The role and incidence of COVID-19-associated invasive pulmonary aspergillosis is not as well understood compared with influenza-associated invasive pulmonary aspergillosis, according to findings of a review published in the Journal of Infectious Diseases.

Although influenza-associated pulmonary aspergillosis is recognized as a relatively rare superinfection, the review authors noted that the incidence of COVID-19-associated pulmonary aspergillosis is much less solidified, with reports in the literature varying between 4% and 35% among patients in the intensive care unit (ICU). However, differing diagnostic factors may explain some of the variability. Of interest, invasive aspergillosis has been reported rarely in the setting of other severe coronavirus respiratory infections, such as severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS).

Compared with influenza-associated pulmonary aspergillosis, COVID-19-associated pulmonary aspergillosis has clinical observations that are different and more heterogeneous. Most patients with COVID-19 are admitted to the ICU after the first week of symptoms, and the timing between admission and invasive pulmonary aspergillosis is variable. For example, a late diagnosis (between 7 and 14 days) is not uncommon. Additionally, the majority of reported cases were only probable or putative. Therefore, it is not possible to distinguish colonization from angio-invasive disease. However, mortality is high (60%-70%) among putative COVID-19 associated pulmonary aspergillosis cases, giving some credence to it being a distinct entity.

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“Whether [COVID-19-associated pulmonary aspergillosis] represents a distinct entity is still debatable and many questions remain unanswered, such as its actual incidence, the predisposing role of corticosteroids or immunomodulatory drugs, and the indications for antifungal therapy,” the study authors wrote.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Lamoth F, Lewis RE, Walsh TJ, Kontoyiannis DP. Navigating the uncertainties of COVID-19 associated aspergillosis (CAPA): a comparison with influenza associated aspergillosis (IAPA). J Infect Dis. Published online March 26, 2021. doi:10.1093/infdis/jiab163