{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:16:39Z","timestamp":1790741799551,"version":"4.1.0"},"reference-count":39,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,5]],"date-time":"2023-01-05T00:00:00Z","timestamp":1672876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) has emerged as an important complication among patients with acute respiratory failure due to SARS-CoV-2 infection. Almost 2.5 years since the start of the COVID-19 pandemic, it continues to raise concerns as an extra factor that contributes to increased mortality, which is mostly because its diagnosis and management remain challenging. The present study utilises the cases of forty-three patients hospitalised between August 2020 and February 2022 whose information was gathered from ten ICUs and special care units based in northern Greece. The main aim was to describe the gained experience in diagnosing CAPA, according to the implementation of the main existing diagnostic consensus criteria and definitions, and present the different classification of the clinical cases due to the alternative algorithms.<\/jats:p>","DOI":"10.3390\/jof9010081","type":"journal-article","created":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T03:19:54Z","timestamp":1672975194000},"page":"81","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["COVID-19-Associated Pulmonary Aspergillosis (CAPA) in Northern Greece during 2020\u20132022: A Comparative Study According to the Main Consensus Criteria and Definitions"],"prefix":"10.3390","volume":"9","author":[{"given":"Panagiotis","family":"Siasios","sequence":"first","affiliation":[{"name":"Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kostoula","family":"Arvaniti","sequence":"additional","affiliation":[{"name":"ICU, \u201cPapageorgiou\u201d General Hospital of Thessaloniki, 56403 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia","family":"Zachrou","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Poulopoulou","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pinelopi","family":"Pisanidou","sequence":"additional","affiliation":[{"name":"ICU, \u201cPapageorgiou\u201d General Hospital of Thessaloniki, 56403 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Vasileiadou","sequence":"additional","affiliation":[{"name":"First ICU, \u201cG. Papanikolaou\u201d General Hospital of Thessaloniki, 57010 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2081-0337","authenticated-orcid":false,"given":"Evangelos","family":"Kaimakamis","sequence":"additional","affiliation":[{"name":"First ICU, \u201cG. Papanikolaou\u201d General Hospital of Thessaloniki, 57010 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athina","family":"Georgopoulou","sequence":"additional","affiliation":[{"name":"First ICU, \u201cG. Papanikolaou\u201d General Hospital of Thessaloniki, 57010 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Foteini","family":"Renta","sequence":"additional","affiliation":[{"name":"ICU, \u201cG. Gennimatas\u201d General Hospital of Thessaloniki, 54635 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Lathyris","sequence":"additional","affiliation":[{"name":"ICU, \u201cG. Gennimatas\u201d General Hospital of Thessaloniki, 54635 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Foteini","family":"Veroniki","sequence":"additional","affiliation":[{"name":"First ICU, \u201cAHEPA\u201d University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Geka","sequence":"additional","affiliation":[{"name":"First ICU, \u201cAHEPA\u201d University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioanna","family":"Soultati","sequence":"additional","affiliation":[{"name":"Second ICU, \u201cAHEPA\u201d University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Argiriadou","sequence":"additional","affiliation":[{"name":"Second ICU, \u201cAHEPA\u201d University General Hospital of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Apostolidou","sequence":"additional","affiliation":[{"name":"ICU, \u201cBodossakio\u201d General Hospital of Ptolemaida, 50200 Ptolemaida, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pinelopi","family":"Amoiridou","sequence":"additional","affiliation":[{"name":"ICU, \u201cBodossakio\u201d General Hospital of Ptolemaida, 50200 Ptolemaida, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Ioannou","sequence":"additional","affiliation":[{"name":"ICU, \u201cBodossakio\u201d General Hospital of Ptolemaida, 50200 Ptolemaida, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonidas","family":"Kouras","sequence":"additional","affiliation":[{"name":"ICU, \u201cMamatsio\u201d General Hospital of Kozani, 50100 Kozani, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioanna","family":"Mimitou","sequence":"additional","affiliation":[{"name":"ICU, \u201cMamatsio\u201d General Hospital of Kozani, 50100 Kozani, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Stokkos","sequence":"additional","affiliation":[{"name":"ICU, \u201cMamatsio\u201d General Hospital of Kozani, 50100 Kozani, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elliniki","family":"Flioni","sequence":"additional","affiliation":[{"name":"ICU, \u201cAgios Pavlos\u201d General Hospital of Thessaloniki, 55134 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelos","family":"Pertsas","sequence":"additional","affiliation":[{"name":"ICU, \u201cAgios Pavlos\u201d General Hospital of Thessaloniki, 55134 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Sileli","sequence":"additional","affiliation":[{"name":"Second ICU, \u201cG. Papanikolaou\u201d General Hospital of Thessaloniki, 57010 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Iasonidou","sequence":"additional","affiliation":[{"name":"Second ICU, \u201cG. Papanikolaou\u201d General Hospital of Thessaloniki, 57010 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evdokia","family":"Sourla","sequence":"additional","affiliation":[{"name":"Respiratory Failure Unit, \u201cG. Papanikolaou\u201d General Hospital of Thessaloniki, 57010 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7426-0890","authenticated-orcid":false,"given":"Georgia","family":"Pitsiou","sequence":"additional","affiliation":[{"name":"Respiratory Failure Unit, \u201cG. Papanikolaou\u201d General Hospital of Thessaloniki, 57010 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2915-6098","authenticated-orcid":false,"given":"Timoleon-Achilleas","family":"Vyzantiadis","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Arastehfar, A., Carvalho, A., Van De Veerdonk, F.L., Jenks, J.D., Koehler, P., Krause, R., Cornely, O.A., Perlin, D.S., Lass-Fl\u00f6rl, C., and Hoenigl, M. (2020). COVID-19 Associated Pulmonary Aspergillosis (CAPA)\u2014From Immunology to Treatment. J. Fungi, 6.","DOI":"10.3390\/jof6020091"},{"key":"ref_2","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_3","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.3201\/eid2704.204895","article-title":"COVID-19\u2013Associated Pulmonary Aspergillosis, March\u2013August 2020","volume":"27","author":"Sprute","year":"2021","journal-title":"Emerg. Infect. Dis."},{"key":"ref_4","first-page":"A4011","article-title":"Invasive Pulmonary Aspergillosis Due to Aspergillus Niger and COVID-19 Pneumonia","volume":"203","author":"Shyu","year":"2021","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1007\/s00134-021-06449-4","article-title":"Taskforce report on the diagnosis and clinical management of COVID-19 associated pulmonary aspergillosis","volume":"47","author":"Verweij","year":"2021","journal-title":"Intensiv. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1111\/myc.12881","article-title":"Point-of-care diagnosis of invasive aspergillosis in non-neutropenic patients: Aspergillus Galactomannan Lateral Flow Assay versus Aspergillus-specific Lateral Flow Device test in bronchoalveolar lavage","volume":"62","author":"Jenks","year":"2019","journal-title":"Mycoses"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e149","DOI":"10.1016\/S1473-3099(20)30847-1","article-title":"Defining and managing COVID-19-associated pulmonary aspergillosis: The 2020 ECMM\/ISHAM consensus criteria for research and clinical guidance","volume":"21","author":"Koehler","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1230","DOI":"10.1016\/j.cmi.2021.02.005","article-title":"Serology anno 2021\u2014Fungal infections: From invasive to chronic","volume":"27","author":"Samardzic","year":"2021","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1086\/588660","article-title":"Revised Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer\/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC\/MSG) Consensus Group","volume":"46","author":"Walsh","year":"2008","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","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":"Donnelly","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_11","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_12","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_13","unstructured":"(2022, May 17). Available online: https:\/\/www.worldometers.info\/coronavirus\/country\/greece\/."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e53","DOI":"10.1016\/S2666-5247(20)30027-6","article-title":"Diagnosing COVID-19-associated pulmonary aspergillosis","volume":"1","author":"Verweij","year":"2020","journal-title":"Lancet Microbe"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e1634","DOI":"10.1093\/cid\/ciaa1298","article-title":"A National Strategy to Diagnose Coronavirus Disease 2019\u2013Associated Invasive Fungal Disease in the Intensive Care Unit","volume":"73","author":"White","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"102816","DOI":"10.1016\/j.amsu.2021.102816","article-title":"Lymphopenia in COVID-19: A single center retrospective study of 589 cases","volume":"69","author":"Ghizlane","year":"2021","journal-title":"Ann. Med. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.imlet.2020.06.013","article-title":"Lymphopenia during the COVID-19 infection: What it shows and what can be learned","volume":"225","author":"Tavakolpour","year":"2020","journal-title":"Immunol. Lett."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1038\/s41392-020-00243-2","article-title":"COVID-19: Immunopathogenesis and Immunotherapeutics","volume":"5","author":"Yang","year":"2020","journal-title":"Signal Transduct. Target. Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e00138-19","DOI":"10.1128\/AAC.00138-19","article-title":"Candida in the Respiratory Tract Potentially Triggers Galactomannan Positivity in Nonhematological Patients","volume":"63","author":"Aigner","year":"2019","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.cmi.2018.01.002","article-title":"Diagnosis and management of Aspergillus diseases: Executive summary of the 2017 ESCMID-ECMM-ERS guideline","volume":"24","author":"Ullmann","year":"2018","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"m2980","DOI":"10.1136\/bmj.m2980","article-title":"Drug treatments for COVID-19: Living systematic review and network meta-analysis","volume":"370","author":"Siemieniuk","year":"2020","journal-title":"BMJ"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.mmcr.2020.05.001","article-title":"Invasive pulmonary aspergillosis complicating COVID-19 in the ICU\u2014A case report","volume":"31","author":"Prattes","year":"2020","journal-title":"Med Mycol. Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/S1473-3099(20)30200-0","article-title":"Clinical and virological data of the first cases of COVID-19 in Europe: A case series","volume":"20","author":"Lescure","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_24","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_25","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":"ref_26","doi-asserted-by":"crossref","first-page":"18","DOI":"10.3201\/eid2701.202896","article-title":"Aspergillosis Complicating Severe Coronavirus Disease","volume":"27","author":"Marr","year":"2021","journal-title":"Emerg. Infect. Dis."},{"key":"ref_27","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_28","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1111\/myc.13185","article-title":"Putative invasive pulmonary aspergillosis in critically ill patients with COVID-19: An observational study from New York City","volume":"63","author":"Mitaka","year":"2020","journal-title":"Mycoses"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1111\/myc.13155","article-title":"Isolation of Aspergillus spp. in respiratory samples of patients with COVID-19 in a Spanish Tertiary Care Hospital","volume":"63","author":"Maseda","year":"2020","journal-title":"Mycoses"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1086\/518852","article-title":"Invasive Aspergillosis in the Intensive Care Unit","volume":"45","author":"Meersseman","year":"2007","journal-title":"Clin. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1186\/s13054-016-1326-1","article-title":"Does galactomannan testing increase diagnostic accuracy for IPA in the ICU? A prospective observational study","volume":"20","author":"Schroeder","year":"2016","journal-title":"Crit. Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1164\/rccm.200704-606OC","article-title":"Galactomannan in bronchoalveolar lavage fluid: A tool for diagnosing aspergillosis in intensive care unit patients","volume":"177","author":"Meersseman","year":"2008","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_33","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":"ref_34","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.cmi.2021.08.014","article-title":"Risk factors and outcome of pulmonary aspergillosis in critically ill coronavirus disease 2019 patients\u2014A multinational observational study by the European Confederation of Medical Mycology","volume":"28","author":"Prattes","year":"2022","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Gregoire, E., Pirotte, B.F., Moerman, F., Altdorfer, A., Gaspard, L., Firre, E., Moonen, M., Fraipont, V., Ernst, M., and Darcis, G. (2021). Incidence and Risk Factors of COVID-19-Associated Pulmonary Aspergillosis in Intensive Care Unit\u2014A Monocentric Retrospective Observational Study. Pathogens, 10.","DOI":"10.3390\/pathogens10111370"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Marta, G.-C., Lorena, F.-E., Laura, M.-V., Angela, L.-M., Blanca, L.-G., Rodrigo, A.-A., Marta, S.-G., Santiago, M.-G., Liliana, P.-M., and Luisa, S.-N.M. (2022). COVID-19-Associated Pulmonary Aspergillosis in a Tertiary Hospital. J. Fungi, 8.","DOI":"10.3390\/jof8020097"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e1645","DOI":"10.1093\/cid\/ciaa1342","article-title":"Invasive Fungal Disease Complicating Coronavirus Disease 2019: When It Rains, It Spores","volume":"73","author":"Hoenigl","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/S1473-3099(21)00066-9","article-title":"Diagnostic dilemma in COVID-19-associated pulmonary aspergillosis","volume":"21","author":"Jabeen","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/S1473-3099(21)00123-7","article-title":"Diagnostic dilemma in COVID-19-associated pulmonary aspergillosis\u2014Authors\u2019 reply","volume":"21","author":"Koehler","year":"2021","journal-title":"Lancet Infect. Dis."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/9\/1\/81\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:00:22Z","timestamp":1760119222000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/9\/1\/81"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,5]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["jof9010081"],"URL":"https:\/\/doi.org\/10.3390\/jof9010081","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,5]]}}}