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Review
. 2020 Oct 10;10(10):807.
doi: 10.3390/diagnostics10100807.

Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

Anna Apostolopoulou  1 , Zerelda Esquer Garrigos  2   3 , Prakhar Vijayvargiya  2   3 , Alexis Hope Lerner  4 , Dimitrios Farmakiotis  4
Affiliations
Review

Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature

Anna Apostolopoulou et al. Diagnostics (Basel). .

Abstract

In this systematic review, we investigate the epidemiology, pathogenesis, risk factors, clinical manifestations, diagnosis and treatment of COVID-19-associated pulmonary aspergillosis (CAPA). We identified 85 cases from 22 studies. The frequency of CAPA is currently unknown but ranges between <5% to >30% in different case series; the possibility of colonization rather than invasive disease is the most important confounder. The vast majority of patients with CAPA did not have any of the classic host risk factors, such as immunosuppression from organ transplant or neutropenia, although a significant proportion (46%) had received corticosteroids. Age, pulmonary comorbidities and male sex were associated with higher mortality. Patients treated with voriconazole had numerically lower case-fatality rate. Clinical vigilance for CAPA is advisable in critically ill patients with COVID-19 who are not improving, even those who do not meet classic host criteria for invasive mycoses, especially if they are receiving corticosteroids. A thorough, multi-faceted diagnostic work-up and early initiation of a mold-active triazole may be lifesaving. Further research studies using standardized, uniform definitions of invasive disease and colonization are urgently needed.

Keywords: CAPA; COVID-19; SARS-CoV-2; aspergillosis; aspergillus.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Proposed pathogenesis of CAPA.
Figure 2
Figure 2
UpSet diagram of diagnostic modalities for the diagnosis of CAPA.
See this image and copyright information in PMC

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