COVID‐19–associated pulmonary aspergillosis: a prospective single‐center dual case series

• Published in: Mycoses Vol. 64; no. 4; pp. 457 - 464
• Main Authors: Meijer, Eelco F. J., Dofferhoff, Anton S. M., Hoiting, Oscar, Meis, Jacques F.
• Format: Journal Article Web Resource
• Language: English
• Published: Germany John Wiley & Sons, Inc 01.04.2021; Wiley Subscription Services, Inc; John Wiley and Sons Inc
• Subjects: Aged; Aspergillosis; Aspergillus fumigatus; CAPA; Cohort Studies; COVID-19; COVID-19 - complications; COVID-19 - diagnosis; Dexamethasone; Female; Humans; ICU; Intensive Care Units; Intubation; Male; Mechanical ventilation; Mortality; Netherlands - epidemiology; Original; Polymerase Chain Reaction; Prospective Studies; pulmonary aspergillosis; Pulmonary Aspergillosis - complications; Pulmonary Aspergillosis - epidemiology; Pulmonary Aspergillosis - etiology; Pulmonary Aspergillosis - mortality; Respiration, Artificial; Respiratory Insufficiency - etiology; Respiratory Insufficiency - therapy; SARS-CoV-2 - genetics; SARS-CoV-2 - isolation & purification; Severe acute respiratory syndrome coronavirus 2; TR34L98H; Ventilators; Netherlands; CAPA; dexamethasone; ICU; pulmonary aspergillosis; Aspergillus fumigatus; TR34L98H
• ISSN: 0933-7407; 1439-0507
• DOI: 10.1111/myc.13254

Background COVID‐19–associated pulmonary aspergillosis (CAPA) has emerged as an invasive fungal disease, often affecting previously immunocompetent, mechanically ventilated, intensive care unit (ICU) patients. Incidence rates of 3.8%–33.3% have been reported depending on the geographic area, with high (47%) mortality. Objectives Here, we describe a single‐centre prospective case series with CAPA cases from both the first (March‐May, n = 5/33) and second (mid‐September through mid‐December, n = 8/33) COVID‐19 wave at a 500‐bed teaching hospital in the Netherlands. Patients/Methods In the first COVID‐19 wave, a total of 265 SARS‐CoV‐2 PCR‐positive patients were admitted to our hospital of whom 33 needed intubation and mechanical ventilation. In the second wave, 508 SARS‐CoV‐2 PCR‐positive patients were admitted of whom 33 needed mechanical ventilation. Data were prospectively collected. Results We found a significant decrease in COVID‐19 patients needing mechanical ventilation in the ICU in the second wave (p < .01). From these patients, however, a higher percentage were diagnosed with CAPA (24.2% vs 15.2%), although not significant (p = .36). All CAPA patients encountered in the second wave received dexamethasone. Mortality between both groups was similarly high (40%–50%). Moreover, we found environmental TR34/L98H azole‐resistant Aspergillus fumigatus isolates in two separate patients. Conclusions In this series, 19.7% (n = 13/66) of mechanically ventilated SARS‐CoV‐2 patients were diagnosed with CAPA. In addition, we found a significant reduction in COVID‐19 patients needing mechanical ventilation on the ICU in the second wave. Numbers are too small to determine whether there is a true difference in CAPA incidence in mechanically ventilated patients between the two waves, and whether it could be attributed to dexamethasone SARS‐CoV‐2 therapy.