Analysis of clinical characteristics of COVID-19 associated pulmonary aspergillosis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LI Qiao , LEI Wei , ZHANG Xiaohui ,  SU Nan

Department of Respiratory and Intensive Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, P. R. China;

Corresponding author：

SU Nan, Email: 15850111090@139.com

Keywords：

COVID-19 associated pulmonary aspergillosis; Coronavirus disease 2019; pulmonary aspergillosis

DOI：

10.7507/1671-6205.202306031

Video：

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Objective To investigate the clinical characteristics of patients with COVID-19 associated pulmonary aspergillosis (CAPA). Methods The clinical data of patients diagnosed with CAPA admitted to the First Affiliated Hospital of Soochow University from December 16, 2022 to February 2, 2023 were collected and analyzed. Results Among the 43 enrolled patients,16 patients required invasive mechanical ventilation, 44.19% (19/43) of them with critical novel coronavirus pneumonia, and 86.05% (37/43) had underlying diseases. The peak period of CAPA was 14 - 28 days after SARS-CoV-2 infection (48.84%, 21/43). In the laboratory results, 86.05% (37/43) of patients had varying degrees of lymphocyte reduction, with a lymphocyte count of 0.63 (0.33, 0.96) × 10⁹/L, the median levels of procalcitonin, CRP, and erythrocyte sedimentation rate were all higher than the reference values. 38.89% (14/36) of patients tested positive for serum GM test, and 75.00% (9/12) of patients tested positive for bronchoalveolar lavage fluid GM test. Aspergillus fumigatus is the most common strain. Voriconazole is the most commonly used antifungal drug (86.05%), and other drugs used include caspofungin, posaconazole, isavuconazonium, and amphotericin B. Two patients received local treatment with amphotericin B under bronchoscopy. After treatment, 27 patients improved and were discharged. Conclusions The symptoms, signs, and imaging manifestations of CAPA are not significantly specific, and are prone to misdiagnosis and missed diagnosis. The mortality rate is high. For patients suspected of CAPA and those with CAPA risk factors, relevant examinations should be promptly improved to improve diagnosis and treatment efficiency.

Citation： LI Qiao, LEI Wei, ZHANG Xiaohui, SU Nan. Analysis of clinical characteristics of COVID-19 associated pulmonary aspergillosis. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(10): 710-715. doi: 10.7507/1671-6205.202306031 Copy

1.	Wu HY, Chang PH, Chen KY, et al. Coronavirus disease 2019 (COVID-19) associated bacterial coinfection: incidence, diagnosis and treatment. J Microbiol Immunol Infect, 2022, 55(6 Pt 1): 985-992.
2.	Machado M, Valerio M, Álvarez-Uría A, et al. Invasive pulmonary aspergillosis in the COVID-19 era: an expected new entity. Mycoses, 2021, 64(2): 132-143.
3.	Zhu XJ, Ge YY, Wu T, et al. Co-infection with respiratory pathogens among COVID-2019 cases. Virus Res, 2020, 285: 198005.
4.	Wang J, Yang Q, Zhang PP, et al. Clinical characteristics of invasive pulmonary aspergillosis in patients with COVID-19 in Zhejiang, China: a retrospective case series. Crit Care, 2020, 24(1): 299.
5.	Dupont D, Menotti J, Turc J, et al. Pulmonary aspergillosis in critically ill patients with Coronavirus Disease 2019 (COVID-19). Med Mycol, 2021, 59(1): 110-114.
6.	Dellière S, Dudoignon E, Fodil S, et al. Risk factors associated with COVID-19-associated pulmonary aspergillosis in ICU patients: a French multicentric retrospective cohort. Clin Microbiol Infect, 2020, 27(5): 790.
7.	Bartoletti M, Pascale R, Cricca M, et al. Epidemiology of Invasive Pulmonary Aspergillosis Among Intubated Patients With COVID-19: A Prospective Study. Clin Infect Dis, 2021, 73(11): e3606-e3614.
8.	Lamoth F, Lewis RE, Walsh TJ, et al. Navigating the uncertainties of COVID-19-associated aspergillosis: a comparison with influenza-associated aspergillosis. J Infect Dis, 2021, 224(10): 1631-1640.
9.	中华人民共和国国家卫生健康委员会办公厅, 中华人民共和国国家中医药管理局综合司. 新型冠状病毒感染诊疗方案(试行第十版). 中国医药, 2023, 18(2): 161-166.
10.	Koehler P, Bassetti M, Chakrabarti A, et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis, 2021, 21(6): e149-e162.
11.	Dewi IM, Janssen NA, Rosati D, et al. Invasive pulmonary aspergillosis associated with viral pneumonitis. Curr Opin Microbiol, 2021, 62: 21-27.
12.	van Arkel A, Rijpstra TA, Belderbos H, et al. COVID-19-associated pulmonary aspergillosis. Am J Respir Crit Care Med, 2020, 202(1): 132-135.
13.	Rutsaert L, Steinfort N, Van Hunsel T, et al. COVID-19-associated invasive pulmonary aspergillosis. Ann Intensive Care, 2020, 10(1): 71.
14.	Alanio A, Dellière S, Fodil S, et al. Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19. Lancet Respir Med, 2020, 8(6): e48-e49.
15.	Vergara-Maestre DA. COVID-19 associated pulmonary aspergillosis: New consensus criteria for diagnosis. Rev Esp Anestesiol Reanim (Engl Ed), 2023, 70(3): 178-179.
16.	Meersseman W, Lagrou K, Maertens J, et al. Galactomannan in bronchoalveolar lavage fluid: a tool for diagnosing aspergillosis in intensive care unit patients. Am J Respir Crit Care Med, 2008, 177(1): 27-34.
17.	Gangneux JP, Bougnoux ME, Dannaoui E, et al. Invasive fungal diseases during COVID-19: We should be prepared. J Mycol Med, 2020, 30(2): 100971.
18.	Dimopoulos G, Almyroudi MP, Myrianthefs P, et al. COVID-19-associated pulmonary aspergillosis (CAPA). J Intensive Med, 2021, 1(2): 71-80.
19.	Lai CC, Yu WL. COVID-19 associated with pulmonary aspergillosis: a literature review. J Microbiol Immunol Infect, 2021, 54(1): 46-53.

1. Wu HY, Chang PH, Chen KY, et al. Coronavirus disease 2019 (COVID-19) associated bacterial coinfection: incidence, diagnosis and treatment. J Microbiol Immunol Infect, 2022, 55(6 Pt 1): 985-992.
2. Machado M, Valerio M, Álvarez-Uría A, et al. Invasive pulmonary aspergillosis in the COVID-19 era: an expected new entity. Mycoses, 2021, 64(2): 132-143.
3. Zhu XJ, Ge YY, Wu T, et al. Co-infection with respiratory pathogens among COVID-2019 cases. Virus Res, 2020, 285: 198005.
4. Wang J, Yang Q, Zhang PP, et al. Clinical characteristics of invasive pulmonary aspergillosis in patients with COVID-19 in Zhejiang, China: a retrospective case series. Crit Care, 2020, 24(1): 299.
5. Dupont D, Menotti J, Turc J, et al. Pulmonary aspergillosis in critically ill patients with Coronavirus Disease 2019 (COVID-19). Med Mycol, 2021, 59(1): 110-114.
6. Dellière S, Dudoignon E, Fodil S, et al. Risk factors associated with COVID-19-associated pulmonary aspergillosis in ICU patients: a French multicentric retrospective cohort. Clin Microbiol Infect, 2020, 27(5): 790.
7. Bartoletti M, Pascale R, Cricca M, et al. Epidemiology of Invasive Pulmonary Aspergillosis Among Intubated Patients With COVID-19: A Prospective Study. Clin Infect Dis, 2021, 73(11): e3606-e3614.
8. Lamoth F, Lewis RE, Walsh TJ, et al. Navigating the uncertainties of COVID-19-associated aspergillosis: a comparison with influenza-associated aspergillosis. J Infect Dis, 2021, 224(10): 1631-1640.
9. 中华人民共和国国家卫生健康委员会办公厅, 中华人民共和国国家中医药管理局综合司. 新型冠状病毒感染诊疗方案(试行第十版). 中国医药, 2023, 18(2): 161-166.
10. Koehler P, Bassetti M, Chakrabarti A, et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis, 2021, 21(6): e149-e162.
11. Dewi IM, Janssen NA, Rosati D, et al. Invasive pulmonary aspergillosis associated with viral pneumonitis. Curr Opin Microbiol, 2021, 62: 21-27.
12. van Arkel A, Rijpstra TA, Belderbos H, et al. COVID-19-associated pulmonary aspergillosis. Am J Respir Crit Care Med, 2020, 202(1): 132-135.
13. Rutsaert L, Steinfort N, Van Hunsel T, et al. COVID-19-associated invasive pulmonary aspergillosis. Ann Intensive Care, 2020, 10(1): 71.
14. Alanio A, Dellière S, Fodil S, et al. Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19. Lancet Respir Med, 2020, 8(6): e48-e49.
15. Vergara-Maestre DA. COVID-19 associated pulmonary aspergillosis: New consensus criteria for diagnosis. Rev Esp Anestesiol Reanim (Engl Ed), 2023, 70(3): 178-179.
16. Meersseman W, Lagrou K, Maertens J, et al. Galactomannan in bronchoalveolar lavage fluid: a tool for diagnosing aspergillosis in intensive care unit patients. Am J Respir Crit Care Med, 2008, 177(1): 27-34.
17. Gangneux JP, Bougnoux ME, Dannaoui E, et al. Invasive fungal diseases during COVID-19: We should be prepared. J Mycol Med, 2020, 30(2): 100971.
18. Dimopoulos G, Almyroudi MP, Myrianthefs P, et al. COVID-19-associated pulmonary aspergillosis (CAPA). J Intensive Med, 2021, 1(2): 71-80.
19. Lai CC, Yu WL. COVID-19 associated with pulmonary aspergillosis: a literature review. J Microbiol Immunol Infect, 2021, 54(1): 46-53.

Chinese Journal of Respiratory and Critical Care Medicine

Analysis of clinical characteristics of COVID-19 associated pulmonary aspergillosis

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