As many as 15% of patients with COVID-19 who are hospitalized in an intensive care unit (ICU) develop Aspergillus infection, according to a multinational study published in the CDC journal Emerging Infectious Diseases.
Damage to the lining of airways from severe SARS-CoV-2 infection allows Aspergillus fungi to invade the tissue, according to a recent consensus guidance from the European Confederation of Medical Mycology and the International Society for Human and Animal Mycology. These secondary fungal infections can worsen patient outcomes, and they’ve raised concern about emerging evidence of Aspergillus resistance to voriconazole and isavuconazole, the first-line therapies.
The study provides new insights about the prevalence of coronavirus disease–associated pulmonary aspergillosis (CAPA) and potential risk factors. One of the study cohorts involved 519 patients with COVID-19 admitted from late February through May 2020 to 4 ICUs in the Netherlands and Belgium. Among 279 patients who could be classified based on the consensus guidance criteria, 2% had proven CAPA, 12% had probable cases, and 1% had possible CAPA. Corticosteroid use wasn’t associated with CAPA.
Among patients with underlying conditions, or “host factors,” like neutropenia or having had a solid organ transplant, 30% had CAPA compared with 16% of patients without such risk factors. Having HIV/AIDS, chronic obstructive pulmonary disease, or treatment with non–corticosteroid immunosuppressing drugs before ICU admission was linked with CAPA.
In a second cohort involving 304 patients in France, 10% of the 209 who could be classified had CAPA. About half of the patients with CAPA in both cohorts died. “Clinicians should be aware of CAPA and that underlying factors…can increase the risks,” the authors wrote.