27 successive mechanically ventilated patients with COVID-19 (18 male and nine female, median age 63 years [IQR 56-71]) were included. Specimens (20 BALs and seven BAs) were obtained on day 3 [IQR 1–6] post-intubation. Probable IPAs were diagnosed in one patient (4%) and putative IPAs were diagnosed in eight patients (30%; table ). Putative IPA diagnosis relied on Aspergillus spp identification in BAL culture (n=2) and validation of 2 or more mycological criteria (n=6).
Table Clinical characteristics of nine critically ill patients with COVID-19 probable (n=1) and putative invasive pulmonary aspergillosis (n=8)
Putative invasive pulmonary aspergillosis patients (sex, age) Probable IPA patient (sex, age)
Patient 1 (male, 53 years) Patient 2 (female, 59 years) Patient3 (female, 69 years) Patient 4 (female, 63 years) Patient 5 (male, 43 years) Patient 6 (male, 79 years) Patient 7 (male, 77 years) Patient 8 (female, 75 years) Patient 9 (male, 47 years)
Risk factors of severe COVID-19 Hypertension, obesity, ischaemic heart disease Hypertension, diabetes, obesity Hypertension, obesity Hypertension, diabetes, ischaemic heart disease Asthma Hypertension Hypertension, asthma Hypertension, diabetes None
EORTC risk factors None None None None Steroids None None None Myeloma, steroids
APACHE II score 26 16 11 20 8 16 25 21 10
Thoracic CT-scan/x-ray* Typical COVID-19 Typical COVID-19 Typical COVID-19 Typical COVID-19 Typical COVID-19 Typical COVID-19, segmental lung atelectasis Typical COVID-19, emphysema Typical COVID-19 Typical COVID-19 + one peripheral nodule
Anti-COVID-19 therapies LPV–RTV LPV–RTV, AZI LPV–RTV LPV–RTV AZI LPV–RTV, HCQ, AZI LPV–RTV, HCQ, AZI LPV–RTV, AZI No
Steroids to treat pneumonia† Yes No Yes Yes No Yes Yes Yes No
Renal replacement therapy Yes No No Yes No No Yes No No
Vasopressor Yes Yes Yes Yes No Yes Yes Yes Yes
Pulmonary specimen‡ BAL BAL BA BAL BAL BAL BAL BAL BA
Invasive pulmonary aspergillosis diagnosis
BAL culture§ − + + − + + + + +
BAL/BA qPCR¶ − − 23·9 − − 34·5 29·0 31·7 −
BAL galactomannan index 0·89 0·03 ND 0·15 0·12 0·05 3·91 0·36 ND
Serum qPCR¶ − − − ND − − − − −
β-D-glucan, pg/mL 523 ND 7·8 105 7 23 135 450 14
Serum galactomannan index 0·13 0·04 0·03 0·51 0·04 0·02 0·37 0·37 0·09
Number of mycological criteria 2 1 2 2 1 2 3 3 1
Antifungal therapy None None None None None None VRC CSP None
Outcome Alive Alive Alive Death (day 0) Alive Alive Death (day 18) Death (day 11) Death day 3)
EORTC=European Organization for Research and Treatment of Cancer. APACHE= Acute Physiology and Chronic Health Enquiry. LPV–RTV=lopnavir–ritonavir combination. AZI=azithromycin. HCQ=hydroxychloroquine. BAL=Bronchoalveolar lavage. BA=bronchial aspiration. ND=not done. VRC=voriconazole. CSP=caspofungin.
* Thoracic CT scan was done in Pt3, Pt4, Pt5, 5 days (median) before respiratory specimens.
† Dexamethasone intravenous dose of 20 mg once daily from day 1 to day 5, followed by 10 mg once daily from day 6 to day 10;
‡ No endotracheal or endobronchial lesion was observed.
§ −=negative; +=positive with Aspergillus fumigatus identification.
¶ qPCR=quantitative real-time PCR (−, negative; if positive, number of quantification cycles).