Volume 27, Number 4—April 2021
Research
COVID-19–Associated Pulmonary Aspergillosis, March–August 2020
, Rosanne Sprute, Jannik Stemler, Michele Bartoletti, Damien Dupont, Maricela Valerio, Carolina Garcia-Vidal, Iker Falces-Romero, Marina Machado, Sofía de la Villa, Maria Schroeder, Irma Hoyo, Frank Hanses, Kennio Ferreira-Paim, Daniele Roberto Giacobbe, Jacques F. Meis, Jean-Pierre Gangneux, Azucena Rodríguez-Guardado, Spinello Antinori, Ertan Sal, Xhorxha Malaj, Danila Seidel, Oliver A. Cornely1, Philipp Koehler1, and The FungiScope European Confederation of Medical Mycology/The International Society for Human and Animal Mycology Working Group2
Table 2
Characteristics of 186 patients with coronavirus disease–associated pulmonary aspergillosis, March–August 2020*
| Patient characteristic | No. (%) |
|---|---|
| Sex | |
| F | 51 (27.4) |
| M |
135 (72.6) |
| Median age, y (IQR) |
68 (58–73) |
| COVID-19† | 186 (100.0) |
| Median length of treatment, d (IQR) | 7 (6–11) |
| Median time from COVID-19 diagnosis to CAPA, d (IQR) |
10 (5–16) |
| Intensive care unit stay | 182 (97.8) |
| Median length of stay before CAPA diagnosis, d (IQR) | 8 (3–14) |
| Acute respiratory distress syndrome | 180 (96.8) |
| Mechanical ventilation | 175 (94.1) |
| Median time on ventilation before CAPA diagnosis, d (IQR) |
7 (3–13) |
| Corticosteroid use |
98 (52.7) |
| Concurrent conditions | |
| Chronic cardiovascular disease | 94 (50.5) |
| Renal failure‡ | 74 (39.8) |
| Diabetes mellitus | 64 (34.4) |
| Obesity | 47 (25.3) |
| Chronic pulmonary disease | 40 (21.5) |
| Hematologic or oncologic disease§ | 21 (11.3) |
| Hematologic malignancy | 10 (5.4) |
| Solid tumor | 9 (4.8) |
| Hematologic disease | 2 (1.1) |
| Solid organ transplantation¶ | 4 (2.2) |
| Neutropenia |
2 (1.1) |
| Other baseline conditions and characteristics# | 70 (37.6) |
| Lung infection | 186 (100.0) |
| Image abnormalities of the lungs | 182 (97.8) |
| Computed tomography scan | 134 (72.0) |
| Radiograph |
88 (47.3) |
| Antifungal treatment | 137 (73.7) |
| Median length of treatment, d (IQR) | 16 (10–33) |
| Amphotericin B | 36 (19.4) |
| Liposomal | 23 (12.4) |
| Deoxycholate | 11 (5.9) |
| Lipid complex | 2 (1.1) |
| Echinocandins | 24 (12.9) |
| Anidulafungin | 10 (5.4) |
| Caspofungin | 13 (7.0) |
| Micafungin | 1 (0.5) |
| Ibrexafungerp | 1 (0.5) |
| Triazoles | 117 (62.9) |
| Voriconazole | 98 (52.7) |
| Isavuconazole | 23 (12.4) |
| Posaconazole | 4 (2.2) |
| Fluconazole |
1 (0.5) |
| Overall mortality | 97 (52.2) |
| <6 wks | 89 (47.8) |
| <12 wks | 93 (50.0) |
| Median time to death, d (IQR) |
9 (3–18) |
| Cause of death** | |
| CAPA | 32 (17.2) |
| COVID-19 | 51 (27.4) |
| Other |
36 (19.4) |
| Median length of observation from CAPA diagnosis, d (IQR) | 22 (7–42) |
*Values are no. (%), except as indicated. Some patients had >1 baseline condition or characteristic, image abnormality, or antifungal drug. CAPA, COVID-19–associated pulmonary aspergillosis; COVID-19, coronavirus disease. †By definition, all CAPA patients had COVID-19 (Appendix Table 3). ‡In total, 54 patients had acute renal failure, 18 had chronic renal failure, and 2 had nonspecified renal failure. §In total, 9 patients had hematologic malignancy: 3 had chronic leukemia, 3 had lymphoma, 2 had myelodysplastic syndrome, and 1 had acute leukemia. Eight patients had a solid tumor: 1 had breast cancer, 1 had carcinoma, 1 had cervical/uterine cancer, 1 had lung cancer, 1 had esophageal carcinoma, 1 had prostate cancer, 1 had testicular cancer, and 1 had urothelial carcinoma. Two patients had hematologic disease: 1 had acquired hemophilia type A and 1 had hemophagocytic lymphohistiocytosis. ¶In total, 3 patients had a kidney transplant, 1 had a liver transplant, and 1 had a lung transplant. #Small numbers of patients had other concurrent conditions and characteristics (Appendix Table 7). **In total, 32 patients died of CAPA or CAPA/COVID-19: 7 died of CAPA only; 25 died of CAPA and COVID-19. In addition, 26 died of COVID-19 only.
1These senior authors contributed equally to this article.
2Members of this group are listed at the end of this article.