COVID-19-Associated Pulmonary Aspergillosis in Russia

Abstract

We studied the risk factors, etiology, clinical features and the effectiveness of therapy of COVID-19-associated pulmonary aspergillosis (CAPA) in adult patients. In this retrospective study, we included 45 patients with proven (7%) and probable (93%) CAPA. The ECMM/ISHAM, 2020 criteria were used to diagnose CAPA. A case-control study was conducted to study the risk factors of CAPA; the control group included 90 adult COVID-19 patients without IA. In CAPA patients, the main underlying diseases were diabetes mellitus (33%), and hematological and oncological diseases (31%). The probability of CAPA developing significantly increased with lymphocytopenia >10 days (OR = 8.156 (3.056-21.771), p = 0.001), decompensated diabetes mellitus (29% vs. 7%, (OR = 5.688 (1.991-16.246), p = 0.001)), use of glucocorticosteroids (GCS) in prednisolone-equivalent dose > 60 mg/day (OR = 4.493 (1.896-10.647), p = 0.001) and monoclonal antibodies to IL-1ß and IL-6 (OR = 2.880 (1.272-6.518), p = 0.01). The main area of localization of CAPA was the lungs (100%). The clinical features of CAPA were fever (98% vs. 85%, p = 0.007), cough (89% vs. 72%, p = 0.002) and hemoptysis (36% vs. 3%, p = 0.0001). Overall, 71% of patients were in intensive care units (ICU) (median-15.5 (5-60) days), mechanical ventilation was used in 52% of cases, and acute respiratory distress syndrome (ARDS) occurred at a rate of 31%. The lung CT scan features of CAPA were bilateral (93%) lung tissue consolidation (89% vs. 59%, p = 0.004) and destruction (47% vs. 1%, p = 0.00001), and hydrothorax (26% vs. 11%, p = 0.03). The main pathogens were A. fumigatus (44%) and A. niger (31%). The overall survival rate after 12 weeks was 47.2%.

Keywords: Aspergillus spp.; CAPA; COVID-19; COVID-19-associated pulmonary aspergillosis; invasive aspergillosis.

Figure 1

Chest CT scans of the patients with CAPA. (A,B) Patient S., 71 years, with CAPA and decompensated diabetes mellitus. There were cavities of destruction in the upper lobe of the right lung. (C) Patient G., 66 years, with CAPA and rheumatoid arthritis. There were infiltrations with areas of destruction (sickle sign) in S6 of the left lung. (D) Patient C, 35 years, with CAPA and diabetes mellitus with ketoacidosis. Large cavity with content localized in S1 + 2 of the left lung. (E) Patient K., 62 years, with CAPA and the debut of diabetes mellitus. There were multiple bilateral infiltrations with “frosted glass” sites and areas of consolidation. (F) Patient J., 68 years, with CAPA and multiple myeloma out of remission. On CT-scans in both lungs, there were polysegmental foci of “frosted glass” compaction and consolidation areas. (G,H) Patient C., 59 years, with CAPA. On CT-scans that showed increased dynamic infiltration and hydrothorax, destruction appeared in line with the level of fluid.

Figure 2

The overall 12-week survival of CAPA patients.