For the diagnosis of pulmonary aspergillosis associated with SARS-CoV-2 infection (CAPA), the modified ECMM/ISHAM 2020 consensus (*) criteria were applied [1 (link)]:
Proven CAPA: IPA confirmed by the histological specimen (lung biopsy or autopsy) or direct lung or tracheobronchial microscopy.
Probable CAPA: Compatible clinical and imaging findings (pulmonary infiltrate or nodules preferably documented by chest CT or cavitating infiltrate), with microbiological isolation of Aspergillus in BAL, or galactomannan (GM) in BAL >1, or GM in serum >0.5 or positive PCR in serum (not available in this study), or positive PCR in BAL (<36 cycles) (not available in this study).
Possible CAPA: Compatible clinical and imaging findings, with microbiological isolation of Aspergillus in respiratory specimens other than BAL: TBA, sputum. Possible pulmonary CAPA requires pulmonary infiltrates, well-circumscribed lesions(s) or nodules, preferably documented by chest CT, or cavitating infiltrate, which is not attributed to another cause. In patients with bilateral, ground-glass opacities or other COVID-19 related findings, significant radiological changes as previously mentioned and confirmed by an expert radiologist were required to be considered possible CAPA. The ECMM/ISHAM 2020 consensus includes non-bronchoscopic lavage as a diagnostic tool (*). Non-bronchoscopic lavage was not performed in this study In this series, these were replaced (only in patients with SARS-CoV-2 infection) with non-bronchoscopic samples: TBA, sputum.
Probable Traqueobronquitis: The presence of tracheobronchial ulceration, nodule, pseudomembrane, plaque, or eschar seen on a bronchoscopic analysis together with visualization of hyphae or isolation of Aspergillus spp. in culture.
Colonization was considered in patients with no radiological findings or unchanged with respect to those attributed to COVID-19.
In case of belonging to more than one group, they were prioritized as follows: In patients with SARS-CoV-2 infection, the modified ECMM/ISHAM 2020 consensus was always applied. In patients without SARS-CoV-2 infection, the EORTC/MSG criteria were taken into account first, then the AspICU criteria and finally the Bulpa criteria.
A separate analysis was performed according to IPA. PPP-IPA integrated the diagnoses of proven, probable/putative, and possible IPA, regardless of the criteria used; in this case, the remaining patients included in the series were considered colonized. PP-IPA integrated only the diagnoses of proven and probable IPA; in this case, the diagnoses of possible IPA were analyzed together with the colonized patients.
Proven CAPA: IPA confirmed by the histological specimen (lung biopsy or autopsy) or direct lung or tracheobronchial microscopy.
Probable CAPA: Compatible clinical and imaging findings (pulmonary infiltrate or nodules preferably documented by chest CT or cavitating infiltrate), with microbiological isolation of Aspergillus in BAL, or galactomannan (GM) in BAL >1, or GM in serum >0.5 or positive PCR in serum (not available in this study), or positive PCR in BAL (<36 cycles) (not available in this study).
Possible CAPA: Compatible clinical and imaging findings, with microbiological isolation of Aspergillus in respiratory specimens other than BAL: TBA, sputum. Possible pulmonary CAPA requires pulmonary infiltrates, well-circumscribed lesions(s) or nodules, preferably documented by chest CT, or cavitating infiltrate, which is not attributed to another cause. In patients with bilateral, ground-glass opacities or other COVID-19 related findings, significant radiological changes as previously mentioned and confirmed by an expert radiologist were required to be considered possible CAPA. The ECMM/ISHAM 2020 consensus includes non-bronchoscopic lavage as a diagnostic tool (*). Non-bronchoscopic lavage was not performed in this study In this series, these were replaced (only in patients with SARS-CoV-2 infection) with non-bronchoscopic samples: TBA, sputum.
Probable Traqueobronquitis: The presence of tracheobronchial ulceration, nodule, pseudomembrane, plaque, or eschar seen on a bronchoscopic analysis together with visualization of hyphae or isolation of Aspergillus spp. in culture.
Colonization was considered in patients with no radiological findings or unchanged with respect to those attributed to COVID-19.
In case of belonging to more than one group, they were prioritized as follows: In patients with SARS-CoV-2 infection, the modified ECMM/ISHAM 2020 consensus was always applied. In patients without SARS-CoV-2 infection, the EORTC/MSG criteria were taken into account first, then the AspICU criteria and finally the Bulpa criteria.
A separate analysis was performed according to IPA. PPP-IPA integrated the diagnoses of proven, probable/putative, and possible IPA, regardless of the criteria used; in this case, the remaining patients included in the series were considered colonized. PP-IPA integrated only the diagnoses of proven and probable IPA; in this case, the diagnoses of possible IPA were analyzed together with the colonized patients.
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