8 July 2020

The Aspergillus fungus is found in the lungs of 20-30% of the COVID patients at the Intensive Care Unit (ICU). A parallel occurs with influenza patients at IC, who often develop a serious fungal infection. However, based on the first data, such a serious fungal infection seems to occur less frequently in COVID-patients, but alertness remains necessary, researchers of the Radboudumc write in The Lancet Microbe.
Patients who are admitted to the ICU with severe flu infections are also increasingly diagnosed with an infection of the fungus Aspergillus fumigatus. "This is a serious problem," says doctor-microbiologist Paul Verweij, theme Infectious diseases and global health. "Of every five flu patients in the ICU, one gets such a fungal infection. Such an infection is often very serious and associated with a high risk of death."


Research into the prevention of such fungal infections after influenza is therefore of great importance. In order to do this properly - also in an international context - a clear definition of this condition is essential and should be used by everyone. In an article in Intensive Care Medicine, six physicians from the Radboudumc, all associated with the Fungal Infections Expertise Centre, and (inter)national colleagues now present such a definition. They call the condition influenza-associated pulmonary aspergillosis, or IAPA for short.


Just before submitting the article, the new coronavirus that causes COVID-19 suddenly surfaced. Just like the flu, this is a serious respiratory tract infection. Although fungal infections were not immediately reported during the outbreak in China, this link was soon established in Europe. Verweij: "In several countries, including France and Germany, an infection with Aspergillus was also seen in 20 to 30 percent of COVID-19 patients. Therefore, we proposed at the same time a specific definition; CAPA, or COVID-19 associated pulmonary aspergillosis".

Definitions important

The importance of a good definition becomes clear when diagnosing the two different disorders. Internist Frank van de Veerdonk, theme Infectious diseases and global health: "Although Aspergillus can cause serious infections in ICU patients with influenza pneumonia, an Aspergillus infection appears to be different in COVID-19 patients. Based on our initial data, the symptoms of an Aspergillus infection appear to be different from those of influenza and the risk of actually developing invasive aspergillosis appears to be lower. Possibly, the fungus often resides in the lungs of COVID-19 patients in the ICU, but without leading to a serious fungal infection, an invasive aspergillosis".

Reliable test

This conclusion is not yet entirely certain. A lung wash (BAL) is the most reliable test to determine an infection with Aspergillus in COVID-19 patients. Because of the risks for patient and staff, this test is not commonly applied . If Aspergillus is found in material from the upper respiratory tract, such as sputum, still little is known about the situation deep in the lungs. "But it can also be the other way around," says clinical pharmacologist Roger Br├╝ggemann (theme Infectious diseases and global health) "that is that we find no evidence of an invasive infection in blood, but that the infection is present in the lungs. Especially in the beginning, the antimalarial agent (hydroxy)chloroquine was often used in the treatment of COVID patients. It may also inhibit fungal growth. This may reduce the sensitivity of the Aspergillus test in the blood, so there is a chance that we will find no evidence of an invasive fungal infection in the blood, while the infection is there."

More certainty

Because of the diagnostic uncertainty about whether or not invasive Aspergillus infection occurs, the preliminary advice is not to give COVID-19 patients standard prophylaxis (protection) against fungi. Verweij: "But if the clinical condition of the patient gives us cause to do so, we will do so. The aim remains to quickly obtain more certainty through national and international research. The IAPA and CAPA definitions now come in very handy in this search".

Flowchart of probable IAPA classification. (*)If hyphae consistent with Aspergillus are documented in a biopsy of an airway lesion AND Aspergillus is grown from sputum or a tracheal aspirate, the case fulfills the definition of proven IAPA

Related news items

Jong KNCV organizes a Pitch competition for PhD candidates

13 August 2020

Are you a PhD candidate and would you like to win 500 euros with a pitch about your research? Young KNCV gives you that chance! During the KNCV Chemistry 2020 Evening on October 8th.

read more

Collective invasion induced by autocrine purinergic loop through connexin-43 hemichannels

13 August 2020

Peter Friedl and Paul Span show in Journal of Cell Biology that breastcancer cells release purines into the extracellular space via connexin-43 hemichannels to control collective invasion.

read more

TP53 allelic state is critical for diagnostic and prognostic precision in blood cancer

12 August 2020

An international study, in which Joop Jansen participated, shows that a double mutaton in TP53 gene deteriotes the prognosis of a rare form of blood cancer. If there is only one mutation or no mutation, then the prognosis is better.

read more

BCG vaccine is safe with no increased risk of COVID-19 symptoms says Mihai Netea

11 August 2020

The BCG vaccine has a general stimulatory effect on the immune system and is therefore effective against multiple infectious diseases - possibly also against COVID-19.

read more

650,000 Euro funding for research into the phasing out of medication for leukaemia patients

30 July 2020

With a 650,000 euro funding from ZonMw, researchers from the Haematology and Pharmacy departments can develop a medication phasing out strategy for patients with chronic myeloid leukaemia. This strategy will be tested in practice.

read more

Increased role of patients after bowel cancer treatment

30 July 2020

Approximately 14,000 patients get colorectal cancer every year. Almost all patients are operated on and monitored afterwards (follow-up). In 2019 Radboudumc started a new approach to follow-up research after the treatment of stage II/III colorectal cancer.

read more