IDCases . Fatal Coronavirus Disease 2019-associated Pulmonary Aspergillosis; A Report of Two Cases and Review of the Literature

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IDCases


. 2020;22:e00935.
doi: 10.1016/j.idcr.2020.e00935. Epub 2020 Aug 22.
Fatal Coronavirus Disease 2019-associated Pulmonary Aspergillosis; A Report of Two Cases and Review of the Literature


Shiema Abdalla ¹ , Muna A Almaslamani ² , Samar M Hashim ² , Abdulsalam S Ibrahim ³ , Ali S Omrani ²



Affiliations

• PMID: 32864340
• PMCID: PMC7443053
• DOI: 10.1016/j.idcr.2020.e00935

Free PMC article

Abstract

Coronavirus Disease 2019 (COVID-19)-associated pulmonary aspergillosis is an emerging entity. We report two fatal cases of putative COVID-19-associated pulmonary aspergillosis. Both cases were diagnosed on the basis of respiratory tract cultures yielding Aspergillus species and otherwise unexplained clinical and radiological deterioration. Existing published literature on COVID-19-associated pulmonary aspergillosis indicate poor outcomes and high mortality. CAPA should be considered in patients with critical COVID-19 who have unexplained progressive respiratory failure despite optimized supportive care. Diagnostic work-up should be initiated as early as possible and should ideally include fungal cultures, galactomannan detection and Aspergillus PCR on tracheal aspirates or broncho-alveolar lavage fluid. Empiric systemic antifungal therapy may be justified in selected cases, pending diagnostic work up results. Large, multi-center studies are required to further understand the pathogenesis of invasive aspergillosis in COVID-19, and the optimal diagnostic and treatment strategies.

Keywords: COVID-19; ICU; aspergillosis; viral pneumonia.