A multinational report on SARS-CoV-2 infection outcomes in people with CF and Aspergillus infection or ABPA

J Cyst Fibros. 2024 Mar;23(2):354-363. doi: 10.1016/j.jcf.2023.10.017. Epub 2023 Nov 3.


Background: Aspergillus infection is known to be associated with worse respiratory outcomes in people with CF (pwCF) and is a well-recognised complication of severe SARS-CoV-2 infection. The aim of this observational cross-sectional study was to examine the association of pre-existing Aspergillus infection and/or allergic bronchopulmonary aspergillosis (ABPA) in pwCF and severity of COVID-19.

Methods: Data on SARS-CoV-2 infections in pwCF from January 2020 to June 2021 were collected by the European Cystic Fibrosis Society Patient Registry. The primary outcome was COVID-19 severity measured by hospitalisation comparing those with Aspergillus infection and/or ABPA in the 12 months preceding COVID-19 and those without.

Results: In total, 1095 pwCF were diagnosed with SARS-CoV-2 and information on pre-existing Aspergillus/ABPA status was available from 807. PwCF and SARS-CoV-2 in the Aspergillus/ABPA group (n = 153), in comparison to the non-Aspergillus/ABPA group (n = 654), were more likely to be hospitalised (adjusted OR 1.79 (1.19 to 2.85); p = 0.005) and their disease course was more likely to be complicated by sepsis (adjusted OR 7.78 (1.78 to 49.43); p = 0.008). The association with hospital admission was no longer significant after excluding patients with ABPA. Secondary analysis comparing pwCF who received antifungal treatment (n = 18), versus those who did not (n = 474) during COVID-19, showed a higher rate of hospitalisation (p < 0.001); intensive care unit admission (p < 0.001), and requirement for invasive ventilation (p < 0.001) in the antifungal treated group.

Conclusion: We show that pre-existing Aspergillus/ABPA is associated with increased rates of hospitalisation and sepsis during COVID-19 in pwCF.

Keywords: Allergic bronchopulmonary aspergillosis; Aspergillus infection; COVID-19; Cystic fibrosis.

Publication types

  • Observational Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aspergillosis / epidemiology
  • Aspergillosis, Allergic Bronchopulmonary* / complications
  • Aspergillosis, Allergic Bronchopulmonary* / diagnosis
  • Aspergillosis, Allergic Bronchopulmonary* / epidemiology
  • COVID-19* / complications
  • COVID-19* / epidemiology
  • COVID-19* / therapy
  • Child
  • Cross-Sectional Studies
  • Cystic Fibrosis* / complications
  • Cystic Fibrosis* / epidemiology
  • Cystic Fibrosis* / microbiology
  • Europe / epidemiology
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Registries
  • SARS-CoV-2
  • Severity of Illness Index