Antifungal

Mechanical ventilation

Coronavirus

Intensive care unit

ARDS

Superinfection

Voriconazole

Dermatology

Aspergillosis

Coronavirus disease 2019 (COVID-19)

Immunology

Physics

Optics

Infectious disease (medical specialty)

Internal medicine

Medicine

Pneumonia

Virus

Disease

Incidence (geometry)

Lung

Emerging infectious diseases

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Because of the severe immunomodulation and lymphocyte depletion caused by this virus and the subsequent administration of drugs directed at the immune system, we anticipated that patients might experience fungal superinfection. We collected data from 186 patients who had coronavirus disease-associated pulmonary aspergillosis (CAPA) worldwide during March-August 2020. Overall, 182 patients were admitted to the intensive care unit (ICU), including 180 with acute respiratory distress syndrome and 175 who received mechanical ventilation. CAPA was diagnosed a median of 10 days after coronavirus disease diagnosis. Aspergillus fumigatus was identified in 80.3% of patient cultures, 4 of which were azole-resistant. Most (52.7%) patients received voriconazole. In total, 52.2% of patients died; of the deaths, 33.0% were attributed to CAPA. We found that the cumulative incidence of CAPA in the ICU ranged from 1.0% to 39.1%.

COVID-19–Associated Pulmonary Aspergillosis, March–August 2020