Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance

Lancet Infect Dis. 2021 Jun;21(6):e149-e162. doi: 10.1016/S1473-3099(20)30847-1. Epub 2020 Dec 14.


Severe acute respiratory syndrome coronavirus 2 causes direct damage to the airway epithelium, enabling aspergillus invasion. Reports of COVID-19-associated pulmonary aspergillosis have raised concerns about it worsening the disease course of COVID-19 and increasing mortality. Additionally, the first cases of COVID-19-associated pulmonary aspergillosis caused by azole-resistant aspergillus have been reported. This article constitutes a consensus statement on defining and managing COVID-19-associated pulmonary aspergillosis, prepared by experts and endorsed by medical mycology societies. COVID-19-associated pulmonary aspergillosis is proposed to be defined as possible, probable, or proven on the basis of sample validity and thus diagnostic certainty. Recommended first-line therapy is either voriconazole or isavuconazole. If azole resistance is a concern, then liposomal amphotericin B is the drug of choice. Our aim is to provide definitions for clinical research and up-to-date recommendations for clinical management of the diagnosis and treatment of COVID-19-associated pulmonary aspergillosis.

Publication types

  • Review

MeSH terms

  • Amphotericin B
  • Antifungal Agents / therapeutic use*
  • Azoles / pharmacology
  • COVID-19 / complications*
  • Coinfection / drug therapy*
  • Humans
  • Nitriles
  • Pulmonary Aspergillosis / complications*
  • Pulmonary Aspergillosis / drug therapy*
  • Pyridines
  • SARS-CoV-2
  • Triazoles
  • Voriconazole / therapeutic use


  • Antifungal Agents
  • Azoles
  • Nitriles
  • Pyridines
  • Triazoles
  • liposomal amphotericin B
  • isavuconazole
  • Amphotericin B
  • Voriconazole