Virus-Associated Pulmonary Aspergillosis

Aspergillus fumigatus and other pathogenic Aspergillus spp. are known to cause invasive aspergillosis in patients with profound immunosuppression. However, a novel entity of the disease affecting patients with severe respiratory viral infections, with or without apparent immune defect, has been recently recognized following the pandemic of H1N1 influenza and Coronavirus disease 2019 (COVID-19). Virus-associated pulmonary aspergillosis mainly consists of two distinct entities, influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA), which differ according to their pathogenesis, clinical presentation, and course. These novel forms of invasive aspergillosis have opened new insights into our understanding of the pathophysiology of the disease and the complexity of the fungus-host interactions and mechanisms that may lead to angio-invasion. IAPA and CAPA currently represent major challenges for intensive care unit physicians in terms of diagnostic and therapeutic approaches, as they are associated with particularly high mortality rates. This chapter goes through the different aspects of IAPA and CAPA and addresses the practical questions regarding their diagnosis and management.