COVID-19-associated subacute invasive pulmonary aspergillosis

Mycoses. 2022 Jan;65(1):57-64. doi: 10.1111/myc.13369. Epub 2021 Sep 29.

Abstract

Background: Though invasive pulmonary aspergillosis is a well known complication of COVID-19 pneumonia, indolent forms of aspergillosis have been rarely described.

Methods: We prospectively collected the clinico-radio-microbiological data of 10 patients of subacute invasive pulmonary aspergillosis (SAIA), who presented to our hospital with recent history of COVID-19 pneumonia along with cavitary lung disease, positive IgG (against Aspergillus) with or without positive respiratory samples for Aspergillus spp.

Result: The mean age of presentation of SAIA was 50.7 ± 11.8 years. All the patients had recently recovered from severe COVID-19 illness with a mean duration of 29.2 ± 12 days from COVID-19 positivity. Cough was the predominant symptom seen in 8/10 (80%) patients followed by haemoptysis. 7/10 (70%) patients were known diabetic. While serum galactomannan was positive in 5/9 patients (55.5%), fungal culture was positive in 2/7 patients (28.5%) and polymerase chain reaction (PCR) for Aspergillus was positive in three patients. Eight (80%) patients presented with a single cavitary lesion; pseudoaneurysm of pulmonary artery was seen in two patients and post-COVID-19 changes were seen in all patients. All patients were treated with voriconazole, out of which four (40%) patients died during the follow-up period.

Conclusion: SAIA should be considered in the differential diagnosis of cavitating lung lesions in patients with recent history of COVID-19 in the background of steroid use with or without pre-existing diabetes.

Keywords: COVID-19; fungal infection; steroid; subacute invasive pulmonary aspergillosis.

MeSH terms

  • Adult
  • Antibodies, Fungal / blood
  • Aspergillus
  • COVID-19* / complications
  • Humans
  • Immunoglobulin G / blood
  • Invasive Pulmonary Aspergillosis* / diagnosis
  • Invasive Pulmonary Aspergillosis* / drug therapy
  • Middle Aged
  • Voriconazole

Substances

  • Antibodies, Fungal
  • Immunoglobulin G
  • Voriconazole