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Comparison of influenza- and COVID-19-associated pulmonary aspergillosis in China

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Abstract

Purpose

We conducted a monocentric retrospective study using the latest definitions to compare the demographic, clinical, and biological characteristics of influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA).

Methods

The study retrospectively enrolled 180 patients, including 70 influenza/IPA patients (with positive influenza A/B and Aspergillus) and 110 COVID-19/IPA patients (with positive SARS-CoV-2 and Aspergillus). Among them, 42 (60%) and 30 (27.3%) patients fulfilled the definitions of IAPA and CAPA, respectively.

Results

The CAPA patients had significantly higher in-hospital mortality (13/31, 41.9%) than IAPA patients (8/42, 19%) with a P-value of 0.033. Kaplan–Meier survival curve also showed significantly higher 30-day mortality for CAPA patients (P = 0.025). Additionally, the CAPA patients were older, though insignificantly, than IAPA patients (70 (60–80) vs. 62 (52–72), P = 0.075). A lower percentage of chronic pulmonary disease (12.9 vs. 40.5%, P = 0.01) but higher corticosteroids use 7 days before and after ICU admission (22.6% vs. 0%, P = 0.002) were found in CAPA patients. Notably, there were no significant differences in the percentage of ICU admission or ICU mortality between the two groups. In addition, the time from observation to Aspergillus diagnosis was significantly longer in CAPA patients than in IAPA patients (7 (2–13) vs. 0 (0–4.5), P = 0.048).

Conclusion

Patients infected with SARS-CoV-2 and Aspergillus during the concentrated outbreak of COVID-19 in China had generally higher in-hospital mortality but a lower percentage of chronic pulmonary disease than those infected with influenza and Aspergillus. For influenza-infected patients who require hospitalization, close attention should be paid to the risk of invasive aspergillosis upfront.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to individual privacy but are available from the corresponding author on reasonable request.

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Funding

This work was founded by the Chinese Academy of Medical Sciences (CAMS) Innovation Fund for Medical Sciences (CIFMS 2021-I2M-1-048).

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Author notes

  1. Jiankang Zhao and Xianxia Zhuo contributed equally to this work.

Authors and Affiliations

  1. National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China

    Jiankang Zhao, Xianxia Zhuo, Danni Pu, Guohui Fan, Binghuai Lu & Bin Cao

  2. Department of Respiratory Medicine, Capital Medical University, Beijing, China

    Xianxia Zhuo & Bin Cao

  3. Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China

    Danni Pu, Binghuai Lu & Bin Cao

  4. Tsinghua University-Peking University Joint Center for Life Sciences, Beijing, China

    Bin Cao

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  1. Jiankang Zhao
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  4. Guohui Fan
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Contributions

BC and BL contributed to the study conception and design. Material preparation, data collection, and analysis were performed by JZ, XZ, and DP. The first draft of the manuscript was written by JZ. JZ, XZ, BL, and BC commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Binghuai Lu or Bin Cao.

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The study was performed in line with the principles of the Ethics Committee of China-Japan Friendship Hospital (2022-KY-052).

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Zhao, J., Zhuo, X., Pu, D. et al. Comparison of influenza- and COVID-19-associated pulmonary aspergillosis in China. Eur J Clin Microbiol Infect Dis 43, 683–692 (2024). https://doi.org/10.1007/s10096-024-04772-4

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