AUTHOR=Ghazanfari Mona , Arastehfar Amir , Davoodi Lotfollah , Yazdani Charati Jamshid , Moazeni Maryam , Abastabar Mahdi , Haghani Iman , Mirzakhani Roghayeh , Mayahi Sabah , Fang Wenjie , Liao Wanqing , Nguyen M. Hong , Perlin David S. , Hoenigl Martin , Pan Weihua , Hedayati Mohammad T. 

TITLE=Pervasive but Neglected: A Perspective on COVID-19-Associated Pulmonary Mold Infections Among Mechanically Ventilated COVID-19 Patients

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.649675

DOI=10.3389/fmed.2021.649675

ISSN=2296-858X

ABSTRACT=Background: Recent studies from multiple countries have shown a high prevalence of COVID-19 associated pulmonary aspergillosis (CAPA) among severely ill patients. Despite providing valuable insight into the clinical management of CAPA, large-scale prospective studies are limited. Here we report on one of the largest multicenter epidemiological studies to explore the clinical features and prevalence of COVID-19 associated pulmonary mold infections (CAPMI) among mechanically ventilated patients. 
Methods: Bronchoalveolar lavage (BAL) and serum samples were collected for culture, galactomannan, and beta-D-glucan testing. Patients were classified as probable CAPMI based on the presence of host factors, radiological findings and mycological criteria. 
Results: During the study period, 302 COVID-19 patients were admitted to ICUs, among whom 105 were mechanically ventilated for ≥4 days. Probable CAPMI was observed among 38% of patients (40/105), among whom BAL culture of 29 patients turned positive for molds, while galactomannan testing on BAL (GM index ≥ 1) and serum (GM index >0.5) samples were positive for 60% (24/40) and 37.5% (15/39) of patients, respectively. Aspergillus (22/29; 75.8%) and Fusarium (6/29; 20.6%) constituted 96.5% of the molds isolated. Diaporthe foeniculina was isolated from a COVID-19 patient. None of the patients presented with CAPMI were treated with antifungal drugs. 
Conclusion: Despite being a prevalent, the absence of appropriate antifungal treatment highlights that CAPMI is a neglected complication among mechanically ventilated COVID-19 patients admitted to intensive care units. CAPMI can be caused by species other than Aspergillus.