A review of significance of Aspergillus detection in airways of ICU COVID-19 patients

Abstract

It is now well known that patients with SARS-CoV-2 infection admitted in ICU and mechanically ventilated are at risk of developing invasive pulmonary aspergillosis (IPA). Nevertheless, symptomatology of IPA is often atypical in mechanically ventilated patients, and radiological aspects in SARS-CoV-2 pneumonia and IPA are difficult to differentiate. In this context, the significance of the presence of Aspergillus in airway specimens (detected by culture, galactomannan antigen or specific PCR) remains to be fully understood. To decipher the relevance of the detection of Aspergillus, we performed a comprehensive review of all published cases of respiratory Aspergillus colonisation and IPA in COVID-19 patients. The comparison of patients receiving or not antifungal treatment allowed us to highlight the most important criteria for the decision to treat. The comparison of surviving and non-surviving patients made it possible to unveil criteria associated with mortality that should be taken into account in the treatment decision.

Keywords: Aspergillus fumigatus; COVID-19; SARS-CoV-2; colonisation; intensive care unit; invasive pulmonary aspergillosis; mortality.

FIGURE 1

Flow chart

FIGURE 2

Schematic comparative representation of reported prevalence of IPA in ICU patients. Each green bar represents an individual study in COVID‐19 patients (details in Table 2). A short and long bar represent a retrospective and prospective study, respectively. The three yellow bars represent the global prevalence in ICU non‐COVID‐19 and non‐Influenza patients (0.3%–6.9%)., , The three red bars represent the prevalence in the group of ICU patients with severe influenza (16%–23%)., ,

FIGURE 3

Mortality odds ratio of clinical and microbiological interest (calculated from Table 3). COPD: chronic obstructive pulmonary disease, GM, galactomannan antigen, Positive blood marker included both positive blood PCR and GM