Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance - 27/05/21

Doi : 10.1016/S1473-3099(20)30847-1

Philipp Koehler, MD ^a,^b,^c, Matteo Bassetti, ProfMD ^e,^f, Arunaloke Chakrabarti, ProfMD ^g, Sharon C A Chen, ProfMD ^h,^i,^j, Arnaldo Lopes Colombo, ProfMD ^k, Martin Hoenigl, ProfMD ^l,^m, Nikolay Klimko, ProfMD ⁿ, Cornelia Lass-Flörl, ProfMD ^o, Rita O Oladele, MD ^p, Donald C Vinh, ProfMD ^q, Li-Ping Zhu, MD ^r, Boris Böll, MD ^a,^c, Roger Brüggemann, ProfPhD ^s,^t, Jean-Pierre Gangneux, ProfMD ^v, John R Perfect, ProfMD ^w, Thomas F Patterson, ProfMD ^x,^y,^z, Thorsten Persigehl, MD ^a,^d, Jacques F Meis, ProfMD ^u,^aa,^ab, Luis Ostrosky-Zeichner, ProfMD ^ac, P Lewis White, PhD ^ad, Paul E Verweij, ProfMD ^u,^ae, Oliver A Cornely, ProfMD ^a,^b,^c,^af,^ag,⁎
on behalf of the
European Confederation of Medical Mycology
the International Society for Human Animal Mycology
the Asia Fungal Working Group
the INFOCUS LATAM/ISHAM Working Group
the ISHAM Pan Africa Mycology Working Group
the European Society for Clinical Microbiology
Infectious Diseases Fungal Infection Study Group
the ESCMID Study Group for Infections in Critically Ill Patients
the Interregional Association of Clinical Microbiology and Antimicrobial Chemotherapy
the Medical Mycology Society of Nigeria
the Medical Mycology Society of China Medicine Education Association
Infectious Diseases Working Party of the German Society for Haematology and Medical Oncology
Association of Medical Microbiology
Infectious Disease Canada
^a Faculty of Medicine, University of Cologne, Cologne, Germany
^b Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
^c Department I of Internal Medicine, European Excellence Center for Medical Mycology (ECMM), University Hospital Cologne, Cologne, Germany
^d Department of Radiology, University Hospital Cologne, Cologne, Germany
^e Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, Genoa, Italy
^f Policlinico San Martino Hospital, Genoa, Italy
^g Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
^h Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, New South Wales Health Pathology, Sydney, NSW, Australia
ⁱ Department of Infectious Diseases, Westmead Hospital, Sydney, NSW, Australia
^j School of Medicine, University of Sydney, Sydney, NSW, Australia
^k Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
^l Clinical and Translational Fungal-Working Group and Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, USA
^m Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria
ⁿ Department of Clinical Mycology, Allergology and Immunology, North Western State Medical University, St Petersburg, Russia
^o Institute of Hygiene and Medical Microbiology, ECMM, Medical University of Innsbruck, Innsbruck, Austria
^p Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos, Nigeria
^q Division of Infectious Diseases, Department of Medicine, Department of Medical Microbiology, and Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, McGill University Health Centre, Montreal, QC, Canada
^r Department of Infectious Diseases, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
^s Department of Pharmacy, ECMM, Center of Expertise in Mycology Radboudumc/CWZ, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands
^t Radboudumc Institute of Health Science, ECMM, Center of Expertise in Mycology Radboudumc/CWZ, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands
^u Department of Medical Microbiology, ECMM, Center of Expertise in Mycology Radboudumc/CWZ, Radboud University Medical Center, Radboud University, Nijmegen, Netherlands
^v Université de Rennes, CHU de Rennes, EHESP, Institut de Recherche en Santé, Environnement et travail, Inserm UMR_S 1085, Rennes, France
^w Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Duke University, Durham, NC, USA
^x University of Texas Health San Antonio, San Antonio, TX, USA
^y University Health, San Antonio, TX, USA
^z South Texas Veterans Health Care System, San Antonio, TX, USA
^aa Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
^ab Bioprocess Engineering and Biotechnology Graduate Program, Federal University of Paraná, Curitiba, Brazil
^ac Division of Infectious Diseases, McGovern Medical School, University of Texas, Houston, TX, USA
^ad Mycology Reference Laboratory, Public Health Wales Microbiology Cardiff, Cardiff, UK
^ae Center for Infectious Diseases Research, Diagnostics and Laboratory Surveillance, National Institute for Public Health and the Environment, Bilthoven, Netherlands
^af Clinical Trials Centre Cologne, ZKS Köln, Cologne, Germany
^ag German Center for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany

^*Correspondence to: Prof Oliver A Cornely, Department I of Internal Medicine, University Hospital Cologne, 50937 Cologne, GermanyDepartment I of Internal MedicineUniversity Hospital CologneCologne50937Germany

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Summary

Severe acute respiratory syndrome coronavirus 2 causes direct damage to the airway epithelium, enabling aspergillus invasion. Reports of COVID-19-associated pulmonary aspergillosis have raised concerns about it worsening the disease course of COVID-19 and increasing mortality. Additionally, the first cases of COVID-19-associated pulmonary aspergillosis caused by azole-resistant aspergillus have been reported. This article constitutes a consensus statement on defining and managing COVID-19-associated pulmonary aspergillosis, prepared by experts and endorsed by medical mycology societies. COVID-19-associated pulmonary aspergillosis is proposed to be defined as possible, probable, or proven on the basis of sample validity and thus diagnostic certainty. Recommended first-line therapy is either voriconazole or isavuconazole. If azole resistance is a concern, then liposomal amphotericin B is the drug of choice. Our aim is to provide definitions for clinical research and up-to-date recommendations for clinical management of the diagnosis and treatment of COVID-19-associated pulmonary aspergillosis.

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Plan

Introduction

Methods

CAPA characteristics and host factors

Imaging

Mycological evidence

Current guidelines for invasive aspergillosis and concerns in defining CAPA

Definition of CAPA for clinical studies

Proven CAPA

Probable CAPA

Guidance on clinical management of CAPA

Antifungal treatment

Therapeutic drug monitoring

Conclusion

Search strategy and selection criteria

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Vol 21 - N° 6

P. e149-e162 - juin 2021 Retour au numéro

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Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance - 27/05/21

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