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Volume 27, Number 4—April 2021
Research

COVID-19–Associated Pulmonary Aspergillosis, March–August 2020

Jon Salmanton-GarcíaComments to Author , Rosanne Sprute, Jannik Stemler, Michele Bartoletti, Damien Dupont, Maricela Valerio, Carolina Garcia-Vidal, Iker Falces-Romero, Marina Machado, Sofía de la Villa, Maria Schroeder, Irma Hoyo, Frank Hanses, Kennio Ferreira-Paim, Daniele Roberto Giacobbe, Jacques F. Meis, Jean-Pierre Gangneux, Azucena Rodríguez-Guardado, Spinello Antinori, Ertan Sal, Xhorxha Malaj, Danila Seidel, Oliver A. Cornely1, Philipp Koehler1, and The FungiScope European Confederation of Medical Mycology/The International Society for Human and Animal Mycology Working Group2
Author affiliations: University of Cologne, Cologne, Germany (J. Salmanton-García, R. Sprute, J. Stemler, E. Sal, X. Malaj, D. Seidel, O.A. Cornely, P. Koehler); L’Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola, Bologna, Italy (M. Bartoletti); Alma Mater Studiorum University of Bologna, Bologna (M. Bartoletti); Hospices Civils de Lyon, Lyon, France (D. Dupont); Université Claude Bernard Lyon 1, Lyon (D. Dupont); Centre de Recherche en Neurosciences de Lyon, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Lyon (D. Dupont); Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain (M. Valerio, M. Machado, S. de la Villa); Hospital Clinic, Institute of Biomedical Research August Pi i Sunyer, Barcelona, Spain (C. Garcia-Vidal); Hospital Universitario La Paz, Madrid (I. Falces-Romero); University Medical Center Hamburg-Eppendorf, Hamburg, Germany (M. Schroeder); Centro Médico ABC, Mexico City, Mexico (I. Hoyo); University Hospital Regensburg, Regensburg, Germany (F. Hanses); Federal University of Triângulo Mineiro, Uberaba, Brazil (K. Ferreira-Paim); Istituto di Ricovero e Cura a Carattere Scientifico San Martino Polyclinic Hospital, Genoa, Italy (D.R. Giacobbe); Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (J.F. Meis); Federal University of Paraná, Curitiba, Brazil (J.F. Meis); University of Rennes I, Institut National de la Santé et de la Recherche Médicale, École des Hautes Études en Santé Publique, Institut de Recherche en Santé, Environnement et Travail, Rennes, France (J.-P. Gangneux); Hospital de Cabueñes, Gijón, Spain (A. Rodríguez-Guardado); Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain (A. Rodríguez-Guardado); University of Milan, Milan, Italy (S. Antinori); German Centre for Infection Research, Cologne (O.A. Cornely)

Main Article

Table 1

Pathogens of 186 patients with coronavirus disease–associated pulmonary aspergillosis, March–August 2020*

Characteristic No. (%)
Pathogens†
Aspergillus fumigatus 122 (65.6)
A. niger 13 (7.0)
A. flavus 10 (5.4)
A. terreus 6 (3.2)
A. calidoustus 1 (0.5)
A. lentulus 1 (0.5)
A. nidulans 1 (0.5)
A. penicillioides 1 (0.5)
A. versicolor 1 (0.5)
A. tubingensis 1 (0.5)
Aspergillus spp. (culture)‡ 1 (0.5)
Aspergillus spp. (serologic techniques) 34 (18.3)
Other pathogens§
 40 (21.5)
Case definition
EORTC/MSG criteria (21)
Proven 7 (3.8)
Probable 10 (5.4)
Nonclassifiable 169 (90.9)
AspICU algorithm (23)¶
Proven 7 (3.8)
Putative 142 (76.3)
Colonization 34 (18.3)
Nonclassifiable 3 (1.6)
Consensus definition (reference 57 in Appendix)
Proven 7 (3.8)
Probable 82 (44.1)
Possible 19 (10.2)
Nonclassifiable¶#
 78 (41.9)
Mycologic evidence
Culture** 152 (81.7)
Microscopy†† 3 (1.6)
Histologic techniques‡‡ 7 (3.8)
PCR§§ 43 (23.1)
Galactomannan test¶¶ 113 (60.8)

*Some patients had >1 pathogen or form of mycologic evidence. BAL, bronchoalveolar lavage; EORTC/MSG, European Organization for Research and Treatment of Cancer/Mycoses Study Group (21).
†A total of 2 patients had A. fumigatus and A. niger coinfection, 1 patient had A. flavus and A. fumigatus coninfection, 1 patient had A. flavus and A. niger coinfection, 1 patient had A. fumigatus and A. terreus coinfection, and 1 patient had A. fumigatus and A. versicolor coinfection.
‡One patient had an Aspergillus spp. infection diagnosed by culture. No species determination was provided. Other patient samples were diagnosed as Aspergillus spp, using serologic techniques.
§Small numbers of other pathogens were also retrieved from patient samples (Appendix Table 6).
¶AspICU method uses algorithm described by Blot et al. (23) for determining proven or putative aspergillosis in patients with influenza.
#Up to 78 cases (41.9%) were considered nonclassifiable according to the definition (reference 56 in Appendix) because of lack of specific details about the type of aspiration performed. Of these, 75 (96.2%) were classified as putative according to the Blot et al. algorithm (23) and 3 (3.8%) as probable according to EORTC/MSG criteria (21).
**Culture was used to analyze 50 BAL, 47 tracheal aspirate, 34 bronchial aspirate, 17 nondirected bronchial lavage, 3 sputum, 2 nonspecified lower respiratory tract, and 1 BAL and tracheal aspirate sample.
††Microscopy was used to analyze 1 BAL, 1 bronchial aspirate, and 1 tracheal aspirate sample.
‡‡Histologic techniques were used to analyze 7 lung tissue samples.
§§PCR was used to analyze 16 BAL, 12 tracheal aspirate, 10 nondirected bronchial lavage, 3 bronchial aspirate, 1 lung tissue, and 1 serum sample.
¶¶Galactomannan tests were used to analyze 63 BAL, 30 serum or plasma, 22 nondirected bronchial lavage, 9 tracheal aspirate, 3 bronchial aspirate, and 1 sputum sample.

Main Article

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Main Article

1These senior authors contributed equally to this article.

2Members of this group are listed at the end of this article.

Page created: February 02, 2021
Page updated: March 18, 2021
Page reviewed: March 18, 2021
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