High Prevalence of Putative Invasive Pulmonary Aspergillosis in Critically Ill COVID-19 Patients

Lancet Respiratory Medicine, Forthcoming

7 Pages Posted: 15 Apr 2020 Last revised: 18 May 2020

See all articles by Alexandre Alanio

Alexandre Alanio

Assistance publique-Hôpitaux de Paris -Saint-Louis Hospital (Paris) - Mycology parasitology Laboratory

Sarah Dellière

University of Paris

Sofiane Fodil

University of Paris

Stéphane Bretagne

University of Paris; University of Paris

Bruno Mégarbane

University of Paris

Date Written: April 14, 2020

Abstract

We are currently facing a frightening increase in COVID-19 patients admitted to the ICU.

Aiming at screening for fungal secondary pneumonia, we collected the data of our first 27 ICU patients, who underwent bronchoalveolar lavage or bronchial aspirates. We classified the patients based on the recently published study on invasive aspergillosis in influenza patients in your journal (Schauwvlinghe et al., 2018.) and found 33% of our COVID-19 patients with putative invasive pulmonary aspergillosis.

Observing such a high prevalence in COVID-infected patients was somehow unexpected since the 30% prevalence of invasive aspergillosis in influenza patients has been attributed to the action of oseltamivir on anti-Aspergillus immunity.

Almost all critically ill COVID-19 patients develop ARDS and are likely to receive high-dose steroids or immunomodulatory therapies to prevent worsening as suggested by reports from China. In the COVID-19 patients with putative invasive aspergillosis, antifungal prophylactic therapy may be questioned to avoid increased lung inflammation that may compromise the outcome. This issue remains to be addressed in future clinical trials.

We are strongly convinced that testing deep lung specimens for Aspergillus in severe COVID-19 patients should be recommended. This message is major, given the high mortality rate of COVID-19 patients in the ICU and should be rapidly released.

Note: Funding: None.

Conflict of Interest: No conflict of interest related the present work.

Ethical Approval: This study was part of the French COVID-19 cohort registry conducted by the REACTing consortium and directed by INSERM and ISARIC. Our institutional ethics committee approved the study (N°, IDRCB, 2020-A00256-33; CPP, 11-20 20.02.04.68737). When possible, signed informed consent was obtained from the patients or the next of kin.

Keywords: Intensive care Unit; Secondary pneumonia; COVID-19; Invasive pulmonary aspergillosis

Suggested Citation

Alanio, Alexandre and Dellière, Sarah and Fodil, Sofiane and Bretagne, Stéphane and Mégarbane, Bruno, High Prevalence of Putative Invasive Pulmonary Aspergillosis in Critically Ill COVID-19 Patients (April 14, 2020). Lancet Respiratory Medicine, Forthcoming , Available at SSRN: https://ssrn.com/abstract=3575581 or http://dx.doi.org/10.2139/ssrn.3575581

Alexandre Alanio (Contact Author)

Assistance publique-Hôpitaux de Paris -Saint-Louis Hospital (Paris) - Mycology parasitology Laboratory ( email )

1 ave Claude Vellefaux
75475 Paris CEDEX 10 15, IDF 75475
France

Sarah Dellière

University of Paris

Paris
France

Sofiane Fodil

University of Paris

Paris
France

Stéphane Bretagne

University of Paris

Paris
France

University of Paris

Paris
France

Bruno Mégarbane

University of Paris

Paris
France

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