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. 2021 May 15;7(5):388.
doi: 10.3390/jof7050388.

Influenza- and COVID-19-Associated Pulmonary Aspergillosis: Are the Pictures Different?

Florian Reizine  1 , Kieran Pinceaux  1 , Mathieu Lederlin  2 , Brice Autier  3   4 , Hélène Guegan  3   4 , Arnaud Gacouin  1 , David Luque-Paz  1 , Christelle Boglione-Kerrien  5 , Astrid Bacle  4   6 , Brendan Le Daré  6 , Yoann Launey  7 , Mathieu Lesouhaitier  1 , Benoit Painvin  1 , Christophe Camus  1 , Alexandre Mansour  1 , Florence Robert-Gangneux  3   4 , Sorya Belaz  3 , Yves Le Tulzo  1 , Jean-Marc Tadié  1 , Adel Maamar  1 , Jean-Pierre Gangneux  3   4
Affiliations

Influenza- and COVID-19-Associated Pulmonary Aspergillosis: Are the Pictures Different?

Florian Reizine et al. J Fungi (Basel). .

Abstract

Invasive pulmonary aspergillosis (IPA) in intensive care unit patients is a major concern. Influenza-associated acute respiratory distress syndrome (ARDS) and severe COVID-19 patients are both at risk of developing invasive fungal diseases. We used the new international definitions of influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) to compare the demographic, clinical, biological, and radiological aspects of IAPA and CAPA in a monocentric retrospective study. A total of 120 patients were included, 71 with influenza and 49 with COVID-19-associated ARDS. Among them, 27 fulfilled the newly published criteria of IPA: 17/71 IAPA (23.9%) and 10/49 CAPA (20.4%). Kaplan-Meier curves showed significantly higher 90-day mortality for IPA patients overall (p = 0.032), whereas mortality did not differ between CAPA and IAPA patients. Radiological findings showed differences between IAPA and CAPA, with a higher proportion of features suggestive of IPA during IAPA. Lastly, a wide proportion of IPA patients had low plasma voriconazole concentrations with a higher delay to reach concentrations > 2 mg/L in CAPA vs. IAPA patients (p = 0.045). Severe COVID-19 and influenza patients appeared very similar in terms of prevalence of IPA and outcome. The dramatic consequences on the patients' prognosis emphasize the need for a better awareness in these particular populations.

Keywords: CAPA; COVID-19; CT-scan; IAPA; acute respiratory distress syndrome; corticosteroids; influenza; pulmonary aspergillosis; therapeutic drug monitoring; voriconazole.

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Conflict of interest statement

J.-P.G. has received research grants and funding from MSD and Pfizer. The other authors report no conflict of interest related to this work.

Figures

Figure 1
Figure 1
Cumulative 90-day mortality from admission to the intensive care unit in the whole population (Top) and among CAPA and IAPA patients (Below).
Figure 2
Figure 2
Chest CT-scan of LAPA and CAPA patients. Chest CT scans in the axial plane (lung window: W1600/L-500 HU) of three patients with LAPA (A–C) and three patients with CAPA (D–F). Typical CT findings in LAPA are unilateral or bilateral areas of consolidation with air bronchogram (A,B), cavity formation (asterisks), tree in bud (white arrowheads), bronchial wall thickening (white arrow), or occasionally nodules with halo signs (C, black arrows). Patients with CAPA may exhibit non-specific CT findings, such as bilateral areas of ground-glass opacity and/or crazy paving (D), extensive consolidations areas associated with peripheral traction bronchiectasis (E, black arrowheads), or, more rarely, unilateral consolidation areas (F). Despite not being very specific for a SARS COV2 infection, findings observed in (D,E) pictures can be seen frequently in severe COVID-19 patients.
See this image and copyright information in PMC

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