{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T23:08:04Z","timestamp":1772060884474,"version":"3.50.1"},"reference-count":26,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T00:00:00Z","timestamp":1622592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Several reports have been published on Aspergillus findings in COVID-19 patients leading to a proposition of new disease entity COVID-19-associated pulmonary aspergillosis. This scoping review is designed at clarifying the concepts on how the findings of Aspergillus spp. in COVID-19 patients were interpreted. We searched Medline to identify the studies on Aspergillus spp. findings in COVID-19 patients. Included were observational studies containing the following information: explicit mention of the total number of the study population, study period, reason for obtaining respiratory samples, case definition, and clinical outcomes. Excluded were case series, case reports and reviews. Identified were 123 publications, and 8 observational studies were included. From the included studies the following issues were identified. The proportion of immunocompromised patients considered as host factors varied from 0 to 17%. Most of the studies did not mention radiographic findings explicitly. Respiratory samples were mostly obtained to investigate clinical deterioration. Aspergillus culture, antigen or PCR testing on bronchoalveolar lavage (BAL) fluid were performed in between 23.3% and 66.3% of the study population. Two studies performed periodic samples of BAL. Galactomannan index (GI) positivity in BAL was between 10% and 28%. GI in blood was found in 0.9% to 6.7% of the available samples. The prevalence of COVID-19-associated pulmonary aspergillosis ranged from 2.7% to 27.7%. Studies compared the mortality between defined cases and non-cases, and all showed increased mortality in cases. No studies showed that antifungal treatment reduced mortality. Concluding, this review showed how studies defined the clinical entity COVID-19-associated pulmonary aspergillosis where positive Aspergillus test in the respiratory sample was the main driver for the diagnosis. There were many differences between studies in terms of test algorithm and Aspergillus test used that largely determined the prevalence. Whether antifungal therapy, either as prophylaxis, pre-emptive or targeted therapy will lead to better outcomes of COVID-19-associated pulmonary aspergillosis patients is still need to be answered.<\/jats:p>","DOI":"10.3390\/jcm10112469","type":"journal-article","created":{"date-parts":[[2021,6,2]],"date-time":"2021-06-02T10:38:39Z","timestamp":1622630319000},"page":"2469","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Aspergillus in Critically Ill COVID-19 Patients: A Scoping Review"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4779-2191","authenticated-orcid":false,"given":"Erlangga","family":"Yusuf","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology and Infectious Disease, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonard","family":"Seghers","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rogier A. S.","family":"Hoek","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes P. C.","family":"van den Akker","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lonneke G. M.","family":"Bode","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Disease, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bart J. A.","family":"Rijnders","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Infectious Disease, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands"},{"name":"Department of Internal Medicine, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1086\/318483","article-title":"Aspergillosis case-fatality rate: Systematic review of the literature","volume":"32","author":"Lin","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_2","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":"ref_3","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jmii.2020.09.004","article-title":"COVID-19 associated with pulmonary aspergillosis: A literature review","volume":"54","author":"Lai","year":"2021","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Apostolopoulou, A., Garrigos, Z.E., Vijayvargiya, P., Lerner, A.H., and Farmakiotis, D. (2020). Invasive pulmonary aspergillosis in patients with SARS-CoV-2 infection: A systematic review of the literature. Diagnostics, 10.","DOI":"10.3390\/diagnostics10100807"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12874-018-0611-x","article-title":"Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach","volume":"18","author":"Munn","year":"2018","journal-title":"BMC Med. Res. Methodol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Chong, W.H., and Neu, K.P. (2021). The Incidence, Diagnosis, and Outcomes of COVID-19-associated Pulmonary Aspergillosis (CAPA): A Systematic Review. J. Hosp. Infect.","DOI":"10.1016\/j.jhin.2021.04.012"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Mitaka, H., Kuno, T., Takagi, H., and Patrawalla, P. (2021). Incidence and mortality of COVID-19-associated pulmonary aspergillosis: A systematic review and meta-analysis. Mycoses.","DOI":"10.26226\/morressier.60780408dc2fa1af562468ce"},{"key":"ref_8","unstructured":"Wells, G., Shea, B., O\u2019Connell, D., Robertson, J., Peterson, J., Welch, V., Losos, M., and Tugwell, P. (2021, March 22). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality if Nonrandomized Studies in Meta-Analyses. Available online: http\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Gangneux, J.P., Reizine, F., Guegan, H., Pinceaux, K., Le Balch, P., Prat, E., Pelletier, R., Belaz, S., Le Souhaitier, M., and Le Tulzo, Y. (2020). Is the covid-19 pandemic a good time to include Aspergillus molecular detection to categorize aspergillosis in icu patients? A monocentric experience. J. Fungi, 6.","DOI":"10.3390\/jof6030105"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13054-020-03417-0","article-title":"Risks of ventilator-associated pneumonia and invasive pulmonary aspergillosis in patients with viral acute respiratory distress syndrome related or not to Coronavirus 19 disease","volume":"24","author":"Razazi","year":"2020","journal-title":"Crit. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1164\/rccm.202009-3400OC","article-title":"Occurrence of Invasive Pulmonary Fungal Infections in Patients with Severe COVID-19 Admitted to the ICU","volume":"203","author":"Fekkar","year":"2021","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Bartoletti, M., Pascale, R., Cricca, M., Rinaldi, M., Maccaro, A., Bussini, L., Fornaro, G., Tonetti, T., Pizzilli, G., and Francalanci, E. (2020). Epidemiology of Invasive Pulmonary Aspergillosis Among Intubated Patients with COVID-19: A Prospective Study. Clin. Infect. Dis.","DOI":"10.1093\/cid\/ciaa1065"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1111\/myc.13219","article-title":"Prevalence of opportunistic invasive aspergillosis in COVID-19 patients with severe pneumonia","volume":"64","author":"Carrillo","year":"2021","journal-title":"Mycoses"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"White, P.L., Dhillon, R., Cordey, A., Hughes, H., Faggian, F., Soni, S., Pandey, M., Whitaker, H., May, A., and Morgan, M. (2020). A National Strategy to Diagnose Coronavirus Disease 2019\u2014Associated Invasive Fungal Disease in the Intensive Care Unit. Clin. Infect. Dis.","DOI":"10.1093\/cid\/ciaa1298"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"790.e1","DOI":"10.1016\/j.cmi.2020.12.005","article-title":"Risk factors associated with COVID-19-associated pulmonary aspergillosis in ICU patients: A French multicentric retrospective cohort","volume":"27","author":"Dudoignon","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"101122","DOI":"10.1016\/j.mycmed.2021.101122","article-title":"Invasive pulmonary aspergillosis in COVID-19 critically ill patients: Results of a French monocentric cohort","volume":"31","author":"Versyck","year":"2021","journal-title":"J. Med. Mycol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/S2213-2600(18)30274-1","article-title":"Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: A retrospective cohort study","volume":"6","author":"Schauwvlieghe","year":"2018","journal-title":"Lancet Respir. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and update of the consensus definitions of invasive fungal disease from the european organization for research and treatment of cancer and the mycoses study group education and research consortium","volume":"71","author":"Chen","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_19","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":"ref_20","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1164\/rccm.201111-1978OC","article-title":"A Clinical Algorithm to Diagnose Invasive Pulmonary Aspergillosis in Critically Ill Patients","volume":"186","author":"Blot","year":"2012","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Koehler, P., Bassetti, M., Chakrabarti, A., Chen, S.C.A., Colombo, A.L., Hoenigl, M., Klimko, N., Lass-Fl\u00f6rl, C., Oladele, R.O., and Vinh, D.C. (2020). Defining and managing COVID-19-associated pulmonary aspergillosis: The 2020 ECMM\/ISHAM consensus criteria for research and clinical guidance. Lancet Infect. Dis.","DOI":"10.1016\/S1473-3099(20)30847-1"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1164\/rccm.201001-0094OC","article-title":"Nosocomial Pneumonia in the Intensive Care Unit Acquired by Mechanically Ventilated versus Nonventilated Patients","volume":"182","author":"Esperatti","year":"2010","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.jcrc.2020.07.002","article-title":"Late histopathologic characteristics of critically ill COVID-19 patients: Different phenotypes without evidence of invasive aspergillosis, a case series","volume":"59","author":"Flikweert","year":"2020","journal-title":"J. Crit. Care"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Boyd, S., and Martin-Loeches, I. (2021). Rates of Aspergillus Co-infection in COVID patients in ICU not as high as previously reported. Clin. Infect. Dis.","DOI":"10.1093\/cid\/ciab008"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Yusuf, E., Vonk, A., Van Den Akker, J.P.C., Bode, L., Sips, G.J., Rijnders, B.J.A., De Steenwinkel, J., Verkaik, N.J., Vogel, M., and Van Der Eerden, M. (2020). Frequency of Positive Aspergillus Tests in COVID-19 Patients in Comparison to Other Patients with Pulmonary Infections Admitted to the ICU. J. Clin. Microbiol., 59.","DOI":"10.1128\/JCM.02278-20"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.3201\/eid2704.204895","article-title":"COVID-19\u2014Associated Pulmonary Aspergillosis, March\u2013August 2020","volume":"27","author":"Sprute","year":"2021","journal-title":"Emerg. Infect. Dis."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/11\/2469\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:10:12Z","timestamp":1760163012000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/11\/2469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,2]]},"references-count":26,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,6]]}},"alternative-id":["jcm10112469"],"URL":"https:\/\/doi.org\/10.3390\/jcm10112469","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,2]]}}}