Is the COVID-19 Pandemic a Good Time to Include Aspergillus Molecular Detection to Categorize Aspergillosis in ICU Patients? A Monocentric Experience

J-P Gangneux (1, 2) , Florian Reizine (1) , Hélène Guegan (1, 2) , Kieran Pinceaux (1) , Pierre Le Balch (1) , Emilie Prat (1) , Romain Pelletier (1) , Sorya Belaz (1) , Mathieu Le Souhaitier (1) , Yves Le Tulzo (1) , Philippe Seguin (1) , Mathieu Lederlin (1) , Jean-Marc Tadié (1) , Florence Robert-Gangneux (1, 2)

1 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
2 Irset - Institut de recherche en santé, environnement et travail

Background The diagnosis of invasive aspergillosis (IA) in an intensive care unit (ICU)remains a challenge and the COVID-19 epidemic makes it even harder. Here, we evaluatedAspergillus PCR input to help classifying IA in SARS-CoV-2-infected patients.Methods 45COVID-19 patients were prospectively monitored twice weekly for Aspergillus markers and anti-Aspergillus serology. We evaluated the concordance between (Ι) Aspergillus PCR and culture inrespiratory samples, and (ΙΙ) blood PCR and serum galactomannan. Patients were classified asputative/proven/colonized using AspICU algorithm and two other methods.Results Theconcordance of techniques applied on respiratory and blood samples was moderate (kappa = 0.58and kappa = 0.63, respectively), with a higher sensitivity of PCR. According to AspICU, 9/45 patientswere classified as putative IA. When incorporating PCR results, 15 were putative IA because theymet all criteria, probably with a lack of specificity in the context of COVID-19. Using a modifiedAspICU algorithm, eight patients were classified as colonized and seven as putative IA.Conclusion An appreciation of the fungal burden using PCR and Aspergillus serology was addedto propose a modified AspICU algorithm. This proof of concept seemed relevant, as it was inagreement with the outcome of patients, but will need validation in larger cohorts.

Mots clés: Aspergillus; COVID-19; ICU; PCR; Sars-CoV-2; classification; galactomannan; invasive aspergillosis; probable; putative

Domaines: Maladies infectieuses

J-P Gangneux, Florian Reizine, Hélène Guegan, Kieran Pinceaux, Pierre Le Balch, et al.. Is the COVID-19 Pandemic a Good Time to Include Aspergillus Molecular Detection to Categorize Aspergillosis in ICU Patients? A Monocentric Experience. Journal of Fungi, 2020, 6 (3), pp.105. ⟨10.3390/jof6030105⟩. ⟨hal-02930002⟩