COVID-19 Associated Pulmonary Aspergillosis

Introduction Data Interpretation

Aspergillosis is the infection caused by aspergillus the common mold, the
symptoms are weight loss, cough, coughing up blood, fatigue and
shortness of breath. COVID-19 is an infectious disease caused by
coronavirus and spreads through droplets of saliva. COVID-19 associated
invasive pulmonary aspergillosis (CAPA) is the combination of coronavirus
and aspergillosis infection.
Treatment and limitations
Among COVID-19 patients on ventilation in the intensive care unit (ICU), Figure 3 B-C- The effect of voriconazole treatment in CAPA patients
invasive aspergillosis affects up to 30% of intubated patients. The
diagnosis of patients with early signs of CAPA can be challenging. Critically
ill patients with COVID-19 must be screened for CAPA using a combination Figure1- Flowchart of COVID-19 patients admitted to hospital Results
of tests such as tomography chest imaging and Aspergillus PCR or
Aspergillus antigen test. The diagnosis is still challenging as Figure 1: 822 patients with COVID-19 admitted to hospitals which among them
galactomannan (GM) testing of BAL fluids is restricted due to the 22% admitted to ICU and 20% were intubated. 108 patients screened for
restricted role of bronchoscopy in COVID-19 patients as well as the aspergillosis.
disinclination to perform a bronchoalveolar lavage (BAL) because of the Figure 2: The survival curve for CAPA positive patients and CAPA negative
aerosol-generating nature of this intervention as the diagnosis yield of patients within 30 days of ICU admission where CAPA positive patients have
this serum is low in CAPA patients. Instead, use of both GM and (1-3)-β-D- higher mortality rate.
glucan biomarker for screening in patients, can be beneficial as the yield Figure 3 (A-C):Demonstrating the analysis of voriconazole treatment in CAPA
of this combination screening is about 90%. patients comprising of the effect of BAL galactomannan in patients received the
treatment compared to patients who have not received the treatment.

Aims
The research analysed patients with pulmonary aspergillosis , intubated
with severe COVID-19 as well as looking at voriconazole treatment.
Figure 2- Kaplan-Meier Survival Probability for 30-day mortality from ICU admission
Methodology
• BAL and GM assays
• GM antigen test: using sandwich enzyme linked- immunosorbent
assay (ELISA, Bio-Rad)
• Aspergillus-specific RT-qPCR: Positive GM assays and BAL samples
stored at -80oC and analysed using RT-qPCR for aspergillus
• Microscopic examination and culture of BAL fluids and tracheal
secretions
• Statistical analysis: Student t Test and Mann Whitteny U test for
normally distributed quantitative variables. Pearson’s chi-square
test or fisher’s exact test used for categorical variables. Shapiro-
Wilk’s and Kolmogorov-Smirnov tests were used for normality tests.
Conclusion
In summary, this research paper found that the acquisition of invasive
aspergillosis was high in severe-clinically ill COVOD-19 patients; this occurrence
(CAPA) changed the mechanism of COVID-19. This (CAPA) also showed an
increase in mortality rate (figure 3) in serve ill patients.
References
[1] Bartoletti et al (2020) Epidemiology of Invasive Pulmonary Aspergillosis
Among Intubated Patients With COVID-19: A Prospective Study
[2] Koehler et al (2020) Defining and managing COVID-19-associated pulmonary
aspergillosis.
Figure 3A- The effect of voriconazole treatment in CAPA patients
[3] Armstrong-James et al (2020) Confronting and mitigating the risk of COVID-
19 associated pulmonary aspergillosis