Lancet Infect Dis
. 2020 Dec 14;S1473-3099(20)30847-1.
doi: 10.1016/S1473-3099(20)30847-1. Online ahead of print.
Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance
Philipp Koehler 1 , Matteo Bassetti 2 , Arunaloke Chakrabarti 3 , Sharon C A Chen 4 , Arnaldo Lopes Colombo 5 , Martin Hoenigl 6 , Nikolay Klimko 7 , Cornelia Lass-Fl?rl 8 , Rita O Oladele 9 , Donald C Vinh 10 , Li-Ping Zhu 11 , Boris B?ll 12 , Roger Br?ggemann 13 , Jean-Pierre Gangneux 14 , John R Perfect 15 , Thomas F Patterson 16 , Thorsten Persigehl 17 , Jacques F Meis 18 , Luis Ostrosky-Zeichner 19 , P Lewis White 20 , Paul E Verweij 21 , Oliver A Cornely 22 , European Confederation of Medical Mycology; International Society for Human Animal Mycology; Asia Fungal Working Group; INFOCUS LATAM/ISHAM Working Group; ISHAM Pan Africa Mycology Working Group; European Society for Clinical Microbiology; Infectious Diseases Fungal Infection Study Group; ESCMID Study Group for Infections in Critically Ill Patients; Interregional Association of Clinical Microbiology and Antimicrobial Chemotherapy; Medical Mycology Society of Nigeria; Medical Mycology Society of China Medicine Education Association; Infectious Diseases Working Party of the German Society for Haematology and Medical Oncology; Association of Medical Microbiology; Infectious Disease Canada
Affiliations
- PMID: 33333012
- DOI: 10.1016/S1473-3099(20)30847-1
Abstract
Severe acute respiratory syndrome coronavirus 2 causes direct damage to the airway epithelium, enabling aspergillus invasion. Reports of COVID-19-associated pulmonary aspergillosis have raised concerns about it worsening the disease course of COVID-19 and increasing mortality. Additionally, the first cases of COVID-19-associated pulmonary aspergillosis caused by azole-resistant aspergillus have been reported. This article constitutes a consensus statement on defining and managing COVID-19-associated pulmonary aspergillosis, prepared by experts and endorsed by medical mycology societies. COVID-19-associated pulmonary aspergillosis is proposed to be defined as possible, probable, or proven on the basis of sample validity and thus diagnostic certainty. Recommended first-line therapy is either voriconazole or isavuconazole. If azole resistance is a concern, then liposomal amphotericin B is the drug of choice. Our aim is to provide definitions for clinical research and up-to-date recommendations for clinical management of the diagnosis and treatment of COVID-19-associated pulmonary aspergillosis.