COVID-19-associated invasive pulmonary aspergillosis in a tertiary care center in Mexico City

Abstract

Invasive pulmonary aspergillosis (IPA) is a severe infection caused by aspergillus sp. that usually develops in patients with severe immunosuppression. IPA has been recently described in critically ill COVID-19 patients (termed as COVID-associated pulmonary aspergillosis, or CAPA) that are otherwise immunocompetent. In order to describe the characteristics of patients with CAPA, we conducted a retrospective cohort study in a tertiary care center in Mexico City. We included all patients with confirmed COVID-19 admitted to the intensive care unit that had serum or bronchoalveolar lavage galactomannan measurements. We used the criteria proposed by Koehler et al. to establish the diagnosis of CAPA. Main outcomes were the need for invasive mechanical ventilation (IMV) and in-hospital mortality. Out of a total of 83 hospitalized patients with COVID-19 in the ICU, 16 (19.3%) met the criteria for CAPA. All patients diagnosed with CAPA required IMV whereas only 84% of the patients in the non-IPA group needed this intervention (P = 0.09). In the IPA group, 31% (n = 5) of the patients died, compared to 13% (n = 9) in the non-CAPA group (P = 0.08). We conclude that CAPA is a frequent co-infection in critically ill COVID-19 patients and is associated with a high mortality rate. The timely diagnosis and treatment of IPA in these patients is likely to improve their outcome.

Lay summary: We studied the characteristics of patients with COVID-19-associated invasive pulmonary aspergillosis (CAPA). Patients with CAPA tended to need invasive mechanical ventilation more frequently and to have a higher mortality rate. Adequate resources for its management can improve their outcome.

Keywords: COVID-19; glucocorticoids; invasive pulmonary aspergillosis; tocilizumab.

Figure 1.

Clinical outcomes. Here we show the comparison of both clinical outcomes of interest (invasive mechanical ventilation and in-hospital death) among both groups. Both outcomes tended to be more frequent in the CAPA group, although neither reached statistical significance.

Figure 2.

Kaplan-Meier curve for in-hospital mortality. Comparison of survival curves in the CAPA group and control group. Mortality tended to be more frequent in the invasive pulmonary aspergillosis, showing a peak in incidence at approximately 30 days of hospitalization. There was no statistical significance in in-hospital mortality (P = 0.1279).