Navigating the Uncertainties of COVID-19-Associated Aspergillosis: A Comparison With Influenza-Associated Aspergillosis

J Infect Dis. 2021 Nov 22;224(10):1631-1640. doi: 10.1093/infdis/jiab163.


Invasive pulmonary aspergillosis (IPA) is increasingly recognized as a life-threatening superinfection of severe respiratory viral infections, such as influenza. The pandemic of Coronavirus Disease 2019 (COVID-19) due to emerging SARS-CoV-2 rose concern about the eventuality of IPA complicating COVID-19 in intensive care unit patients. A variable incidence of such complication has been reported, which can be partly attributed to differences in diagnostic strategy and IPA definitions, and possibly local environmental/epidemiological factors. In this article, we discuss the similarities and differences between influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA). Compared to IAPA, the majority of CAPA cases have been classified as putative rather than proven/probable IPA. Distinct physiopathology of influenza and COVID-19 may explain these discrepancies. Whether CAPA represents a distinct entity is still debatable and many questions remain unanswered, such as its actual incidence, the predisposing role of corticosteroids or immunomodulatory drugs, and the indications for antifungal therapy.

Keywords: Aspergillus fumigates; SARS-CoV-2; acute respiratory distress syndrome; corticosteroids; flu; intensive care unit; mechanical ventilation; pneumonia.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antifungal Agents / therapeutic use
  • Aspergillosis* / complications
  • Aspergillosis* / drug therapy
  • COVID-19* / complications
  • Humans
  • Influenza, Human* / complications
  • Influenza, Human* / drug therapy
  • Invasive Pulmonary Aspergillosis* / complications
  • Invasive Pulmonary Aspergillosis* / diagnosis
  • Invasive Pulmonary Aspergillosis* / drug therapy
  • Pulmonary Aspergillosis* / complications
  • Pulmonary Aspergillosis* / drug therapy
  • SARS-CoV-2


  • Antifungal Agents