J Clin Microbiol. 2020 Dec 4:JCM.02278-20. doi: 10.1128/JCM.02278-20. Online ahead of print.
The aim of this study was to describe the frequency of positive Aspergillus tests in COVID-19 patients and investigate the association between COVID-19 and a positive Aspergillus test result. We compared the proportion of positive Aspergillus tests in COVID-19 patients admitted to the ICU for > 24 hours with two control groups; patients with community acquired pneumonia with 1. a PCR confirmed influenza infection (considered as ‘positive’ control since the link between influenza and invasive aspergillosis has been established), and 2. Streptococcus pneumoniae pneumonia (in whom positive Aspergillus tests are mostly considered as colonisation). During the study period, 92 COVID-19 patients (mean age (SD) 62(14) years, 76.1% males), 48 influenza (55(14), 56.2% males), and 65 pneumococcal pneumonia (58 (15), 63,1% males) patients were identified. Any positive Aspergillus test from any respiratory sample was found in 10.9% of the COVID-19 patients, 6.2% of the patients with pneumococcal pneumonia and 22.9% of those infected with influenza. A positive culture or PCR or galactomannan test on bronchoalveolar lavage fluid (BAL) only was found in 5.4% of COVID-19 patients, which was lower than in patients with influenza (18.8%) and comparable to pneumococcal pneumonia group (4.6%). Using logistic regression analysis, the odds ratio, OR (95% CI) for a positive Aspergillus test on BAL fluid for COVID19 patients was 1.2 (0.3 to 5.1, p=0.8) compared to the pneumococcal pneumonia group while it was 0.2 (0.1 to 0.8, p=0.02) compared with influenza group. This difference remained significant when corrected for age and sex. In conclusion, in COVID19 patients, the prevalence of a positive aspergillus test was comparable to patients with admitted for pneumococcal pneumonia but substantially lower than what we observed in patients with influenza.