COVID-19-associated pulmonary aspergillosis in critically ill patients: experience of a Chilean public hospital

Abstract

Background: Aspergillus spp. fungal coinfections have been described in critically ill COVID-19 patients. Aim: To describe the clinical characteristics, diagnosis, treatment and evolution of patients with acute respiratory distress syndrome with COVID-19, who present with COVID-19 associated pulmonary aspergillosis (CAPA) in a single public hospital. Methods: Retrospective review of clinical records during 12 months in patients diagnosed with CAPA by cultures of respiratory samples or determination of galactomannan (GM). Results: Probable CAPA was diagnosed in 11 patients (average APACHE II score of 11.7). Respiratory samples were obtained in 73% of cases by bronchoalveolar lavage and in 27% by tracheal aspirate. A. fumigatus was isolated in 4 cultures, A. niger, A. terreus and Aspergillus spp on one occasion each and the cultures were negative in 4 samples. Respiratory sample GM was performed in 7 patients, median: 3.6 (IQR: 1.71-4.4). In 10 patients, serum GM was performed, median: 0.5 (IQR: 0.265-0.9 75) with 50% of them > 0.5. Two patients showed classic findings suggestive of CAPA on computed tomography. All received antifungal therapy with voriconazole, mean time 14 days. Four patients died. Conclusions: The presence of CAPA should be a diagnosis to be considered in critically ill COVID-19 patients.