UK National Mycology Reference Laboratory, Public Health England South-West, Bristol, United Kingdom
Medical Research Council Centre for Medical Mycology (MRC CMM), University of Exeter, Exeter, United Kingdom.
J Clin Microbiol. 2020 Dec 17;59(1). doi: 10.1128/JCM.02136-20.
COVID-19-associated pulmonary aspergillosis (CAPA) was recently reported as a potential infective complication affecting critically ill patients with acute respiratory distress syndrome following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with incidence rates varying from 8 to 33% depending on the study. However, definitive diagnosis of CAPA is challenging. Standardized diagnostic algorithms and definitions are lacking, clinicians are reticent to perform aerosol-generating bronchoalveolar lavages for galactomannan testing and microscopic and cultural examination, and questions surround the diagnostic sensitivity of different serum biomarkers. Between 11 March and 14 July 2020, the UK National Mycology Reference Laboratory received 1,267 serum and respiratory samples from 719 critically ill UK patients with COVID-19 and suspected pulmonary aspergillosis. The laboratory also received 46 isolates of from COVID-19 patients (including three that exhibited environmental triazole resistance). Diagnostic tests performed included 1,000 (1-3)-β-d-glucan and 516 galactomannan tests on serum samples. The results of this extensive testing are presented here. For a subset of 61 patients, respiratory specimens (bronchoalveolar lavage specimens, tracheal aspirates, and sputum samples) in addition to serum samples were submitted and subjected to galactomannan testing, -specific PCR, and microscopy and culture. The incidence of probable/proven and possible CAPA in this subset of patients was approximately 5% and 15%, respectively. Overall, our results highlight the challenges in biomarker-driven diagnosis of CAPA, especially when only limited clinical samples are available for testing, and the importance of a multimodal diagnostic approach involving regular and repeat testing of both serum and respiratory samples.
COVID-19 相关肺曲霉病（CAPA）最近被报道为一种潜在的感染性并发症，影响 SARS-CoV-2 感染后发生急性呼吸窘迫综合征的危重症患者，发病率因研究而异，为 8%至 33%。然而，CAPA 的明确诊断具有挑战性。缺乏标准化的诊断算法和定义，临床医生不愿进行产生气溶胶的支气管肺泡灌洗以进行半乳甘露聚糖检测以及显微镜和培养检查，并且对不同血清生物标志物的诊断敏感性存在疑问。在 2020 年 3 月 11 日至 7 月 14 日期间，英国国家真菌学参考实验室收到了来自 719 名患有 COVID-19 和疑似肺曲霉病的英国危重症患者的 1267 份血清和呼吸道样本。该实验室还收到了 46 株来自 COVID-19 患者的 （包括三株表现出环境三唑耐药性）。进行的诊断测试包括对 1000 份血清样本进行（1-3）-β-D-葡聚糖和 516 份半乳甘露聚糖测试。这里呈现了这些广泛测试的结果。对于 61 名患者的一个子集，除了血清样本外，还提交了呼吸道标本（支气管肺泡灌洗液标本、气管吸出物和痰标本）并进行了半乳甘露聚糖测试、-特异性 PCR 以及显微镜和培养。该亚组患者中，可能/确诊和可能 CAPA 的发生率分别约为 5%和 15%。总体而言，我们的结果强调了在生物标志物驱动的 CAPA 诊断方面所面临的挑战，特别是在仅可获得有限的临床样本进行检测时，以及涉及定期和重复检测血清和呼吸道样本的多模态诊断方法的重要性。
