A new review, published in the Journal of Infectious Diseases, explores the incidence of COVID-19-associated invasive pulmonary aspergillosis.

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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