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. 2020 Jul 10;6(3):105.
doi: 10.3390/jof6030105.

Is the COVID-19 Pandemic a Good Time to Include Aspergillus Molecular Detection to Categorize Aspergillosis in ICU Patients? A Monocentric Experience

Jean-Pierre Gangneux  1   2 , Florian Reizine  3 , Hélène Guegan  1   2 , Kieran Pinceaux  3 , Pierre Le Balch  3 , Emilie Prat  1 , Romain Pelletier  1 , Sorya Belaz  1 , Mathieu Le Souhaitier  3 , Yves Le Tulzo  3 , Philippe Seguin  4 , Mathieu Lederlin  5 , Jean-Marc Tadié  3 , Florence Robert-Gangneux  1   2
Affiliations

Is the COVID-19 Pandemic a Good Time to Include Aspergillus Molecular Detection to Categorize Aspergillosis in ICU Patients? A Monocentric Experience

Jean-Pierre Gangneux et al. J Fungi (Basel). .

Abstract

(1) Background: The diagnosis of invasive aspergillosis (IA) in an intensive care unit (ICU)remains a challenge and the COVID-19 epidemic makes it even harder. Here, we evaluatedAspergillus PCR input to help classifying IA in SARS-CoV-2-infected patients. (2) Methods: 45COVID-19 patients were prospectively monitored twice weekly for Aspergillus markers and anti-Aspergillus serology. We evaluated the concordance between (Ι) Aspergillus PCR and culture inrespiratory samples, and (ΙΙ) blood PCR and serum galactomannan. Patients were classified asputative/proven/colonized using AspICU algorithm and two other methods. (3) Results: Theconcordance of techniques applied on respiratory and blood samples was moderate (kappa = 0.58and kappa = 0.63, respectively), with a higher sensitivity of PCR. According to AspICU, 9/45 patientswere classified as putative IA. When incorporating PCR results, 15 were putative IA because theymet all criteria, probably with a lack of specificity in the context of COVID-19. Using a modifiedAspICU algorithm, eight patients were classified as colonized and seven as putative IA. (4)Conclusion: An appreciation of the fungal burden using PCR and Aspergillus serology was addedto propose a modified AspICU algorithm. This proof of concept seemed relevant, as it was inagreement with the outcome of patients, but will need validation in larger cohorts.

Keywords: Aspergillus; COVID-19; ICU; PCR; Sars-CoV-2; classification; galactomannan; invasive aspergillosis; probable; putative.

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Conflict of interest statement

J.-P.G. received funds for communications and congress attendance from Pfizer and Gilead. The other authors declare they have no conflict of interest.

Figures

Figure 1
Figure 1
Correlation between molecular and cultural quantification of Aspergillus burden in respiratory samples (rare: 1–2 CFU/plate; few: 2–5; numerous: >5). * significantly different with p < 0.05. ** significantly different with p < 0.01.
Figure 2
Figure 2
Computed tomography of the chest of patients with COVID-19 with secondary invasive aspergillosis. Unenhanced chest CT in a 59-year-old man with COVID-19 and biological markers of invasive aspergillosis performed at baseline (A) and at 12-day follow-up (B) showing subpleural ground-glass and reticular opacities presumed to correspond to COVID-19 lesions (arrowheads) as well as a right apical consolidation area presumed to correspond to invasive aspergillosis (arrow). Enhanced chest CT in a 69-year-old man with COVID-19 and biological markers of invasive aspergillosis showing at baseline (C) ground-glass opacities (arrowheads), and at 11-day follow-up (D) a left postero-basal consolidation presumed to correspond to invasive aspergillosis (arrow). (346-mm field of view, 512 × 512 image matrix, lung window (W1600/L-500 HU)).
See this image and copyright information in PMC

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