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. 2020 Sep 15;2(9):e0211.
doi: 10.1097/CCE.0000000000000211. eCollection 2020 Sep.

Does Pulmonary Aspergillosis Complicate Coronavirus Disease 2019?

Karlyn D Beer  1 , Brendan R Jackson  1 , Tom Chiller  1 , Paul E Verweij  2 , Frank L Van de Veerdonk  2 , Joost Wauters  3
Affiliations

Does Pulmonary Aspergillosis Complicate Coronavirus Disease 2019?

Karlyn D Beer et al. Crit Care Explor. .

Abstract

Objectives: Aspergillus coinfection in coronavirus disease 2019 patients has rarely been described but may be occurring among coronavirus disease 2019 patients admitted to ICUs. Previous reports of viral coinfections with Aspergillus, including influenza-associated pulmonary aspergillosis, suggest that coronavirus disease 2019-associated aspergillosis is plausible. This report aims to summarize what is known about coronavirus disease 2019 complicated by Aspergillus, introduces coronavirus disease 2019-associated pulmonary aspergillosis as a possible clinical entity, and describes reasons clinical suspicion of Aspergillus is warranted in the critical care setting.

Data sources: We summarize the available evidence suggesting the existence of Aspergillus coinfection among severe coronavirus disease 2019 patients. This includes published coronavirus disease 2019 patient case series, a case description, and a review of potential biologic mechanisms.

Study selection: Reports of coronavirus disease 2019 patient attributes were selected if they included clinical, microbiologic, or radiologic signs of invasive fungal infection.

Data extraction: Data included in summary tables were identified through a literature search for coronavirus disease 2019-associated pulmonary aspergillosis.

Data synthesis: We present descriptive data extracted from coronavirus disease 2019-associated pulmonary aspergillosis case series current at the time of article submission.

Discussion: Pulmonary aspergillosis is known to occur among influenza patients requiring intensive care and is associated with increased mortality. If Aspergillus coinfections are occurring among coronavirus disease 2019 patients, early clinical suspicion and testing are needed to understand the epidemiology of these infections and prevent associated mortality. As the coronavirus disease 2019 pandemic unfolds, reports on the existence of this coinfection are needed, and opportunities to contribute cases of Aspergillus coinfection among coronavirus disease 2019 patients to an ongoing registry are described.

Keywords: Aspergillus infection; aspergillosis; coronavirus; coronavirus disease 2019; critical care; viral coinfection.

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Conflict of interest statement

Dr. Verweij has received honoraria from Mundipharma, F2G, Pfizer, and Gliead Sciences paid to the institution; research grants from F2G, Pfizer, Thermofisher, and Gilead Sciences; and nonfinancial support from IMMY outside the submitted work. Dr. van de Veerdonk has received honoraria from Gliead Sciences. Dr. Wauters received speakers fee from Merck Sharp & Dohme (MSD), Pfizer, and Gilead; research grants from MSD and Pfizer; and nonfinancial support from MSD outside the submitted work. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Joseph C, Togawa Y, Shindo N. Bacterial and viral infections associated with influenza. Influenza Other Respir Viruses. 2013; 7Suppl 2105–113 - PMC - PubMed
    1. Schauwvlieghe AFAD, Rijnders BJA, Philips N, et al. ; Dutch-Belgian Mycosis study group. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: A retrospective cohort study. Lancet Respir Med. 2018; 6:782–792 - PubMed
    1. Crum-Cianflone NF. Invasive aspergillosis associated with severe influenza infections. Open Forum Infect Dis. 2016; 3:ofw171. - PMC - PubMed
    1. Clancy CJ, Nguyen MH. Acute community-acquired pneumonia due to aspergillus in presumably immunocompetent hosts: Clues for recognition of a rare but fatal disease. Chest. 1998; 114:629–634 - PubMed
    1. Dutch Working Party on Antibiotic Policy: SWAB Guidelines for the Management of Invasive Fungal Infections 2017, Bergen, The Netherlands. Available at: https://www.nvmm.nl/media/1424/p-medische-microbiologie-nvmm-nvmm-richtl.... Accessed March 25, 2020