Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Oct 1;28(5):470-479.
doi: 10.1097/MCC.0000000000000977. Epub 2022 Aug 11.

COVID-19-associated pulmonary aspergillosis: an underdiagnosed or overtreated infection?

Anahita Rouzé  1 , Ignacio Martin-Loeches  2   3   4 , Saad Nseir  1
Affiliations
Review

COVID-19-associated pulmonary aspergillosis: an underdiagnosed or overtreated infection?

Anahita Rouzé et al. Curr Opin Crit Care. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

A.R.: MSD (lecture), I.M.L.: Gilead, Pfizer and Mundipharma (board and lectures), S.N.: Pfizer, Gilead, MSD, Biomérieux, Bio-Rad, Fisher and Payekel (lectures).

Figures

Box 1
Box 1
no caption available
FIGURE 1
FIGURE 1
Pathogenesis of COVID-19-associated pulmonary aspergillosis. Factors promoting Aspergillus respiratory tract colonization and invasion in critically ill patients infected with SARS-CoV-2. ARDS, acute respiratory distress syndrome; COPD, chronic obstructive pulmonary disease; EORTC/MSGERC, European Organization for Research and Treatment of Cancer / Mycoses Study Group Education and Research Consortium; ICU, intensive care unit; IL-6, interleukin-6.
FIGURE 2
FIGURE 2
Diagnostic strategy for COVID-19-associated pulmonary aspergillosis in the ICU, based on recent recommendations. Systematic screening is suggested by the 2020 ECMM/ISHAM guidelines [▪▪]. Diagnostic procedure triggered by clinical assessment or specific computed tomography lesions is recommended by an international taskforce of experts in the field [▪▪]. ARDS, acute respiratory distress syndrome; BAL, bronchoalveolar lavage; CT, computed tomography; EORTC/MSGERC, European Organization for Research and Treatment of Cancer / Mycoses Study Group Education and Research Consortium; GM, galactomannan; IL-6, interleukin-6; MV, mechanical ventilation; PCR, polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Meersseman W, Vandecasteele SJ, Wilmer A, et al. . Invasive aspergillosis in critically ill patients without malignancy. Am J Respir Crit Care Med 2004; 170:621–625. - PubMed
    1. Pardo E, Lemiale V, Mokart D, et al. . Invasive pulmonary aspergillosis in critically ill patients with hematological malignancies. Intensive Care Med 2019; 45:1732–1741. - PubMed
    1. Delsuc C, Cottereau A, Frealle E, et al. . Putative invasive pulmonary aspergillosis in critically ill patients with chronic obstructive pulmonary disease: a matched cohort study. Crit Care Lond Engl 2015; 19:421. - PMC - PubMed
    1. Levesque E, Ait-Ammar N, Dudau D, et al. . Invasive pulmonary aspergillosis in cirrhotic patients: analysis of a 10-year clinical experience. Ann Intensive Care 2019; 9:31. - PMC - PubMed
    1. Contou D, Dorison M, Rosman J, et al. . Aspergillus-positive lower respiratory tract samples in patients with the acute respiratory distress syndrome: a 10-year retrospective study. Ann Intensive Care 2016; 6:52. - PMC - PubMed

Publication types