Influenza- and COVID-19-associated pulmonary aspergillosis: are the pictures different?

Abstract

Invasive pulmonary aspergillosis (IPA) in intensive care unit patients is a major concern Influenza-associated acute respiratory distress syndrome (ARDS) and severe COVID-19 patients are both at risk of developing invasive fungal diseases We used the new international definitions of influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) to compare the demographic, clinical, biological, and radiological aspects of IAPA and CAPA in a monocentric retrospective study A total of 120 patients were included, 71 with influenza and 49 with COVID-19-associated ARDS Among them, 27 fulfilled the newly published criteria of IPA: 17/71 IAPA (23 9%) and 10/49 CAPA (20 4%) Kaplan–Meier curves showed significantly higher 90-day mortality for IPA patients overall (p = 0 032), whereas mortality did not differ between CAPA and IAPA patients Radiological findings showed differences between IAPA and CAPA, with a higher proportion of features suggestive of IPA during IAPA Lastly, a wide proportion of IPA patients had low plasma voriconazole concentrations with a higher delay to reach concentrations >2 mg/L in CAPA vs IAPA patients (p = 0 045) Severe COVID-19 and influenza patients appeared very similar in terms of prevalence of IPA and outcome The dramatic consequences on the patients’ prognosis emphasize the need for a better awareness in these particular populations