A retrospective observational study on incidence and clinico-epidemiological features of COVID-19 associated pulmonary aspergillosis among cancer patients hospitalized with COVID-19 in a tertiary care cancer centre of India
Keywords:Cancer, Invasive aspergillosis, CAPA, COVID-19
Background: COVID-19 associated pulmonary aspergillosis (CAPA) is an emerging complication among patients with COVID-19 but hasn’t been well studied in cancer patients. This study, we try to find out important aspects associated with CAPA among cancer patients with regards to clinico-epidemiological factors.
Methods: In this retrospective observational study, we included 198 consecutive patients COVID-19 between April 2020 and February 2021. CAPA cases were classified according to CAPA-European Confederation of Medical Mycology criteria (2020 ECMM/ISHAM consensus criteria).
Results: The overall incidence of CAPA was found to be 10.1% in our study population. The incidence among hematological malignancies was 11.25% and solid tumors was 10%. In-hospital mortality was significantly high among patients with CAPA as compared to that among without CAPA (40% versus 16.85%; p<0.012695). Significant number of patients with CAPA had received chemotherapy in last 3 months before diagnosis of COVID-19 (50% versus 28.09%, p=0.043222) and had evidence of culture positive bacterial infection (30% versus 5.62; p=0.000888). Significantly more patients having CAPA were on steroids, required oxygen and/or ventilator support as compared to those without CAPA.
Conclusions: CAPA is a significant cause of mortality and length of hospital stay (16 versus 7 days; p=0.00001) among cancer patients with COVID-19. Cancer patients with COVID-19 were at increased risk of CAPA as compared to non-cancer patients.
Meijer EFJ, Dofferhoff ASM, Hoiting O, Meis JF. COVID-19-associated pulmonary aspergillosis: a prospective single-center dual case series. Mycoses. 2021;64(4):457-4.
Borman AM, Palmer MD, Fraser M, Patterson Z, Mann C, Oliver D, et al. COVID-19-associated invasive aspergillosis: data from the UK National Mycology Reference Laboratory. J Clin Microbiol. 2020;59(1):e02136-20.
Koehler P, Bassetti M, Chakrabarti A, Chen SC, Colombo AL, Hoenigl M, et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis. 2021;21(6):e149-62.
Mitaka H, Kuno T, Takagi H, Patrawalla P. Incidence and mortality of COVID-19-associated pulmonary aspergillosis: a systematic review and meta-analysis. Mycoses. 2021;64(9):993-1001.
Paramythiotou E, Dimopoulos G, Koliakos N, Siopi M, Vourli S, Pournaras S, et al. Epidemiology and incidence of COVID-19-associated pulmonary aspergillosis (CAPA) in a Greek tertiary care academic reference hospital. Infect Dis Ther. 2021;10(3):1779-12.
Chong WH, Saha BK, Neu KP. Comparing the clinical characteristics and outcomes of COVID-19-associate pulmonary aspergillosis (CAPA): a systematic review and meta-analysis. Infection. 2022:1-4.
Iqbal A, Ramzan M, Akhtar A, Ahtesham A, Aslam S, Khalid J. COVID-associated pulmonary aspergillosis and its related outcomes: a single-center prospective observational study. Cureus. 2021;13(8).
Lai CC, Yu WL. COVID-19 associated with pulmonary aspergillosis: A literature review. J Microbiol Immunol Infect. 2021;54(1):46-53.
Montrucchio G, Lupia T, Lombardo D. Risk factors for invasive aspergillosis in ICU patients with COVID-19: current insights and new key elements. Ann Intens Care. 2021;11(1):1-11.
Arastehfar A, Carvalho A, van de Veerdonk FL, Jenks JD, Koehler P, Krause R, et al. COVID-19 associated pulmonary aspergillosis (CAPA)- from immunology to treatment. J Fungi. 2020;6(2):91.
Rothe K, Feihl S, Schneider J, Wallnöfer F, Wurst M, Lukas M, et al. Rates of bacterial co-infections and antimicrobial use in COVID-19 patients: a retrospective cohort study in light of antibiotic stewardship. Eur J Clin Microbiol Infect Dis. 2021;40:859-69.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.
Lescure FX, Bouadma L, Nguyen D, Parisey M, Wicky PH, Behillil S, et al. Clinical and virological data of the first cases of COVID-19 in Europe: a case series. Lancet Infect Dis. 2020;20(6):697-6.
Vijay S, Bansal N, Rao BK, Veeraraghavan B, Rodrigues C, Wattal C, et al. Secondary infections in hospitalized COVID-19 patients: Indian experience. Infect Drug Resist. 2021;14:1893.
Lahmer T, Kriescher S, Herner A, Rothe K, Spinner CD, Schneider J, et al. Invasive pulmonary aspergillosis in critically ill patients with severe COVID-19 pneumonia: Results from the prospective AspCOVID-19 study. PLoS One. 2021;16(3):e0238825.
Machado M, Valerio M, Álvarez-Uría A. Invasive pulmonary aspergillosis in the COVID-19 era: an expected new entity. Mycoses. 2021;64(2):132-3.
Reizine F, Pinceaux K, Lederlin M, Autier B, Guegan H, Gacouin A, et al. Influenza- and COVID-19-associated pulmonary aspergillosis: are the pictures different? J Fungi. 2021;7(5):388.
Logan PM MN. High-resolution computed tomography and pathologic findings in pulmonary aspergillosis: a pictorial essay. Can Assoc Radiol J. 47(6):444-2.
Covid-19 management. Version 3, 2021. Available from: https://www.mohfw.gov.in/pdf/ ClinicalManagementProtocolforCOVID19.pdf. Accessed on 19 July 2021.
Mishra DK, Goel G, Arora N, Krishnan S, Bhattacharya S, Mathur P, et al. The importance of intra- and inter-institutional networks for capacity building in severe acute respiratory syndrome coronavirus 2 reverse transcription polymerase chain reaction services: Experience from an oncology centre in eastern India. Indian J Med Microbiol. 2020;38(1):9-17.
Das P, Pandey P, Harishankar A, Chandy M, Bhattacharya S, Chakrabarti A. Standardization of a two-step real-time polymerase chain reaction based method for species-specific detection of medically important Aspergillus species. Indian J Med Microbiol. 2017;35(3).
Prattes J, Wauters J, Giacobbe DR, Salmanton-García J, Maertens J, Bourgeois M, et al. Risk factors and outcome of pulmonary aspergillosis in critically ill coronavirus disease 2019 patients- a multinational observational study by the European Confederation of Medical Mycology. Clin Microbiol Infect. 2022;28(4):580-7.
Alanio A, Dellière S, Fodil S, Bretagne S, Mégarbane B. Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19. Lancet Respir Med. 2020;8(6):e48-9.
Salmanton-García J, Sprute R, Stemler J, Bartoletti M, Dupont D, Valerio M, et al. COVID-19–associated pulmonary aspergillosis, March-August 2020. Emerg Infect Dis. 2021;27(4):1077.
Sivasubramanian G, Ghanem H, Maison-Fomotar M, Jain R, Libke R. COVID-19-associated pulmonary aspergillosis: a single-center experience in Central Valley, California, January 2020-March 2021. J Fungi. 2021;7(11).
Singh S, Verma N, Kanaujia R, Chakrabarti A, Rudramurthy SM. Mortality in critically ill patients with coronavirus disease 2019‐associated pulmonary aspergillosis: a systematic review and meta‐analysis. Mycoses. 2021;64(9):1015-27.
Singh S, Verma N, Kanaujia R, Chakrabarti A, Rudramurthy SM. Mortality in critically ill patients with coronavirus disease 2019-associated pulmonary aspergillosis: a systematic review and meta-analysis. Mycoses. 2021;64(9).
Beović B, Doušak M, Ferreira-Coimbra J, Nadrah K, Rubulotta F, Belliato M, et al. Antibiotic use in patients with COVID-19: a ‘snapshot’ Infectious Diseases International Research Initiative (ID-IRI) survey. J Antimicrob Chemother. 2020;75(11):3386-90.
Kayarat B, Khanna P, Sarkar S. Superadded coinfections and antibiotic resistance in the context of COVID-19: where do we stand? Indian J Crit Care Med. 2021;25(6):698-2.
Wasylyshyn AI, Wasylyshyn GR, Linder KA, Miceli MH. COVID-19-associated pulmonary aspergillosis at an academic medical center in the midwestern United States. Mycopathologia. 2021;186(4):1.
Permpalung N, Chiang TP, Massie AB, Zhang SX, Avery RK, Nematollahi S, et al. Coronavirus disease 2019–associated pulmonary aspergillosis in mechanically ventilated patients. Clin Infect Dis. 2022;74(1):83-91.
Nasrullah A, Javed A, Malik K. Coronavirus disease-associated pulmonary aspergillosis: a devastating complication of COVID-19. Cureus. 2021;13(1).
Yao Y, Cao J, Wang Q, Shi Q, Liu K, Luo Z, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. J Intens Care. 2020;8(1):1-11.
van Arkel ALE, Rijpstra TA, Belderbos HNA, van Wijngaarden P, Verweij PE, Bentvelsen RG. COVID-19-associated pulmonary aspergillosis. Am J Respir Crit Care Med. 2020;202(1):132-5.
Armstrong-James D, Youngs J, Bicanic T, Abdolrasouli A, Denning DW, Johnson E,et al. Confronting and mitigating the risk of COVID-19 associated pulmonary aspergillosis. Eur Respir J. 2020;56(4).