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

Frederic Lamoth; Russell E Lewis; Thomas J Walsh; Dimitrios P Kontoyiannis

doi:10.1093/infdis/jiab163

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.

Authors

Frederic Lamoth¹, Russell E Lewis², Thomas J Walsh³, Dimitrios P Kontoyiannis⁴

Affiliations

¹ Infectious Diseases Service and Institute of Microbiology, University Hospital of Lausanne and Lausanne University, Lausanne, Switzerland.
² Clinic of Infectious Diseases, S'Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
³ Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medicine of Cornell University, New York, New York, USA.
⁴ Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.

Abstract

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

Substances

Antifungal Agents