COVID‐19‐associated pulmonary aspergillosis (CAPA) in patients admitted with severe COVID‐19 pneumonia: An observational study from Pakistan

• Published in: Mycoses 2020-08, Vol.63 (8), p.766-770
• Main Authors: Nasir, Nosheen, Farooqi, Joveria, Mahmood, Syed Faisal, Jabeen, Kauser
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Aspergillosis; Aspergillus; Azithromycin - therapeutic use; Coronavirus Infections - complications; Coronavirus Infections - drug therapy; COVID-19; COVID‐19‐associated aspergillosis; Diabetes Complications - complications; Diabetes mellitus; Female; Humans; Hydroxychloroquine - therapeutic use; ICU admission; Influenza; invasive aspergillosis; Invasive Pulmonary Aspergillosis - complications; Invasive Pulmonary Aspergillosis - drug therapy; Male; Middle Aged; Nasopharynx - virology; Observational studies; Original; Pakistan; Pandemics; Pneumonia; Pneumonia, Viral - complications; Pneumonia, Viral - drug therapy; Respiratory distress syndrome; Respiratory Distress Syndrome - complications; Respiratory Distress Syndrome - mortality; Retrospective Studies; Risk Factors; severe COVID‐19
• ISSN: 0933-7407; 1439-0507
• DOI: 10.1111/myc.13135

Summary Background Invasive aspergillosis is a well‐known complication of severe influenza pneumonia with acute respiratory distress syndrome (ARDS). However, recent studies are reporting emergence of aspergillosis in severe COVID‐19 pneumonia, named as COVID‐19‐associated pulmonary aspergillosis (CAPA). Methods A retrospective observational study was conducted in patients with severe COVID‐19 pneumonia from February 2020 to April 2020. Patients ≥18 years of age with clinical features and abnormal chest imaging with confirmed COVID‐19 by RT‐PCR for SARS‐CoV‐2 were included. CAPA was diagnosed based on clinical parameters, radiological findings and mycological data. Data were recorded on a structured proforma, and descriptive analysis was performed using Stata ver 12.1. Results A total of 147 patients with confirmed COVID‐19 and 23 (15.6%) patients requiring ICU admission were identified. Aspergillus species were isolated from tracheal aspirates of nine (39.1%) patients, and of these, five patients (21.7%) were diagnosed with CAPA and four (17.4%) had Aspergillus colonisation. The mean age of patients with CAPA was 69 years (Median age: 71, IQR: 24, Range: 51‐85), and 3/5 patients were male. The most frequent co‐morbid was diabetes mellitus (4/5). The overall fatality rate of COVID‐19 patients with aspergillosis was 44% (4/9). The cause of death was ARDS in all three patients with CAPA, and the median length of stay was 16 days (IQR: 10; Range 6‐35 days). Conclusion This study highlights the need for comparative studies to establish whether there is an association of aspergillosis and COVID‐19 and the need for screening for fungal infections in severe COVID‐19 patients with certain risk factors.