EC Microbiology

Background: Invasive Pulmonary Aspergillosis (IPA) is a secondary fungal infection that increasing the mortality rate and enhanced the concerns due to its detrimental effect among COVID-19 patients. Direct impairment to the airway epithelium is facilitated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which allow the invasion of Aspergillus species.

Aim: The study aimed to evaluate the diagnostic criteria, incidence, risk factors and mortality rate that leads to the complication of COVID-19-associated pulmonary aspergillosis (CAPA) from the available data in the studies.

Method: A systemic literature review was carried out to evaluate all current epidemiology that reports the incidence of CAPA from relevant published articles.

Results: In critical ill COVID-19 patients, sputum and tracheal aspirate are usually positive but can represent upper airway colonization. Bronchoscopy with bronchoalveolar lavage is insignificant due to the risk of infection and nosocomial transmission among health care workers. Alternatively, CT-guide biopsies post mortem have been used more than autopsy and non-bronchoscopic lavage is usually preferred method for CAPA diagnosis when compared to bronchoalveolar lavage. The mortality rate is about 52/90 (58%) approximately and common comorbidities include diabetes mellitus, obesity, arterial hypertension, chronic respiratory failure, chronic obstructive pulmonary disease, chronic renal failure, bronchial asthma and cerebrovascular disease. Aspergillus fumigatus is a common causative agents of CAPA. Italy and UK had the highest mortality rate of 25.0% followed by Spain with 15.4% when compared to other locations.

Conclusion: Respiratory specimen is the most preferred invasive pulmonary aspergillosis (IPA) sample for fungal diagnostic examination. The detection of galactomannan does not prove tissue invasion and infection. The results of serum galactomannan is usually low in CAPA. Further studies on CAPA are needed urgently to differentiate between pulmonary and tracheobronchitis phenotypes of aspergillosis, immunological defense and host factors and to address the therapeutic options and appropriate diagnostic criteria of the infection.

Keywords: Invasive Pulmonary Aspergillosis; COVID-19; SARS-CoV-2; Aspergillus fumigatus; Galactomannan

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