Diagnosis and Antifungal Prophylaxis for COVID-19 Associated Pulmonary Aspergillosis

The COVID-19 pandemic has redemonstrated the importance of the fungal-after-viral phenomenon, and the question of whether prophylaxis should be used to prevent COVID-19-associated pulmonary aspergillosis (CAPA). A distinct pathophysiology from invasive pulmonary aspergillosis (IPA), CAPA has an incidence that ranges from 5% to 30%, with significant mortality. The aim of this work was to describe the current diagnostic landscape of CAPA and review the existing literature on antifungal prophylaxis. A variety of definitions for CAPA have been described in the literature and the performance of the diagnostic tests for CAPA is limited, making diagnosis a challenge. There are only six studies that have investigated antifungal prophylaxis for CAPA. The two studied drugs have been posaconazole, either a liquid formulation via an oral gastric tube or an intravenous formulation, and inhaled amphotericin. While some studies have revealed promising results, they are limited by small sample sizes and bias inherent to retrospective studies. Additionally, as the COVID-19 pandemic changes and we see fewer intubated and critically ill patients, it will be more important to recognize these fungal-after-viral complications among non-critically ill, immunocompromised patients. Randomized controlled trials are needed to better understand the role of antifungal prophylaxis.

Automated summary

This article describes the current diagnostic landscape of COVID-19-associated pulmonary aspergillosis (CAPA) and reviews the existing literature on antifungal prophylaxis. There is inconsistency in the definitions of CAPA and limitations in the performance of diagnostic tests, making diagnosis challenging. There are limited studies on antifungal prophylaxis for CAPA, with small sample sizes and inherent bias in retrospective studies. As the COVID-19 pandemic evolves, it becomes more important to recognize fungal-after-viral complications among immunocompromised patients. Further randomized controlled trials are needed to better understand the role of antifungal prophylaxis.