COVID-19-associated pulmonary aspergillosis in Latin America: A systematic review of 575 cases

BACKGROUND: Although COVID-19-associated pulmonary aspergillosis (CAPA) has been well characterized in Europe and North America, data from Latin America remain scarce, despite the region's high COVID-19 burden. AIMS: This systematic review compiles all published CAPA cases from Latin America, providing a comprehensive analysis of clinical characteristics, diagnostic practices, treatment patterns, and mortality risk factors across the region. METHODS: A systematic review was conducted on 32 studies, encompassing a total of 575 CAPA cases from Latin America. Data were extracted from PubMed, Embase, and LILACS (search date: March 7, 2024), following Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Individual and aggregate patient data were used. RESULTS: Most cases originated from Argentina, Brazil, Chile, and Mexico. Patients were predominantly male (72.6%), with hypertension (39.8%), obesity (38.1%), and diabetes (35.3%) as leading comorbidities. Probable CAPA accounted for 81.9% of cases, with Aspergillus fumigatus identified in 58.5%. Antifungal treatment, mainly voriconazole (57.5%), was administered in 75.5% of cases. Overall mortality was 50.1%. In the multivariate analysis, higher galactomannan (GM) levels in bronchoalveolar lavage (BAL) were independently associated with mortality (OR: 1.40; 95% CI: 1.04-2.03; p=0.045). CONCLUSIONS: This is the most comprehensive analysis of CAPA in Latin America to date, revealing high mortality despite antifungal treatment and limited diagnostic access. The presence of GM in BAL was independently associated with death, reinforcing its prognostic value. These findings underscore the urgent need for improved diagnostic strategies and targeted interventions in resource-limited settings.