Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Mycoses. 2021 Feb;64(2):132-143. doi: 10.1111/myc.13213. Epub 2020 Nov 29.
Information on the recently COVID-19-associated pulmonary aspergillosis (CAPA) entity is scarce. We describe eight CAPA patients, compare them to colonised ICU patients with coronavirus disease 2019 (COVID-19), and review the published literature from Western countries.
Prospective study (March to May, 2020) that included all COVID-19 patients admitted to a tertiary hospital. Modified AspICU and European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria were used.
COVID-19-associated pulmonary aspergillosis was diagnosed in eight patients (3.3% of 239 ICU patients), mostly affected non-immunocompromised patients (75%) with severe acute respiratory distress syndrome (ARDS) receiving corticosteroids. Diagnosis was established after a median of 15 days under mechanical ventilation. Bronchoalveolar lavage was performed in two patients with positive Aspergillus fumigatus cultures and galactomannan (GM) index. Serum GM was positive in 4/8 (50%). Thoracic CT scan findings fulfilled EORTC/MSG criteria in one case. Isavuconazole was used in 4/8 cases. CAPA-related mortality was 100% (8/8). Compared with colonised patients, CAPA subjects were administered tocilizumab more often (100% vs. 40%, p = .04), underwent longer courses of antibacterial therapy (13 vs. 5 days, p = .008), and had a higher all-cause mortality (100% vs. 40%, p = .04). We reviewed 96 similar cases from recent publications: 59 probable CAPA (also putative according modified AspICU), 56 putative cases and 13 colonisations according AspICU algorithm; according EORTC/MSG six proven and two probable. Overall, mortality in the reviewed series was 56.3%.
COVID-19-associated pulmonary aspergillosis must be considered a serious and potentially life-threatening complication in patients with severe COVID-19 receiving immunosuppressive treatment.
关于最近与 COVID-19 相关的肺曲霉病（CAPA）的信息很少。我们描述了 8 例 CAPA 患者，将其与患有 2019 年冠状病毒病（COVID-19）的 ICU 定植患者进行比较，并回顾了来自西方国家的已发表文献。
这是一项前瞻性研究（2020 年 3 月至 5 月），纳入了所有收治于三级医院的 COVID-19 患者。使用改良的 AspICU 和欧洲癌症研究与治疗组织/霉菌病研究组（EORTC/MSG）标准。
8 例患者（239 例 ICU 患者中的 3.3%）被诊断为 COVID-19 相关肺曲霉病，这些患者大多为非免疫功能低下的患者（75%），患有严重急性呼吸窘迫综合征（ARDS），并接受了皮质类固醇治疗。在接受机械通气治疗 15 天后中位时间确诊。对 2 例培养出烟曲霉且半乳甘露聚糖（GM）指数阳性的患者进行了支气管肺泡灌洗。8 例患者中有 4 例（50%）血清 GM 阳性。1 例患者的胸部 CT 扫描结果符合 EORTC/MSG 标准。4 例患者（8/8）使用了伊曲康唑。CAPA 相关死亡率为 100%（8/8）。与定植患者相比，CAPA 患者更常接受托珠单抗治疗（100% vs. 40%，p=0.04），接受更长时间的抗菌治疗（13 天 vs. 5 天，p=0.008），全因死亡率更高（100% vs. 40%，p=0.04）。我们回顾了最近文献中的 96 例类似病例：59 例可能的 CAPA（根据改良 AspICU 也是推测性的），56 例推测性病例和 13 例根据 AspICU 算法的定植病例；根据 EORTC/MSG，有 6 例确诊和 2 例可能的病例。总的来说，在回顾的系列中，死亡率为 56.3%。
对于接受免疫抑制治疗的重症 COVID-19 患者，必须考虑 COVID-19 相关肺曲霉病是一种严重且可能危及生命的并发症。
