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Volume 27, Number 1—January 2021

Aspergillosis Complicating Severe Coronavirus Disease

Kieren A. MarrComments to Author , Andrew Platt, Jeffrey A. Tornheim, Sean X. Zhang, Kausik Datta, Celia Cardozo, and Carolina Garcia-Vidal
Author affiliations: Johns Hopkins School of Medicine, Baltimore, Maryland, USA (K.A. Marr, J.A. Tornheim, S.X. Zhang, K. Datta); National Institutes of Health, Bethesda, Maryland, USA (A. Platt); Hospital Clinic of Barcelona, Barcelona, Spain (C. Cardozo, C. Garcia-Vidal)

Main Article


Case series of aspergillosis complicating severe viral pneumonia in 20 persons with coronavirus disease*

Patient no. Age, y/sex Underlying condition Previous IS Days from ICU to CAPA Days from symptoms to CAPA CT result† BDG assay GM assay GM BAL Respiratory culture Outcome
1 71/F COPD, ESRD Neg 8 9 GGO, nodulesA Pos Neg ND A. fumigatus Survived
2 56/F COPD, DM, HTN, CHF, obesity Neg 2 2 GGO, nodulesB ND Pos ND ND Survived
3 70/F HTN Neg 10 10 ND Pos Pos ND ND Died
4 68/F HTN, dementia Neg 2 4 ND ND Neg ND A. fumigatus Survived
5 69/M HTN Neg 12 13 GGO, consolidationsC ND Neg ND A. niger Died
6 55/M Quadriplegia, HTN, CAD Neg −1 1 GGO, consolidationsD Neg Neg ND A. fumigatus Survived
7 85/F DM, HTN, ESRD Neg 9 11 Consolidations, nodules, cavitiesE Pos Pos ND A. fumigatus Survived
8 50/F ESRD, asthma Tocilizumab 23 ND ND Pos Neg ND A. fumigatus Survived
9 45/F MS, SLE, asthma Ocrelizumab 12 23 GGO, consolidations, airway wall thickeningF Int Neg ND A. fumigatus§ Survived
10 57/F DM Neg 4 13 ND Neg Neg ND A. fumigatus Survived
11 57/M Lymphoma Rituximab 22 5 ND Int Neg ND A. fumigatus Survived
12 61/M HTN Neg 16 11 ND Neg Pos ND Neg Died
13 75/F HTN, COPD, DM, obesity Neg 12 14 ND ND ND ND A. fumigatus Survived
14 56/F Asthma Tocilizumab 2 8 ND ND Neg ND A. fumigatus Survived
15 70/M HTN Neg 3 9 ConsolidationsG ND ND ND A. fumigatus‡, A. niger Survived
16 76/M COPD Steroids 11 14 ND ND Neg ND A. fumigatus†, 
A. niger Survived
17 73/M HTN, DM Steroids 7 13 GGO, consolidationsH ND Neg ND Aspergillus spp‡ Survived
18 78/M HTN, prosthetic mitral valve Steroids, siltuximab 14 16 ND ND ND ND Aspergillus spp.‡ Survived
19 56/F None Tocilizumab, anakinra 9 19 ND ND ND ND A. terreus§ Survived
20 81/M DM, HTN, cirrhosis Steroid 24 39 Consolidations, cavityI ND Neg Pos A. niger§ Survived
Total 55% F, mean age 65.5 y (range 45–81 y) HTN 60%; COPD/asthma 35%; DM 30%, ESRD 15% Steroids (4/20, 20%); other (6/20, 30%) Median 9.5 (range −1 to 24) Median 11 
(range 1–42) pos 4/9 (44%); neg 3/9 (33%); int 2/9 (22%) pos 4/16 (25%); neg 12/16 (75%) 0/1 Culture pos 3 BAL, 14 airways Died 3/20 (15%)

*Patients 1–12 were from the United States, and patients 13–20 were from Spain. BAL, bronchioalveolar lavage; BGD, β-d glucan assay; CAD, coronary artery disease; CAPA, coronavirus disease–associated pulmonary aspergillosis; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; CT, computed tomography; DM, diabetes mellitus; ESRD, end-stage renal disease; GM, galactomannan; GGO, ground glass opacities; HTN, hypertension; Int, intermediate; IS, immunosuppression; MS, multiple sclerosis; ND, not done; neg, negative; pos, positive; SLE, systemic lupus erythematosus. 
†Results are from CT scan unless indicated otherwise. Chest radiograph images representing descriptions are shown in [[ANCHOR###F1###Figure 1###Anchor]]. Corresponding panels are indicated as superscript letters.
‡Tracheal aspirate/sputum.

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Page created: September 25, 2020
Page updated: December 21, 2020
Page reviewed: December 21, 2020
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