Invasive pulmonary aspergillosis in critically Ill patients with pneumonia due to COVID-19, influenza, and community- acquired pneumonia: A prospective observational study

Syed Ahsan Ali; Kausar Jabeen; Joveria Farooqi; Hammad Niamatullah; Aisha Fareed Siddiqui; Safia Awan; Alishah Akbar; Muhammad Irfan

doi:10.18502/cmm.8.2.10328

Syed Ahsan Ali Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
Kausar Jabeen Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan
Joveria Farooqi Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan
Hammad Niamatullah Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, Pakistan
Aisha Fareed Siddiqui Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
Safia Awan Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
Alishah Akbar Aga Khan Medical College, Karachi, Pakistan
Muhammad Irfan Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan

DOI: https://doi.org/10.18502/cmm.8.2.10328

Keywords: Aspergillus, Aspergillosis, COVID-19, Influenza, Pneumonia, Outcomes

Abstract

Background and Purpose: Influenza A and SARS-CoV-2 are risk factors for invasive pulmonary aspergillosis. Both influenza-associated pulmonary aspergillosis and COVID-19- associated pulmonary aspergillosis result in high mortality and poor clinical outcomes. No prospective study has so far compared the features, treatment, and outcomes of influenza-associated pulmonary aspergillosis and COVID-19-associated pulmonary aspergillosis within a similar time frame. Therefore, this study aimed to determine the frequency, risk factors, and outcomes of invasive pulmonary aspergillosis in critically ill patients with influenza, COVID-19, and community-acquired pneumonia.

Materials and Methods: This prospective study included adult patients with pneumonia and was conducted at The Aga Khan University Hospital in Karachi, Pakistan. Patients were divided into three groups, including community-acquired pneumonia, influenza pneumonia, and COVID-19 pneumonia. The data collected included information on demographic characteristics, comorbidities, clinical features, laboratory results, treatment, and outcomes.

Results: A total of 140 patients were included in this study. These included 35 (25%), 70 (50%), and 35 (25%) patients with community-acquired pneumonia, influenza pneumonia, and COVID-19 pneumonia, respectively. In addition, 20 (14.2%) patients were found to have invasive aspergillosis, of whom 10/35 (28.5%), 9/70 (12.8%), and 1/35 (2.8%) patients were in the COVID-19, influenza, and community-acquired pneumonia groups, respectively. Moreover, nine (90%) COVID-19-associated pulmonary aspergillosis patients required vasopressors, compared to three (33%) patients with influenza-associated pulmonary aspergillosis (P=0.020). In total, seven (70%) COVID-19-associated pulmonary aspergillosis patients required invasive mechanical ventilation compared to four (44%) influenza-associated pulmonary aspergillosis patients (P=0.37). The mean±SD length of hospital stay was highest in the COVID-19-associated pulmonary aspergillosis patients (18.3±7.28 days) compared to influenza-associated pulmonary aspergillosis patients (11.7±5.34 days) (P=0.036). The number of deaths in influenza-associated pulmonary aspergillosis and COVID-19-associated pulmonary aspergillosis patients was three (33.3%) and five (50%), respectively (P=0.526).

Conclusion: A higher proportion of patients with COVID-19 developed invasive aspergillosis compared to those with influenza. Although the mortality rate in COVID19-associated pulmonary aspergillosis was comparable to that in influenza-associated pulmonary aspergillosis patients, COVID-19-associated pulmonary aspergillosis patients had a significantly longer stay in the hospital.