Multinational Observational Cohort Study of COVID-19–Associated Pulmonary Aspergillosis1

Nico A.F. Janssen; Rémy Nyga; Lore Vanderbeke; Cato Jacobs; Mehmet Ergün; Jochem B. Buil; Karin van Dijk; Josje Altenburg; Catherine S.C. Bouman; Hans I. van der Spoel; Bart J.A. Rijnders; Albert Dunbar; Jeroen A. Schouten; Katrien Lagrou; Marc Bourgeois; Marijke Reynders; Niels van Regenmortel; Lynn Rutsaert; Piet Lormans; Simon Feys; Yves Debavaye; Fabienne Tamion; Damien Costa; Julien Maizel; Hervé Dupont; Taieb Chouaki; Saad Nseir; Boualem Sendid; Roger J.M. Brüggemann; Frank L. van de Veerdonk; Joost Wauters; Paul E. Verweij


Emerging Infectious Diseases. 2021;27(11):2892-2898. 

In This Article

Abstract and Introduction


We performed an observational study to investigate intensive care unit incidence, risk factors, and outcomes of coronavirus disease–associated pulmonary aspergillosis (CAPA). We found 10%–15% CAPA incidence among 823 patients in 2 cohorts. Several factors were independently associated with CAPA in 1 cohort and mortality rates were 43%–52%.


Incidence of coronavirus disease (COVID-19)–associated pulmonary aspergillosis (CAPA) in hospital intensive care units (ICUs) is 3.8%–33.3%.[1–9] Variations might be explained by differences in patient populations and CAPA definitions used, complicating direct comparisons between studies.

Diagnosing CAPA is complex because cases frequently lack typical radiologic features and European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) host factors[10] and because mycologic evidence is difficult to obtain. Serum galactomannan (GM) detection has low sensitivity in CAPA.[7,10]

The European Confederation of Medical Mycology and International Society for Human and Animal Mycology (ECMM/ISHAM) published consensus criteria for a CAPA definition.[11] We used these criteria to perform an observational cohort study to assess CAPA incidence in patients with COVID-19 admitted to ICUs during the first wave of the COVID-19 pandemic.