A multinational report on SARS-COV-2 infection outcomes in people with CF and Aspergillus infection or ABPA

Jacob D Bradbury; Emily Chesshyre; Annalisa Orenti; Andreas Jung; Adilia Warris; European Cystic Fibrosis COVID project group

doi:10.1016/j.jcf.2023.10.017

A multinational report on SARS-COV-2 infection outcomes in people with CF and Aspergillus infection or ABPA

J Cyst Fibros. 2023 Nov 3:S1569-1993(23)01666-1. doi: 10.1016/j.jcf.2023.10.017. Online ahead of print.

Authors

Jacob D Bradbury¹, Emily Chesshyre², Annalisa Orenti³, Andreas Jung⁴, Adilia Warris⁵; European Cystic Fibrosis COVID project group

Affiliations

¹ MRC Centre for Medical Mycology, University of Exeter, EX4 4QD, UK; Department of Pharmacology, University of Oxford, OX1 3QT, UK.
² MRC Centre for Medical Mycology, University of Exeter, EX4 4QD, UK; Department of Paediatrics, Royal Devon University Healthcare NHS Foundation Trust, EX2 5DW, UK.
³ Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Biometry and Epidemiology G.A. Maccacaro, University of Milan, Milan 20122, Italy.
⁴ Paediatric Pulmonology, University Children's Hospital Zurich, Ramistrasse 102, Stadtkreis 7 8006, Zurich, Switzerland.
⁵ MRC Centre for Medical Mycology, University of Exeter, EX4 4QD, UK; Department of Paediatric Infectious Diseases, Great Ormond Street Hospital, London, WC1N 3JH, UK.

PMID: 37925255
DOI: 10.1016/j.jcf.2023.10.017

Abstract

Background: Aspergillus infection is known to be associated with worse respiratory outcomes in people with CF (pwCF) and is a well-recognised complication of severe SARS-CoV-2 infection. The aim of this observational cross-sectional study was to examine the association of pre-existing Aspergillus infection and/or allergic bronchopulmonary aspergillosis (ABPA) in pwCF and severity of COVID-19.

Methods: Data on SARS-CoV-2 infections in pwCF from January 2020 to June 2021 were collected by the European Cystic Fibrosis Society Patient Registry. The primary outcome was COVID-19 severity measured by hospitalisation comparing those with Aspergillus infection and/or ABPA in the 12 months preceding COVID-19and those without.

Results: In total, 1095 pwCF were diagnosed with SARS-CoV-2 and information on pre-existing Aspergillus/ABPA status was available from 807. PwCF and SARS-CoV-2 in the Aspergillus/ABPA group (n = 153), in comparison to the non-Aspergillus/ABPA group (n = 654), were more likely to be hospitalised (adjusted OR 1.79 (1.19 to 2.85); p = 0.005) and their disease course was more likely to be complicated by sepsis (adjusted OR 7.78 (1.78 to 49.43); p = 0.008). The association with hospital admission was no longer significant after excluding patients with ABPA. Secondary analysis comparing pwCF who received antifungal treatment (n = 18), versus those who did not (n = 474) during COVID-19, showed a higher rate of hospitalisation (p < 0.001); intensive care unit admission (p < 0.001), and requirement for invasive ventilation (p < 0.001) in the antifungal treated group.

Conclusion: We show that pre-existing Aspergillus/ABPAis associated with increased rates of hospitalisation and sepsis during COVID-19 in pwCF.

Keywords: Allergic bronchopulmonary aspergillosis; Aspergillus infection; COVID-19; Cystic fibrosis.