Characteristics  Patient #1  Patient #2  Patient #3  Patient #4  Patient #5
Gender  Female  Male  Male  Male  Female
Age (y)  62  70  54  73  54
Medical history  Lap. cholecystectomy for cholecystitis
Arterial hypertension
Obesity with sleep apnea (BMI 31.5)
Hypercholesterolemia
Ex‐smoker (30 PY; 5 y previously)
Moderate COPD (GOLD 2)  Vertebral disc prolapse left L4/5, flavectomy and nucleotomy
Ex‐smoker (4 months previously)  Arterial hypertension
Diabetes mellitus
Aneurysm coiling right A. vertebralis  Arterial hypertension
Bullous Emphysema
Smoker
Severe COPD (GOLD 3)
Previous Hepatitis B  No
Underlying immuno‐compromising condition  (inhalational steroids for COPD)  No  (intravenous corticosteroid therapy 0.4 mg/kg/d, total of 13 d)  (inhalational steroids for COPD)  No
ICU Ward  MICU  MICU  SICU  SICU  MICU
ARDS
Horowitz‐Index, admission 12  Severe (53 mm Hg)  Severe (93 mm Hg)  Moderate (128 mm Hg)  Severe (83 mm Hg)  Moderate (167 mm Hg)
Prone positioning  Yes  Yes  Yes  Yes  Yes
vvECMO  Yes  No  No  No  No
Acute renal failure  Yes  Yes  Yes  Yes  Yes
Dialysis  No  SLEDD  SLEDD  SLEDD  No
Microbiology
Serum GM (>0.5)  Negative  Positive (0.7)  Negative  Negative  2× positive (2.7 and 1.3)
Fungal culture  BALF: Aspergillus fumigatus  BALF: negative  TA: Aspergillus fumigatus  TA: Aspergillus fumigatus  TA: negative
Susceptibility testing  Azole susceptible a  Not applicable  Azole susceptible
Itraconazole MIC 0.380 (mg/L)
Voriconazole MIC 0.094 (mg/L)  Azole susceptible
Itraconazole MIC 0.380 (mg/L)
Voriconazole MIC 0.094 (mg/L)  Not applicable
Fungal PCR  BALF: Aspergillus fumigatus  BALF: Aspergillus fumigatus  BALF: Aspergillus fumigatus  TA: Aspergillus fumigatus  TA: negative
TA/BALF GM (>0.5)  BALF: Positive (>2.5)  BALF: Positive (>2.5)  BALF: Positive (>2.5)  Not available  Not available
Definition of IPA
EORTC/MSG Criteria 8  Not classifiable (no host criterion)  Not classifiable (no host criterion)  Not classifiable (no host criterion)  Not classifiable (no host criterion)  Not classifiable (no host criterion)
(modified) AspICU algorithm 3 ,  7  Putative  Modified putative 3  (GM positivity)  Putative  Putative  Modified putative 3  (GM positivity)
Virology
PCR  TA: positive for hMPV and SARS‐CoV‐2 (E‐gene: C t 13.29; S‐gene: C t 12.61)  TA: positive for hMPV and SARS‐CoV‐2(E‐gene: C t 34.29; ORF1 a/b: C t 31.47)  TA positive for SARS‐CoV‐2 (E‐gene: C t 29.74; ORF1 a/b: C t 27.86)  TA positive for SARS‐CoV‐2 (E‐gene: C t 21.47; ORF1 a/b: C t 20.12)  TA positive for SARS‐CoV‐2 (C t values not available)
CT imaging studies  Combined bilateral ground‐glass opacities with crazy paving and peripheral nodular consolidations (Video S1, Figure 1A)  Ground‐glass opacities with occasional nodules (Video S2, Figure 1B)  Bilateral ground‐glass opacities, nodular infiltrates with cavities and air crescent sign (Video S3, Figure 1C)  Ground‐glass opacities with occasional nodules, known bullous emphysema (Video S4, Figure 1D)  Ground‐glass opacities, smaller areas with crazy paving pattern, central and peripheral consolidations, and smaller nodular infiltrates (Video S5, Figure 1E)
Therapy
Antifungal treatment  Voriconazole iv (6/4 mg/kg BW twice daily)  Isavuconazole iv (200 mg thrice daily for 2 d; 200 mg once daily from 3 d)  Caspofungin (70/50 mg once daily) followed by voriconazole iv (6/4 mg/kg BW twice daily)  Voriconazole iv (6/4 mg/kg BW twice daily)  Caspofungin (70/50 mg once daily) followed by voriconazole iv (6/4 mg/kg BW twice daily)
Antiviral therapy  Supportive only  Supportive only  Hydroxychloroquine, darunavir and cobicistat at external hospital, in house changed to supportive only  Supportive only  Ribavirin, lopinavir/ritonavir at external hospital, in house changed to supportive only
Outcome  Died  Died  Alive  Died  Alive