COVID-19-Associated Pulmonary Aspergillosis in a Series of Complete Autopsies from the Brazilian Amazon

Abstract

Between April and July 2020, and, therefore, prior to the broad recommendation of corticosteroids for severe COVID-19, a total of 50 full autopsies were performed in Manaus. We confirmed two invasive cases of aspergillosis through histopathology and gene sequencing (4%) in our autopsy series. The confirmed invasive aspergillosis incidence seems much lower than expected based on the "probable and possible" definitions, and an individualized approach should be considered for each country scenario. Interestingly, a prolonged length of stay in the intensive care unit was not observed in any of the cases. Timely diagnosis and treatment of fungal infection can reduce mortality rates.

Figure 1.

Histopathology of the lungs of the two cases of COVID-19-associated pulmonary aspergillosis. (A) Numerous hyphae and fungal spores. (B) Aspergillus head, allowing visualization of phialides and conidia, with numerous fungal spores. (C) Numerous hyphae and fungal spores. Microscopic cavitation surrounded by numerous hyphae and fungal spores. (D) Presence of fungal hyphae compatible with Aspergillus sp. This figure appears in color at www.ajtmh.org.