tetano
Editor, Senior Moderator
J Infect Chemother
. 2025 May 26:102739.
doi: 10.1016/j.jiac.2025.102739. Online ahead of print. A Nationwide Epidemiological Survey of Coronavirus Disease 2019-Associated Pulmonary Aspergillosis in Japan
Yuya Ito[SUP] 1 [/SUP], Takahiro Takazono[SUP] 2 [/SUP], Hotaka Namie[SUP] 3 [/SUP], Masato Tashiro[SUP] 4 [/SUP], Hiroshi Kakeya[SUP] 5 [/SUP], Yoshitsugu Miyazaki[SUP] 6 [/SUP], Hiroshi Mukae[SUP] 1 [/SUP], Hiroshige Mikamo[SUP] 7 [/SUP], Tomoo Fukuda[SUP] 8 [/SUP], Kazutoshi Shibuya[SUP] 9 [/SUP], Koichi Izumikawa[SUP] 3 [/SUP]
Affiliations
Background: Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a severe complication of COVID-19 with a poor prognosis. In this study, we aimed to analyze the nationwide epidemiology of CAPA in Japan.
Methods: This nationwide retrospective study involved data of 98 patients with CAPA reported in 221 hospitals in Japan between January 2020 and August 2023, using both online and paper-based questionnaires. We investigated the clinical characteristics of CAPA, assessed outcomes using Kaplan-Meier curves, and identified independent predictors of 90-day mortality using Cox proportional hazards analysis.
Results: The median age of the patients with CAPA was 71 years, and 71.4% were men. The positivity rates for β-D-glucan and serum galactomannan antigen were 59.1% and 68.4%, respectively, while chest computed tomography revealed cavities in 25.5% of patients. The 30-day and 90-day mortality rates were 50.0% and 55.1%, respectively. Kaplan-Meier analysis showed that the mortality rate of patients treated with echinocandin monotherapy was significantly higher than that of patients treated with other antifungals (log-rank test, p=0.04). Multivariate analysis identified a neutrophil count of ≥10,000/μL (hazard ratio
: 2.67, 95% confidence interval [CI]: 1.49-4.89) and echinocandin monotherapy (HR: 2.06, 95% CI: 1.01-3.93) as independent predictors of 90-day mortality. Patients treated with echinocandin monotherapy were older, and Aspergillus spp. was not isolated in half of these patients.
Conclusion: This study provides a comprehensive overview of CAPA in Japan. Appropriate antifungal therapy is essential to improve the prognosis of patients with CAPA.
Keywords: COVID-19-associated pulmonary aspergillosis; antifungals; outcome; prognosis.
. 2025 May 26:102739.
doi: 10.1016/j.jiac.2025.102739. Online ahead of print. A Nationwide Epidemiological Survey of Coronavirus Disease 2019-Associated Pulmonary Aspergillosis in Japan
Yuya Ito[SUP] 1 [/SUP], Takahiro Takazono[SUP] 2 [/SUP], Hotaka Namie[SUP] 3 [/SUP], Masato Tashiro[SUP] 4 [/SUP], Hiroshi Kakeya[SUP] 5 [/SUP], Yoshitsugu Miyazaki[SUP] 6 [/SUP], Hiroshi Mukae[SUP] 1 [/SUP], Hiroshige Mikamo[SUP] 7 [/SUP], Tomoo Fukuda[SUP] 8 [/SUP], Kazutoshi Shibuya[SUP] 9 [/SUP], Koichi Izumikawa[SUP] 3 [/SUP]
Affiliations
- PMID: 40436249
- DOI: 10.1016/j.jiac.2025.102739
Background: Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a severe complication of COVID-19 with a poor prognosis. In this study, we aimed to analyze the nationwide epidemiology of CAPA in Japan.
Methods: This nationwide retrospective study involved data of 98 patients with CAPA reported in 221 hospitals in Japan between January 2020 and August 2023, using both online and paper-based questionnaires. We investigated the clinical characteristics of CAPA, assessed outcomes using Kaplan-Meier curves, and identified independent predictors of 90-day mortality using Cox proportional hazards analysis.
Results: The median age of the patients with CAPA was 71 years, and 71.4% were men. The positivity rates for β-D-glucan and serum galactomannan antigen were 59.1% and 68.4%, respectively, while chest computed tomography revealed cavities in 25.5% of patients. The 30-day and 90-day mortality rates were 50.0% and 55.1%, respectively. Kaplan-Meier analysis showed that the mortality rate of patients treated with echinocandin monotherapy was significantly higher than that of patients treated with other antifungals (log-rank test, p=0.04). Multivariate analysis identified a neutrophil count of ≥10,000/μL (hazard ratio
: 2.67, 95% confidence interval [CI]: 1.49-4.89) and echinocandin monotherapy (HR: 2.06, 95% CI: 1.01-3.93) as independent predictors of 90-day mortality. Patients treated with echinocandin monotherapy were older, and Aspergillus spp. was not isolated in half of these patients.
Conclusion: This study provides a comprehensive overview of CAPA in Japan. Appropriate antifungal therapy is essential to improve the prognosis of patients with CAPA.
Keywords: COVID-19-associated pulmonary aspergillosis; antifungals; outcome; prognosis.