{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:27:52Z","timestamp":1791678472834,"version":"4.3.4"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,3,16]],"date-time":"2021-03-16T00:00:00Z","timestamp":1615852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:label\/>\n                  <jats:p>Invasive pulmonary aspergillosis (IPA) is a severe infection caused by aspergillus sp. that usually develops in patients with severe immunosuppression. IPA has been recently described in critically ill COVID-19 patients (termed as COVID-associated pulmonary aspergillosis, or CAPA) that are otherwise immunocompetent. In order to describe the characteristics of patients with CAPA, we conducted a retrospective cohort study in a tertiary care center in Mexico City. We included all patients with confirmed COVID-19 admitted to the intensive care unit that had serum or bronchoalveolar lavage galactomannan measurements. We used the criteria proposed by Koehler et al. to establish the diagnosis of CAPA. Main outcomes were the need for invasive mechanical ventilation (IMV) and in-hospital mortality. Out of a total of 83 hospitalized patients with COVID-19 in the ICU, 16 (19.3%) met the criteria for CAPA. All patients diagnosed with CAPA required IMV whereas only 84% of the patients in the non-IPA group needed this intervention (P = 0.09). In the IPA group, 31% (n = 5) of the patients died, compared to 13% (n = 9) in the non-CAPA group (P = 0.08). We conclude that CAPA is a frequent co-infection in critically ill COVID-19 patients and is associated with a high mortality rate. The timely diagnosis and treatment of IPA in these patients is likely to improve their outcome.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Lay Summary<\/jats:title>\n                  <jats:p>We studied the characteristics of patients with COVID-19-associated invasive pulmonary aspergillosis (CAPA). Patients with CAPA tended to need invasive mechanical ventilation more frequently and to have a higher mortality rate. Adequate resources for its management can improve their outcome<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/mmy\/myab009","type":"journal-article","created":{"date-parts":[[2021,3,4]],"date-time":"2021-03-04T20:11:02Z","timestamp":1614888662000},"page":"828-833","source":"Crossref","is-referenced-by-count":34,"title":["COVID-19-associated invasive pulmonary aspergillosis in a tertiary care center in Mexico City"],"prefix":"10.1093","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7834-4917","authenticated-orcid":false,"given":"Mariana","family":"V\u00e9lez Pintado","sequence":"first","affiliation":[{"name":"Department of Medicine, Centro M\u00e9dico ABC, Mexico City, Mexico. Sur 136 No. 116, Col. Las Am\u00e9ricas, \u00c1lvaro Obreg\u00f3n, 01120"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0957-9509","authenticated-orcid":false,"given":"Antonio","family":"Camiro-Z\u00fa\u00f1iga","sequence":"additional","affiliation":[{"name":"Department of Medicine, Centro M\u00e9dico ABC, Mexico City, Mexico. Sur 136 No. 116, Col. Las Am\u00e9ricas, \u00c1lvaro Obreg\u00f3n, 01120"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3522-8406","authenticated-orcid":false,"given":"Mercedes","family":"Aguilar Soto","sequence":"additional","affiliation":[{"name":"Department of Medicine, Centro M\u00e9dico ABC, Mexico City, Mexico. Sur 136 No. 116, Col. Las Am\u00e9ricas, \u00c1lvaro Obreg\u00f3n, 01120"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9961-4667","authenticated-orcid":false,"given":"Dalia","family":"Cuenca","sequence":"additional","affiliation":[{"name":"Department of Medicine, Centro M\u00e9dico ABC, Mexico City, Mexico. Sur 136 No. 116, Col. Las Am\u00e9ricas, \u00c1lvaro Obreg\u00f3n, 01120"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4748-9734","authenticated-orcid":false,"given":"Mois\u00e9s","family":"Mercado","sequence":"additional","affiliation":[{"name":"Research Unit in Endocrine Diseases, Hospital de Especialidades, Centro M\u00e9dico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City. Av. Cuauht\u00e9moc 330, Doctores, Cuauht\u00e9moc, 06720"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2587-1123","authenticated-orcid":false,"given":"Brenda","family":"Crabtree-Ramirez","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n Salvador Zubir\u00e1n, Vasco de Quiroga 15, Belisario Dom\u00ednguez Secc 16, Tlalpan, 14080 Ciudad de M\u00e9xico, CDMX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the ARMII study gruop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,3,16]]},"reference":[{"key":"2021080323595131800_bib1","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1056\/NEJMoa2001017","article-title":"A novel coronavirus from patients with pneumonia in China, 2019","volume":"382","author":"Zhu","year":"2020","journal-title":"N Engl J Med"},{"key":"2021080323595131800_bib2","volume-title":"Situation Report. Coronavirus Disease (COVID-19)","author":"WHO","year":"2020"},{"key":"2021080323595131800_bib3","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s40249-020-00646-x","article-title":"Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review","volume":"9","author":"Adhikari","year":"2020","journal-title":"Infect Dis Poverty"},{"key":"2021080323595131800_bib4","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.riam.2018.07.002","article-title":"Epidemiolog\u00eda de las micosis invasoras: un paisaje en continuo cambio","volume":"35","author":"Quind\u00f3s","year":"2018","journal-title":"Rev Iberoam Micol"},{"key":"2021080323595131800_bib5","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1128\/IAI.73.1.494-503.2005","article-title":"Differences in patterns of infection and inflammation for corticosteroid treatment and chemotherapy in experimental invasive pulmonary aspergillosis","volume":"73","author":"Balloy","year":"2005","journal-title":"Infect Immun."},{"key":"2021080323595131800_bib6","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1136\/thoraxjnl-2014-206291","article-title":"The clinical spectrum of pulmonary aspergillosis","volume":"70","author":"Kosmidis","year":"2015","journal-title":"Thorax"},{"key":"2021080323595131800_bib7","doi-asserted-by":"crossref","first-page":"1524","DOI":"10.1007\/s00134-020-06091-6","article-title":"Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion","volume":"46","author":"Verweij","year":"2020","journal-title":"Intensive Care Med"},{"key":"2021080323595131800_bib8","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.3201\/eid2607.201603","article-title":"Fatal invasive aspergillosis and coronavirus disease in an immunocompetent patient","volume":"26","author":"Blaize","year":"2020","journal-title":"Emerg Infect Dis"},{"key":"2021080323595131800_bib9","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1111\/myc.13096","article-title":"COVID-19 associated pulmonary aspergillosis","volume":"63","author":"Koehler","year":"2020","journal-title":"Mycoses"},{"key":"2021080323595131800_bib10","doi-asserted-by":"crossref","first-page":"105954","DOI":"10.1016\/j.ijantimicag.2020.105954","article-title":"Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality","volume":"55","author":"Zhang","year":"2020","journal-title":"Int J Antimicrob Agents"},{"key":"2021080323595131800_bib11","doi-asserted-by":"crossref","first-page":"104380","DOI":"10.1016\/j.jcv.2020.104380","article-title":"Supportive treatment with tocilizumab for COVID-19: a systematic review","volume":"127","author":"Alzghari","year":"2020","journal-title":"J Clin Virol"},{"key":"2021080323595131800_bib12","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.jcjo.2018.11.005","article-title":"Refractory giant cell arteritis on prednisone and tocilizumab: improvement with subsequent tuberculosis reactivation","volume":"54","author":"Kherani","year":"2019","journal-title":"Can J Ophthalmol"},{"key":"2021080323595131800_bib13","article-title":"Dexamethasone in hospitalized patients with Covid-19 - preliminary report","author":"RECOVERY Collaborative Group","year":"2020","journal-title":"N Engl J Med"},{"key":"2021080323595131800_bib14","doi-asserted-by":"crossref","first-page":"2475","DOI":"10.1099\/13500872-140-9-2475","article-title":"Hydrocortisone-enhanced growth of Aspergillus spp: implications for pathogenesis","volume":"140","author":"Ng","year":"1994","journal-title":"Microbiology"},{"key":"2021080323595131800_bib15","author":"Koehler","year":"2020","journal-title":"Lancet Infect Dis."},{"key":"2021080323595131800_bib16","doi-asserted-by":"crossref","first-page":"91","DOI":"10.3390\/jof6020091","article-title":"COVID-19 associated pulmonary aspergillosis (CAPA)-From immunology to treatment","volume":"6","author":"Arastehfar","year":"2020","journal-title":"J Fungi (Basel)"},{"key":"2021080323595131800_bib17","article-title":"COVID-19-associated pulmonary aspergillosis","author":"Salmanton-Garc\u00eda","journal-title":"Emerg Infect Dis."},{"key":"2021080323595131800_bib18","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1164\/rccm.202004-1038LE","article-title":"COVID-19-associated pulmonary aspergillosis","volume":"202","author":"van Arkel","year":"2020","journal-title":"Am J Respir Crit Care Med"},{"key":"2021080323595131800_bib19","doi-asserted-by":"crossref","first-page":"e48","DOI":"10.1016\/S2213-2600(20)30237-X","article-title":"Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19","volume":"8","author":"Alanio","year":"2020","journal-title":"Lancet Respir Med"},{"key":"2021080323595131800_bib20","first-page":"807","article-title":"Invasive pulmonary aspergillosis in patients with SARS-CoV-2 infection: A systematic review of the literature","volume-title":"Diagnostics (Basel)","author":"Apostolopoulou","year":"2020"},{"key":"2021080323595131800_bib21","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1111\/myc.12926","article-title":"Baseline predictors influencing the prognosis of invasive aspergillosis in adults","volume":"62","author":"Koehler","year":"2019","journal-title":"Mycoses"},{"key":"2021080323595131800_bib22","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1111\/myc.13135","article-title":"COVID-19-associated pulmonary aspergillosis (CAPA) in patients admitted with severe COVID-19 pneumonia: An observational study from Pakistan","volume":"63","author":"Nasir","year":"2020","journal-title":"Mycoses"},{"key":"2021080323595131800_bib23","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/QCO.0000000000000504","article-title":"Invasive pulmonary aspergillosis complicating severe influenza: epidemiology, diagnosis and treatment","volume":"31","author":"Vanderbeke","year":"2018","journal-title":"Curr Opin Infect Dis"},{"key":"2021080323595131800_bib24","doi-asserted-by":"crossref","first-page":"200038","DOI":"10.1183\/16000617.0038-2020","article-title":"Respiratory viral sepsis: epidemiology, pathophysiology, diagnosis and treatment","volume":"29","author":"Gu","year":"2020","journal-title":"Eur Respir Rev"},{"key":"2021080323595131800_bib25","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.jaci.2017.02.034","article-title":"IL-10 overexpression predisposes to invasive aspergillosis by suppressing antifungal immunity","volume":"140","author":"Cunha","year":"2017","journal-title":"J Allergy Clin Immunol"},{"key":"2021080323595131800_bib26","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1038\/nrmicro3231","article-title":"The co-pathogenesis of influenza viruses with bacteria in the lung","volume":"12","author":"McCullers","year":"2014","journal-title":"Nat Rev Microbiol"},{"key":"2021080323595131800_bib27","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/s13613-020-00686-4","article-title":"COVID-19-associated invasive pulmonary aspergillosis","volume":"10","author":"Rutsaert","year":"2020","journal-title":"Ann Intensive Care"},{"key":"2021080323595131800_bib28","doi-asserted-by":"crossref","first-page":"115","DOI":"10.3390\/jof6030115","article-title":"COVID-19 associated invasive pulmonary aspergillosis: diagnostic and therapeutic challenges","volume":"6","author":"Mohamed","year":"2020","journal-title":"J Fungi (Basel)"},{"key":"2021080323595131800_bib29","article-title":"Risk factors associated with Covid-19-associated pulmonary aspergillosis in ICU patients: a French multicentric retrospective cohort","author":"Delli\u00e8re","year":"2020","journal-title":"Clin Microbiol Infect."}],"container-title":["Medical Mycology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/mmy\/article-pdf\/59\/8\/828\/38982246\/myab009.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/mmy\/article-pdf\/59\/8\/828\/38982246\/myab009.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T00:00:20Z","timestamp":1628035220000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mmy\/article\/59\/8\/828\/6174029"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,16]]},"references-count":29,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,3,16]]},"published-print":{"date-parts":[[2021,7,14]]}},"URL":"https:\/\/doi.org\/10.1093\/mmy\/myab009","relation":{},"ISSN":["1369-3786","1460-2709"],"issn-type":[{"value":"1369-3786","type":"print"},{"value":"1460-2709","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,8]]},"published":{"date-parts":[[2021,3,16]]}}}