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Volume 27, Number 4—April 2021

COVID-19–Associated Pulmonary Aspergillosis, March–August 2020

Jon Salmanton-GarcíaComments to Author , 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
Author affiliations: University of Cologne, Cologne, Germany (J. Salmanton-García, R. Sprute, J. Stemler, E. Sal, X. Malaj, D. Seidel, O.A. Cornely, P. Koehler); L’Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy (M. Bartoletti); Alma Mater Studiorum University of Bologna, Bologna (M. Bartoletti); Hospices Civils de Lyon, Lyon, France (D. Dupont); Université Claude Bernard Lyon 1, Lyon (D. Dupont); Centre de Recherche en Neurosciences de Lyon, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Lyon (D. Dupont); Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain (M. Valerio, M. Machado, S. de la Villa); Hospital Clinic, Institute of Biomedical Research August Pi i Sunyer, Barcelona, Spain (C. Garcia-Vidal); Hospital Universitario La Paz, Madrid (I. Falces-Romero); University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M. Schroeder); Centro Médico ABC, Mexico City, Mexico (I. Hoyo); University Hospital Regensburg, Regensburg, Germany (F. Hanses); Federal University of Triângulo Mineiro, Uberaba, Brazil (K. Ferreira-Paim); Istituto di Ricovero e Cura a Carattere Scientifico San Martino Polyclinic Hospital, Genoa, Italy (D.R. Giacobbe); Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (J.F. Meis); Federal University of Paraná, Curitiba, Brazil (J.F. Meis); University of Rennes I, Institut National de la Santé et de la Recherche Médicale, École des Hautes Études en Santé Publique, Institut de Recherche en Santé, Environnement et Travail, Rennes, France (J.-P. Gangneux); Hospital de Cabueñes, Gijón, Spain (A. Rodríguez-Guardado); Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain (A. Rodríguez-Guardado); University of Milan, Milan, Italy (S. Antinori); German Centre for Infection Research, Cologne (O.A. Cornely)

Main Article

Table 2

Characteristics of 186 patients with coronavirus disease–associated pulmonary aspergillosis, March–August 2020*

Patient characteristic No. (%)
F 51 (27.4)
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)
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)
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)
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)
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.

Main Article

1These senior authors contributed equally to this article.

2Members of this group are listed at the end of this article.

Page created: February 02, 2021
Page updated: March 18, 2021
Page reviewed: March 18, 2021
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