COVID-19 associated with pulmonary aspergillosis: A literature review
Autor
Lai, Chih-Cheng
Yu, Weng-Liang
Institución
Resumen
Bacterial or virus co-infections with severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2) have been reported in many studies, however,
the knowledge on Aspergillus co-infection among patients with coronavirus
disease 2019 (COVID-19) was limited. This literature review aims to explore
and describe the updated information about COVID-19 associated with
pulmonary aspergillosis. We found that Aspergillus spp. can cause
co-infections in patients with COVID-19, especially in severe/critical illness.
The incidence of IPA in COVID-19 ranged from 19.6% to 33.3%. Acute
respiratory distress syndrome requiring mechanical ventilation was the
common complications, and the overall mortality was high, which could be up
to 64.7% (n =22) in the pooled analysis of 34 reported cases. The conventional
risk factors of invasive aspergillosis were not common among these specific
populations. Fungus culture and galactomannan test, especially from
respiratory specimens could help early diagnosis. A. fumigatus was the most
common species causing co-infection in COVID-19 patients, followed by A.
flavus. Although voriconazole is the recommended anti-Aspergillus agent and
also the most commonly used antifungal agent, aspergillosis caused by
azole-resistant Aspergillus is also possible. Additionally, voriconazole should be used carefully in the concern of complicated drug-drug interaction and
enhancing cardiovascular toxicity on anti-SARS-CoV-2 agents. Finally, this
review suggests that clinicians should keep alerting the possible occurrence of
pulmonary aspergillosis in severe/critical COVID-19 patients, and aggressively
microbiologic study in addition to SARS-CoV-2 via respiratory specimens
should be indicated.