부산대학교 도서관

Acute respiratory distress syndrome (ARDS) is a major complication of coronavirus disease 2019 (COVID-19). Patients presenting with ARDS can rapidly develop invasive pulmonary aspergillosis. Reports of COVID-19-associated pulmonary aspergillosis (CAPA) have raised concerns about it worsening the COVID-19 disease course and increasing mortality rates. Immune dysregulation and epithelial lung damage arising from COVID-19 immunopathology are likely predisposing mechanisms for CAPA. This article introduces the prevalence and incidence of CAPA and its associated risk factors. The diagnosis of CAPA remains challenging, mainly because the bronchoalveolar lavage fluid galactomannan test, culture, and polymerase chain reaction are the most sensitive diagnostic tests for aspergillosis. However, because of the risk of disease transmission, bronchoscopies are rarely performed for patients with COVID-19. We discuss the definition of CAPA provided by the European Organization for the Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium. Finally, voriconazole and isavuconazole are the first-line treatment choices for possible, probable, and proven CAPA cases. However, drug-drug interactions associated with broad-spectrum azoles require consideration. Antifungal prophylaxis was associated with a significantly reduced CAPA incidence, but this did not translate into improved survival rates. Therefore, further randomized controlled trials are warranted.