Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Pathology Unit, University of Padova Medical School, Padova, Italy.
UOC Institute of Anaesthesia and Intensive Care Unit, Padova University Hospital, Padova, Italy.
Mycoses. 2021 Oct;64(10):1223-1229. doi: 10.1111/myc.13342. Epub 2021 Jul 4.
An increasing number of reports have described the COVID-19-associated pulmonary aspergillosis (CAPA) as being a further contributing factor to mortality. Based on a recent consensus statement supported by international medical mycology societies, it has been proposed to define CAPA as possible, probable, or proven on the basis of sample validity and thus diagnostic certainty. Considering current challenges associated with proven diagnoses, there is pressing need to study the epidemiology of proven CAPA.
We report the incidence of histologically diagnosed CAPA in a series of 45 consecutive COVID-19 laboratory-confirmed autopsies, performed at Padova University Hospital during the first and second wave of the pandemic. Clinical data, laboratory data and radiological features were also collected for each case.
Proven CAPA was detected in 9 (20%) cases, mainly in the second wave of the pandemic (7/17 vs. 2/28 of the first wave). The population of CAPA patients consisted of seven males and two females, with a median age of 74 years. Seven patients were admitted to the intensive care unit. All patients had at least two comorbidities, and concomitant lung diseases were detected in three cases.
We found a high frequency of proven CAPA among patients with severe COVID-19 thus confirming at least in part the alarming epidemiological data of this important complication recently reported as probable CAPA.
越来越多的报告描述了 COVID-19 相关肺曲霉病 (CAPA) 是导致死亡率进一步升高的一个因素。基于最近由国际医学真菌学会支持的共识声明，建议根据样本有效性将 CAPA 定义为可能、很可能或确诊，从而确定诊断的确定性。鉴于目前确诊诊断所面临的挑战，迫切需要研究确诊 CAPA 的流行病学。
我们报告了在 COVID-19 大流行第一波和第二波期间，在帕多瓦大学医院进行的一系列 45 例连续 COVID-19 实验室确诊尸检中，组织学诊断为 CAPA 的发生率。还为每个病例收集了临床数据、实验室数据和放射学特征。
在 9 例（20%）中检测到确诊 CAPA，主要发生在大流行的第二波（第一波为 2/28，第二波为 7/17）。CAPA 患者人群由 7 名男性和 2 名女性组成，中位年龄为 74 岁。7 名患者入住重症监护病房。所有患者至少有两种合并症，在 3 例中发现了并存肺部疾病。
我们在重症 COVID-19 患者中发现了确诊 CAPA 的高频率，这至少部分证实了最近报告的这种重要并发症的令人震惊的流行病学数据，CAPA 被认为是可能的。
