Confronting and mitigating the risk of COVID-19 associated pulmonary aspergillosis

• Published in: The European respiratory journal Vol. 56; no. 4; p. 2002554
• Main Authors: Armstrong-James, Darius, Youngs, Jonathan, Bicanic, Tihana, Abdolrasouli, Alireza, Denning, David W, Johnson, Elizabeth, Mehra, Varun, Pagliuca, Tony, Patel, Brijesh, Rhodes, Johanna, Schelenz, Silke, Shah, Anand, van de Veerdonk, Frank L, Verweij, Paul E, White, P Lewis, Fisher, Matthew C
• Format: Journal Article
• Language: English
• Published: England European Respiratory Society 01-10-2020
• Subjects: Adrenal Cortex Hormones - therapeutic use; Antifungal Agents - therapeutic use; Betacoronavirus; Bronchoalveolar Lavage Fluid - microbiology; Bronchoscopy; Coinfection - diagnosis; Coinfection - drug therapy; Coinfection - epidemiology; Coronavirus Infections - drug therapy; Coronavirus Infections - epidemiology; COVID-19; COVID-19 Drug Treatment; Humans; Immunologic Factors - therapeutic use; Intensive Care Units; Invasive Pulmonary Aspergillosis - diagnosis; Invasive Pulmonary Aspergillosis - drug therapy; Invasive Pulmonary Aspergillosis - epidemiology; Pandemics; Pneumonia, Viral - drug therapy; Pneumonia, Viral - epidemiology; Pulmonary Aspergillosis - diagnosis; Pulmonary Aspergillosis - drug therapy; Pulmonary Aspergillosis - epidemiology; Risk Factors; SARS-CoV-2; Ventilation
• ISSN: 0903-1936; 1399-3003
• DOI: 10.1183/13993003.02554-2020

The coronavirus disease 2019 (COVID-19) virus caused a wide spectrum of disease in healthy individuals, as well as those with common comorbidities [1]. Severe COVID-19 is characterised by acute respiratory distress syndrome (ARDS) secondary to viral pneumonitis, treatment of which may require mechanical ventilation or extracorporeal membrane oxygenation [2]. Clinicians are alert to the possibility of bacterial co-infection as a complication of lower respiratory tract viral infection; for example, a recent review found that 72% of patients with COVID-19 received antimicrobial therapy [3]. However, the risk of fungal co-infection, in particular COVID-19 associated pulmonary aspergillosis (CAPA), remains underappreciated.
Cases of COVID-19 associated pulmonary aspergillosis (CAPA) are being increasingly reported and physicians treating patients with COVID-19-related lung disease need to actively consider these fungal co-infections
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