COVID‐19 associated pulmonary aspergillosis (CAPA) in patients admitted with severe COVID‐19 pneumonia: An observational study from Pakistan

Nasir, Nosheen; Farooqi, Joveria; Mahmood, Syed Faisal; Jabeen, Kauser

BACKGROUND: Invasive aspergillosis is a well‐known complication of severe influenza pneumonia with acute respiratory distress syndrome (ARDS). However, recent studies are reporting emergence of aspergillosis in severe COVID‐19 pneumonia, named as COVID‐19 associated aspergillosis (CAPA). METHODS: A retrospective observational study was conducted in patients with severe COVID‐19 pneumonia from February 2020‐ April 2020. Patients’ ≥18 years of age with clinical features and abnormal chest imaging with confirmed COVID‐19 by RT‐PCR for SARS‐Cov‐2 were included. CAPA was diagnosed based on clinical parameters, radiological findings and mycological data. Data were recorded on a structured proforma and descriptive analysis was performed using Stata ver 12.1. RESULTS: A total of 147 patients with confirmed COVID‐19 and 23 (15.6%) patients requiring ICU admission were identified. Aspergillus species were isolated from tracheal aspirates of nine (39.1%) patients and of these five patients (21.7%) were diagnosed with CAPA and four (17.4%) had Aspergillus colonization. The mean age of patients with CAPA was 69 years (Median age: 71, IQR: 24, Range: 51 – 85) and 3/5 patients were male. The most frequent co‐morbid was diabetes mellitus (4/5). The overall fatality rate of COVID‐19 patients with aspergillosis was 44% (4/9). The cause of death was ARDS in all 3 patients with CAPA and the median length of stay was 16 days (IQR: 10; Range 6‐35 days). CONCLUSION: This study highlights the need for comparative studies to establish whether there is an association of aspergillosis and COVID‐19 and the need for screening for fungal infections in severe COVID‐19 patients with certain risk factors.