Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr;64(4):457-464.
doi: 10.1111/myc.13254. Epub 2021 Feb 16.

COVID-19-associated pulmonary aspergillosis: a prospective single-center dual case series

Eelco F J Meijer  1   2   3 , Anton S M Dofferhoff  3   4 , Oscar Hoiting  5 , Jacques F Meis  1   2   3   6
Affiliations

COVID-19-associated pulmonary aspergillosis: a prospective single-center dual case series

Eelco F J Meijer et al. Mycoses. 2021 Apr.

Abstract

Background: COVID-19-associated pulmonary aspergillosis (CAPA) has emerged as an invasive fungal disease, often affecting previously immunocompetent, mechanically ventilated, intensive care unit (ICU) patients. Incidence rates of 3.8%-33.3% have been reported depending on the geographic area, with high (47%) mortality.

Objectives: Here, we describe a single-centre prospective case series with CAPA cases from both the first (March-May, n = 5/33) and second (mid-September through mid-December, n = 8/33) COVID-19 wave at a 500-bed teaching hospital in the Netherlands.

Patients/methods: In the first COVID-19 wave, a total of 265 SARS-CoV-2 PCR-positive patients were admitted to our hospital of whom 33 needed intubation and mechanical ventilation. In the second wave, 508 SARS-CoV-2 PCR-positive patients were admitted of whom 33 needed mechanical ventilation. Data were prospectively collected.

Results: We found a significant decrease in COVID-19 patients needing mechanical ventilation in the ICU in the second wave (p < .01). From these patients, however, a higher percentage were diagnosed with CAPA (24.2% vs 15.2%), although not significant (p = .36). All CAPA patients encountered in the second wave received dexamethasone. Mortality between both groups was similarly high (40%-50%). Moreover, we found environmental TR34 /L98H azole-resistant Aspergillus fumigatus isolates in two separate patients.

Conclusions: In this series, 19.7% (n = 13/66) of mechanically ventilated SARS-CoV-2 patients were diagnosed with CAPA. In addition, we found a significant reduction in COVID-19 patients needing mechanical ventilation on the ICU in the second wave. Numbers are too small to determine whether there is a true difference in CAPA incidence in mechanically ventilated patients between the two waves, and whether it could be attributed to dexamethasone SARS-CoV-2 therapy.

Keywords: Aspergillus fumigatus; CAPA; ICU; TR34L98H; dexamethasone; pulmonary aspergillosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. White PL, Dhillon R, Cordey A, et al. A national strategy to diagnose COVID‐19 associated invasive fungal disease in the ICU. Clin Infect Dis. 2020; 10.1093/cid/ciaa1298 - DOI - PMC - PubMed
    1. Borman AM, Palmer MD, Fraser M, et al. COVID‐19‐associated invasive Aspergillosis: data from the UK National Mycology Reference Laboratory. J Clin Microbiol. 2021;59(1):e02136‐20. - PMC - PubMed
    1. van Arkel ALE, Rijpstra TA, Belderbos HNA, van Wijngaarden P, Verweij PE, Bentvelsen RG. COVID‐19‐associated pulmonary aspergillosis. Am J Respir Crit Care Med. 2020;202(1):132‐135. - PMC - PubMed
    1. Van Biesen S, Kwa D, Bosman RJ, Juffermans NP. Detection of invasive pulmonary aspergillosis in COVID‐19 with non‐directed bronchoalveolar lavage. Am J Respir Crit Care Med. 2020;202(8):1171‐1173. - PMC - PubMed
    1. Rutsaert L, Steinfort N, Van Hunsel T, et al. COVID‐19‐associated invasive pulmonary aspergillosis. Ann Intensive Care. 2020;10(1):71. - PMC - PubMed

MeSH terms