key: cord-0713753-ymfagwyu
authors: Zhang, Sean X.; Balada-Llasat, Joan-Miquel; Pancholi, Preeti; Sullivan, Kaede V.; Riedel, Stefan
title: COVID-Associated Pulmonary Aspergillosis in the United States: Is It Rare or Have We Missed the Diagnosis?
date: 2021-09-20
journal: J Clin Microbiol
DOI: 10.1128/jcm.01135-21
sha: d1490c54a30b19ad824f07ecb1c023d7fc0b543f
doc_id: 713753
cord_uid: ymfagwyu

While the incidence of COVID-associated pulmonary aspergillosis (CAPA) in COVID-19 patients admitted to the ICU in Europe is widely published (incidence up to 30%) (1), data on CAPA from the United States is lacking or has not been well described (2, 3).….

Days from ICU admission.

c Probable CAPA was defined as having one of the following: (i) Aspergillus from BAL, (ii) positive serum GM index of Based on our data, the incidence of CAPA after ICU admission in the United States appears to be low. This finding is consistent with findings in a recent autopsy study demonstrating a low incidence of CAPA (8) as well as low incidence reported from other centers (1, 9, 10) . However, the low incidence may be due to a suboptimal diagnostic workup that may be hindering the establishment of a diagnosis of CAPA: (i) reluctance to perform bronchoalveolar lavage in COVID-19 cases for fungal culture plus underutilization of BAL GM testing, (ii) infrequent fungal diagnostic workup, (iii) low sensitivity of serum GM, and (iv) lack of alternative diagnostic tools (e.g., Aspergillus PCR, GM testing in non-BAL respiratory samples). Given the high mortality associated with CAPA, a concerted effort is needed to develop a diagnostic strategy that is both safe and sensitive. Furthermore, it may also need to take into account that the process of sample collection and environmental hygiene in various hospital settings may contribute to false diagnosis of aspergillosis (11) . Further studies will be needed to assess the true incidence and prevalence of CAPA.

Aspergillus in critically ill COVID-19 patients: a scoping review

Aspergillosis complicating severe coronavirus disease

COVID-19 associated pulmonary aspergillosis in mechanically ventilated patients

Fungal Diagnostics Laboratories Consortium (FDLC). 2021. Recognition of diagnostic gaps for laboratory diagnosis of fungal diseases: expert opinion from the Fungal Diagnostics Laboratories Consortium (FDLC)

Infectious Diseases Fungal Infection Study Group, ESCMID Study Group for Infections in Critically Ill Patients, Interregional Association of Clinical Microbiology and Antimicrobial Chemotherapy, Medical Mycology Society of Nigeria, Medical Mycology Society of China Medicine Education Association, Infectious Diseases Working Party of the German Society for Haematology and Medical Oncology, Association of Medical Microbiology, Infectious Disease Canada. 2021. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance

COVID-19-associated invasive aspergillosis: data from the UK National Mycology Reference Laboratory

A national strategy to diagnose COVID-19 associated invasive fungal disease in the ICU

Invasive mould disease in fatal COVID-19: a systematic review of autopsies

Occurrence of invasive pulmonary fungal infections in patients with severe COVID-19 admitted to the ICU

Frequency of positive Aspergillus tests in COVID-19 patients in comparison to other patients with pulmonary infections admitted to the intensive care unit

Navigating the uncertainties of COVID-19 associated aspergillosis (CAPA): a comparison with influenza associated aspergillosis (IAPA)