Pervasive but Neglected: A Perspective on COVID-19-Associated Pulmonary Mold Infections Among Mechanically Ventilated COVID-19 Patients

Mona Ghazanfari, Amir Arastehfar, Lotfollah Davoodi, Jamshid Yazdani Charati, Maryam Moazeni, Mahdi Abastabar, Iman Haghani, Roghayeh Mirzakhani, Sabah Mayahi, Wenjie Fang, Wanqing Liao, M. Hong Nguyen, David S. Perlin, Martin Hoenigl, Weihua Pan, Mohammad T. Hedayati

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Recent studies from multiple countries have shown a high prevalence of coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) among severely ill patients. Despite providing valuable insight into the clinical management of CAPA, large-scale prospective studies are limited. Here, we report on one of the largest multicenter epidemiological studies to explore the clinical features and prevalence of COVID-19-associated pulmonary mold infections (CAPMIs) among mechanically ventilated patients. Methods: Bronchoalveolar lavage (BAL) and serum samples were collected for culture, galactomannan (GM), and β-D-glucan (BDG) testing. Patients were classified as probable CAPMI based on the presence of host factors, radiological findings, and mycological criteria. Results: During the study period, 302 COVID-19 patients were admitted to intensive care units (ICUs), among whom 105 were mechanically ventilated for ≥4 days. Probable CAPMI was observed among 38% of patients (40/105), among whom BAL culture of 29 patients turned positive for molds, while galactomannan testing on BAL (GM index ≥1) and serum (GM index >0.5) samples were positive for 60% (24/40) and 37.5% (15/39) of patients, respectively. Aspergillus (22/29; 75.8%) and Fusarium (6/29; 20.6%) constituted 96.5% of the molds isolated. Diaporthe foeniculina was isolated from a COVID-19 patient. None of the patients who presented with CAPMI were treated with antifungal drugs. Conclusion: Despite being prevalent, the absence of appropriate antifungal treatment highlights that CAPMI is a neglected complication among mechanically ventilated COVID-19 patients admitted to ICUs. CAPMI can be caused by species other than Aspergillus.

Original languageEnglish (US)
Article number649675
JournalFrontiers in Medicine
StatePublished - Jun 14 2021
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Medicine(all)


  • Aspergillus
  • COVID-19-associated pulmonary mold infections
  • Fusarium
  • galactomannan
  • mechanically ventilation


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