COVID-Associated Pulmonary Aspergillosis in the United States: Is It Rare or Have We Missed the Diagnosis?
Sean X. Zhang, Joan-Miquel Balada-Llasat, Preeti Pancholi, Kaede V. Sullivan, Stefan Riedel
Abstract
While the incidence of coronavirus disease (COVID)-associated pulmonary aspergillosis (CAPA) in COVID-19 patients admitted to the intensive care unit (ICU) in Europe is widely published (incidence up to 30%) (1), data on CAPA from the United States is lacking or has not been well described (2, 3). During the first surge of COVID-19 (March to August 2020), members of the Fungal Diagnostic Laboratories Consortium (FDLC) were formally asked if they had recovered Aspergillus species in respiratory specimens from patients with confirmed COVID-19 after ICU admission (4). Only 8 of the 23 FDLC member laboratory sites (35%) responded in the affirmative. Cumulatively, data from 33 patients who were admitted to the ICU and/or intubated in the ICU setting were identified at four academic medical centers (among a total of 1,633 ICU patients) and were collected and summarized (Table 1). The overall incidence was 2%. Based on the most recent CAPA case definition (3, 5), 17 cases were considered to be possible CAPA, and 16 cases were determined to be probable CAPA.