8. Future Perspectives
We anticipate that autopsies of COVID-19 fatalities will increase and likely prove the clinical relevance of CAPA [96]. Immune dysregulation together with epithelial lung damage stemming from COVID-19 immunopathology is a likely mechanism predisposing for IPA development [97]. IPA will be recognized as important co-infection in patients with severe COVID-19, but incidence will likely vary between different ICU settings. In settings where COVID-19 associated IPA occurs most commonly, screening for IPA in blood and true BALF samples (i.e., obtained via bronchoscopy) will be implemented followed by preemptive treatment in those with mycological evidence of IPA. In other high-incidence settings, clinical antifungal prophylaxis trials will be conducted among COVID-19 patients admitted to the ICU aiming to show a decrease in putative [4] and proven IPA cases, as well as overall mortality. Treatment trials will compare efficacy and safety of new antifungal drugs currently under development with established antifungals, initiating a new era of antifungal treatment.