COVID-19-associated invasive aspergillosis: Data from the UK national mycology reference laboratory

Andrew Borman*, Michael Palmer, Mark Fraser, Zoe Patterson, Ciara Mann, Debra Oliver, Christopher J. Linton, Martin Gough, Phillipa Brown, Agnieszka Dzietczyk, Michelle Hedley, Sue McLachlan, Julie King, Elizabeth M. Johnson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

56 Citations (Scopus)


COVID-19-associated pulmonary aspergillosis (CAPA) was recently reported as a potential infective complication affecting critically ill patients with acute respiratory distress syndrome following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with incidence rates varying from 8 to 33% depending on the study. However, definitive diagnosis of CAPA is challenging. Standardized diagnostic algorithms and definitions are lacking, clinicians are reticent to perform aerosol-generating bronchoalveolar lavages for galactomannan testing and microscopic and cultural examination, and questions surround the diagnostic sensitivity of different serum biomarkers. Between 11 March and 14 July 2020, the UK National Mycology Reference Laboratory received 1,267 serum and respiratory samples from 719 critically ill UK patients with COVID-19 and suspected pulmonary aspergillosis. The laboratory also received 46 isolates of Aspergillus fumigatus from COVID-19 patients (including three that exhibited environmental triazole resistance). Diagnostic tests performed included 1,000 (1-3)-β-D-glucan and 516 galactomannan tests on serum samples. The results of this extensive testing are presented here. For a subset of 61 patients, respiratory specimens (bronchoalveolar lavage specimens, tracheal aspirates, and sputum samples) in addition to serum samples were submitted and subjected to galactomannan testing, Aspergillus-specific PCR, and microscopy and culture. The incidence of probable/proven and possible CAPA in this subset of patients was approximately 5% and 15%, respectively. Overall, our results highlight the challenges in biomarker-driven diagnosis of CAPA, especially when only limited clinical samples are available for testing, and the importance of a multimodal diagnostic approach involving regular and repeat testing of both serum and respiratory samples.

Original languageEnglish
Article numberARTN e02136-20
Number of pages12
JournalJournal of Clinical Microbiology
Issue number1
Publication statusPublished - Jan 2021

Bibliographical note

Publisher Copyright:
© Crown copyright 2020.


  • Biomarkers
  • Candidemia
  • CAPA
  • COVID-19
  • Diagnosis
  • Invasive pulmonary aspergillosis
  • SARS-CoV-2
  • biomarkers
  • diagnosis
  • candidemia
  • invasive pulmonary aspergillosis


Dive into the research topics of 'COVID-19-associated invasive aspergillosis: Data from the UK national mycology reference laboratory'. Together they form a unique fingerprint.

Cite this