key: cord-0845988-f592wlk2
authors: Verweij, Paul E; Alanio, Alexandre
title: Fungal infections should be part of the core outcome set for COVID-19
date: 2020-12-07
journal: Lancet Infect Dis
DOI: 10.1016/s1473-3099(20)30591-0
sha: 454e6860ff81d0b27292d0fa9ac7049753bcaaee
doc_id: 845988
cord_uid: f592wlk2

nan

Secondary infections with Aspergillus spp have emerged in association with influenza infection. Severe influenza was found to be an independent risk factor for invasive pulmonary aspergillosis. 3 All-cause mortality of patients in the ICU with influenzaassociated pulmonary aspergillosis was notably higher than in patients in the ICU with influenza only (51% vs 28%, p<0·001), 3 and some manifestations of influenza-associated pulmonary aspergillosis, such as invasive aspergillus tracheobronchitis, have been reported to have a mortality rate as high as 90%. 4 The first data collected indicate that aspergillus disease manifestations are more heterogeneous in patients with COVID-19 than in those with influenza, 5 which might be due to differences in the pathophysiology of the viral infection. Notably, serum galactomannan was frequently negative in patients with COVID-19-associated pulmonary aspergillosis (CAPA), whereas respiratory samples were aspergillus positive. Distinguishing between airway colonisation and invasive disease might prove difficult. Indeed, whereas patients with presumed CAPA can survive without antifungal therapy, cases of proven CAPA have been reported that were serum galactomannan negative. 6 Given these diagnostic challenges and the lack of a CAPA case definition, clinical studies are urgently needed to gain more insight into the pathophysiology of CAPA, to identify host and risk factors, and to design diagnostic and treatment strategies. To benefit from data collected through international clinical research studies of COVID-19, we believe that fungal infections should be part of the proposed core outcome set.

WHO Working Group on the Clinical Characterisation and Management of COVID-19 infection. A minimal common outcome measure set for COVID-19 clinical research

Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19

Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study

Invasive tracheobronchial aspergillosis in critically ill patients with severe influenza

Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion

COVID-19-associated invasive pulmonary aspergillosis