INTRODUCTION
COVID-19 is characterized by asymptomatic and/or mild flu-like symptoms; however, about 20% of patients may progress to pneumonia and sepsis, thus requiring intensive support 1 . Patients with acute respiratory distress syndrome due to viral infections, such as SARS-CoV-2, are prone to secondary complications, including aspergillosis 2 . Invasive aspergillosis is not uncommon in immunocompromised patients, and is a well-described complication in acute respiratory failure and severe influenza-related pneumonia 3 . A retrospective multicenter cohort study showed that influenza infection was an independent risk factor for invasive pulmonary aspergillosis (IPA) 4 .
Although influenza-associated IPA is associated with high mortality and morbidity, its pathogenesis is not well known 3 . Direct immunomodulation and the use of drugs, such as oseltamivir and corticosteroids, may play a role 5  ,  6 . Wang et al. 2  reported a patient with severe acute respiratory syndrome (SARS), who died of aspergillosis after prolonged treatment with corticosteroids. Blaize et al. 7  and Antinori et al. 8  reported fatal cases of IPA in immunocompetent patients with severe COVID-19, whose bronchoalveolar aspirate grew Aspergillus fumigatus and had a positive serum galactomannan (GM) antigen. Antinori et al. 8  evidenced the pathological pulmonary alterations postmortem and confirmed the infective Aspergillus via molecular techniques. It is possible that aspergillosis could predispose patients with COVID-19 to clinical worsening.
Therefore, testing for the presence of Aspergillus spp in lower respiratory secretions and GM (not routinely positive in peripheral blood) in patients with COVID-19 in the intensive care unit (ICU) should be considered to allow timely treatment and avoid potential immunosuppression with the use of medications 5  ,  6 . However, conducting a bronchoscopy in patients with COVID-19 is relatively contraindicated due to the biological risk and clinical deterioration caused by the procedure 9 . Lung biopsy, which might also be considered a gold standard diagnosis method, is also impractical in such a scenario.
Latin America seems to be the most recent COVID-19 epicenter, after Asia, Europe, and the US. In Manaus, in the Brazilian Amazon, more than 2,000 deaths were officially reported in April/May 2020.