COVID-19 associated pulmonary aspergillosis

Abstract

Objectives: Patients with acute respiratory distress syndrome (ARDS) due to viral infection are at risk for secondary complications like invasive aspergillosis. Our study evaluates coronavirus disease 19 (COVID-19) associated invasive aspergillosis at a single centre in Cologne, Germany.

Methods: A retrospective chart review of all patients with COVID-19 associated ARDS admitted to the medical or surgical intensive care unit at the University Hospital of Cologne, Cologne, Germany.

Results: COVID-19 associated invasive pulmonary aspergillosis was found in five of 19 consecutive critically ill patients with moderate to severe ARDS.

Conclusion: Clinicians caring for patients with ARDS due to COVID-19 should consider invasive pulmonary aspergillosis and subject respiratory samples to comprehensive analysis to detect co-infection.

Keywords: Aspergillus; ECMO; ICU; SARS-CoV-2; isavuconazole; voriconazole.

Conflict of interest statement

PK has received non‐financial scientific grants from Miltenyi Biotec GmbH, Bergisch Gladbach, Germany, and the Cologne Excellence Cluster on Cellular Stress Responses in Aging‐Associated Diseases, University of Cologne, Cologne, Germany, and received lecture honoraria from Akademie für Infektionsmedizin e.V., Astellas Pharma, Gilead Sciences, GPR Academy Ruesselsheim, MSD Sharp & Dohme GmbH, and University Hospital, LMU Munich outside the submitted work. OAC is supported by the German Federal Ministry of Research and Education, is funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany's Excellence Strategy—CECAD, EXC 2030—390 661 388 and has received research grants from, is an advisor to, or received lecture honoraria from Actelion, Allecra Therapeutics, Amplyx, Astellas, Basilea, Biosys UK Limited, Cidara, Da Volterra, Entasis, F2G, Gilead, Grupo Biotoscana, Janssen Pharmaceuticals, Matinas, Medicines Company, MedPace, Melinta Therapeutics, Menarini Ricerche, Roche Diagnostics, Merck/MSD, Nabriva Therapeutics, Octapharma, Paratek Pharmaceuticals, Pfizer, PSI, Rempex, Scynexis, Seres Therapeutics, Tetraphase, Vical. BWB is European Resuscitation Council (ERC) Board Director Science and Research; Chairman of the German Resuscitation Council (GRC); Member of the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR); Member of the executive committee of the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI); Associated Editor of the European Journal of Anaesthesiology (EJA), Co‐Editor of ‘Resuscitation’; Editor of the Journal ‘Notfall + Rettungsmedizin’. He received professional fees for lectures from the following companies: Medupdate GmbH, ‘Forum für medizinische Fortbildung (FomF)’, Baxalta Deutschland GmbH, Bayer Vital GmbH, ZOLL Medical Deutschland GmbH, C. R. Bard GmbH, GS Elektromedizinische Geräte G. Stemple GmbH, Novartis Pharma GmbH, Philips GmbH Market DACH. FD reports personal fees from Forum für medizinische Fortbildung GmbH, BioMérieux GmBH, M3 Inc, and pm‐result GmbH, outside the submitted work. FD: Associated Editor of 'BMC Anesthesiology'. DAE has no potential conflict of interest. FF reports scientific grants from the Medical Faculty of the University of Cologne (Maria Pesch grant and GEROK grant), outside the submitted work. MH reports grants from Roche, personal fees from Roche, personal fees from Roche, grants from Abbvie, personal fees from Abbvie, personal fees from Abbvie, during the conduct of the study; grants from Gilead, personal fees from Gilead, personal fees from Gilead, grants from Janssen, personal fees from Janssen, personal fees from Janssen, personal fees from Celgene, personal fees from Celgene, personal fees from Boehringer Ingelheim, personal fees from Boehringer Ingelheim, outside the submitted work. NJ reports lecture fees from Gilead, Infectopharm and MSD and travel grants from Gilead, Basilea, Correvio and Pfizer outside the submitted work. FK is supported by the German Center for Infection Research (DZIF), the German Research Foundation (CRC 1279 and CRC 1310), the Bill and Melinda Gates Foundation, and the European Research Council (ERC‐StG639961). FK received lecture and consulting honoraria from MSD, Roche and ViiV outside the submitted work. TP has no potential conflict of interest. JR has nothing to disclose. MK reports personal fees from Pfizer, Astellas Pharma, Gilead Sciences and MSD Sharp & Dohme GmbH outside the submitted work. BB is a consultant to Baxalta, Celgene, MSD, Mundipharma and received Honoraria and Research funding from Astellas, Celgene, J&J, Maquet, Miltenyi, MSD, Takeda, Roche and Sanofi. ASV reports travel grants from Gilead Sciences outside the submitted work.

© 2020 The Authors. Mycoses published by Blackwell Verlag GmbH.

Figures

FIGURE 1

Chest CT images of patients with COVID‐19 Associated Invasive Pulmonary Aspergillosis. A, Patient #1: Combined bilateral ground‐glass opacities with crazy paving and peripheral nodular consolidations. B, Patient #2: Ground‐glass opacities with small nodular infiltrations of up to 1 cm. C, Patient #3: Bilateral ground‐glass opacities diffuse nodular infiltrates and cystic cavities and partly air crescent sign. D, Patient #4: Bullous emphysema and ground‐glass opacities, interstitial changes and consolidations with nodular infiltrates. E, Patient #5: Ground‐glass opacities, smaller areas with crazy paving pattern, central and peripheral consolidations, and smaller nodular infiltrates