B) and lobe-wise involvement (C,D) (upper lobe: green line, lower lobe: red line) by days after COVID-19 symptom onset in COVID-19 patients (A,C) and COVID-19-associated pulmonary aspergillosis (CAPA) patients (B,D). Dots show % of affected tissue of individual CTs and the curved lines represent the locally estimated scatterplot smoothing (loess) regression line. The dotted vertical lines (left to right) illustrate median days until detection of SARS-CoV-2 (CoV), ICU admission (ICU) and CAPA diagnosis (CAPA). Chronological changes in the abnormal extent of CT did not differ between COVID-19 and CAPA patients (p = 0.29) for interactions.
Figure 2
Figure 2
Chronological changes in CT (predicted probabilities) of consolidation (A), crazy paving (B) and ground glass opacity (C) for patients with and without COVID-19-associated pulmonary aspergillosis (CAPA) with corresponding 95% confidence intervals. In early COVID-19 disease, consolidation was associated with CAPA, whereas ground glass opacity was less common.
Figure 3
Figure 3
Imaging example of bronchial wall thickening (arrow) in a patient with probable COVID-19-associated pulmonary aspergillosis (CAPA). CT was performed 10 days after symptom onset on the day of the CAPA diagnosis. The T/D ratio (wall thickness (T) divided by the total diameter of bronchus (D)) was 0.32 in this case.
Figure 4
Figure 4
Chronological changes in CT (predicted probabilities of consolidation) with corresponding 95% confidence intervals for patients with COVID-19-associated pulmonary aspergillosis (CAPA), COVID-19 without bacterial superinfection (CoV) and COVID-19 with bacterial superinfection (CoV bact.). In early disease, consolidation is most common in CAPA patients and more common in COVID-19 patients with bacterial superinfection compared to patients without bacterial superinfection.
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Grants and funding

Funding in part by the Research Commission of the St. Gallen Cantonal Hospital.