Abstract

Invasive pulmonary aspergillosis (IPA) is a severe infection caused by aspergillus sp. that usually develops in patients with severe immunosuppression. IPA has been recently described in critically ill COVID-19 patients (termed as COVID-associated pulmonary aspergillosis, or CAPA) that are otherwise immunocompetent. In order to describe the characteristics of patients with CAPA, we conducted a retrospective cohort study in a tertiary care center in Mexico City. We included all patients with confirmed COVID-19 admitted to the intensive care unit that had serum or bronchoalveolar lavage galactomannan measurements. We used the criteria proposed by Koehler et al. to establish the diagnosis of CAPA. Main outcomes were the need for invasive mechanical ventilation (IMV) and in-hospital mortality. Out of a total of 83 hospitalized patients with COVID-19 in the ICU, 16 (19.3%) met the criteria for CAPA. All patients diagnosed with CAPA required IMV whereas only 84% of the patients in the non-IPA group needed this intervention (P = 0.09). In the IPA group, 31% (n = 5) of the patients died, compared to 13% (n = 9) in the non-CAPA group (P = 0.08). We conclude that CAPA is a frequent co-infection in critically ill COVID-19 patients and is associated with a high mortality rate. The timely diagnosis and treatment of IPA in these patients is likely to improve their outcome.

Lay Summary

We studied the characteristics of patients with COVID-19-associated invasive pulmonary aspergillosis (CAPA). Patients with CAPA tended to need invasive mechanical ventilation more frequently and to have a higher mortality rate. Adequate resources for its management can improve their outcome

中文翻译：

---

墨西哥城一家三级护理中心的 COVID-19 相关侵袭性肺曲霉病

摘要

侵袭性肺曲霉病 (IPA) 是一种由曲霉菌引起的严重感染。这通常发生在患有严重免疫抑制的患者身上。IPA 最近已在其他免疫功能正常的危重 COVID-19 患者（称为 COVID 相关肺曲霉病或 CAPA）中进行了描述。为了描述 CAPA 患者的特征，我们在墨西哥城的一家三级护理中心进行了一项回顾性队列研究。我们纳入了所有入住重症监护病房且接受血清或支气管肺泡灌洗半乳甘露聚糖测量的确诊 COVID-19 患者。我们使用了 Koehler 等人提出的标准。建立CAPA的诊断。主要结果是对有创机械通气 (IMV) 的需求和住院死亡率。在 ICU 中总共 83 名 COVID-19 住院患者中，16 名（19.3%）符合 CAPA 的标准。所有被诊断患有 CAPA 的患者都需要 IMV，而非 IPA 组中只有 84% 的患者需要这种干预。P = 0.09）。在 IPA 组中，31%（n = 5）的患者死亡，而在非 CAPA 组中为 13%（n = 9）（P = 0.08）。我们得出结论，CAPA 是重症 COVID-19 患者的常见合并感染，并且与高死亡率相关。在这些患者中及时诊断和治疗 IPA 可能会改善他们的预后。

总结

我们研究了 COVID-19 相关侵袭性肺曲霉病 (CAPA) 患者的特征。CAPA患者往往更频繁地需要有创机械通气并且死亡率更高。为其管理提供充足的资源可以改善其结果