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Diagnosis of probable\/proven viral-associated pulmonary aspergillosis (VAPA) was made based on the Intensive Care Medicine influenza-associated pulmonary aspergillosis and the European Confederation of Medical Mycology (ECMM) and the International Society for Human and Animal Mycology (ISHAM) COVID-19\u2013associated pulmonary aspergillosis consensus criteria. All respiratory tissues were independently reviewed by two experienced pathologists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>In the 44 patients of the autopsy-verified cohort, 6 proven influenza-associated and 6 proven COVID-19\u2013associated pulmonary aspergillosis diagnoses were identified. Fungal disease was identified as a missed diagnosis upon autopsy in 8% of proven cases (n\u2009=\u20091\/12), yet it was most frequently found as confirmation of a probable antemortem diagnosis (n\u2009=\u200911\/21, 52%) despite receiving antifungal treatment. Bronchoalveolar lavage galactomannan testing showed the highest sensitivity for VAPA diagnosis. Among both viral entities, an impeded fungal growth was the predominant histologic pattern of pulmonary aspergillosis. Fungal tracheobronchitis was histologically indistinguishable in influenza (n\u2009=\u20093) and COVID-19 (n\u2009=\u20093) cases, yet macroscopically more extensive at bronchoscopy in influenza setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A proven invasive pulmonary aspergillosis diagnosis was found regularly and with a similar histological pattern in influenza and in COVID-19 ICU case fatalities. Our findings highlight an important need for VAPA awareness, with an emphasis on mycological bronchoscopic work-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202208-1570oc","type":"journal-article","created":{"date-parts":[[2023,6,13]],"date-time":"2023-06-13T17:16:01Z","timestamp":1686676561000},"page":"301-311","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":50,"title":["A Pathology-based Case Series of Influenza- and COVID-19\u2013associated Pulmonary Aspergillosis: The Proof Is in the Tissue"],"prefix":"10.1093","volume":"208","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3364-1213","authenticated-orcid":false,"given":"Lore","family":"Vanderbeke","sequence":"first","affiliation":[{"name":"Department of Microbiology, Immunology, and Transplantation"},{"name":"Medical Intensive Care 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