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Fungal co-infection in COVID-19 patients: Should we be concerned?

Javier Pemán1, Alba Ruiz-Gaitán2, Carolina García-Vidal3

  • 1Servicio de Microbiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.

Revista Iberoamericana De Micologia
|October 12, 2020
PubMed

Insights

Critically ill COVID-19 patients exhibit altered immune responses, increasing fungal infection risk. Early antifungal therapy is recommended upon detecting fungal markers, despite low reported invasive mycoses incidence.

Area of Science:

  • Infectious Diseases
  • Immunology
  • Critical Care Medicine

Background:

  • Critically ill COVID-19 patients display dysregulated immune responses with elevated pro-inflammatory and anti-inflammatory cytokines.
  • This immune imbalance, alongside reduced CD4 and CD8 cell counts, elevates the risk of severe fungal coinfections like invasive pulmonary aspergillosis, candidiasis, and Pneumocystis pneumonia.
  • Limited research has explored the prevalence and impact of fungal coinfections in this vulnerable patient group.

Purpose of the Study:

  • To review and update the understanding of fungal coinfections in critically ill COVID-19 patients.
  • To present personal clinical experience from three Spanish hospitals regarding fungal coinfections in this population.
  • To provide recommendations for managing potential invasive mycoses in SARS-CoV-2 infected individuals.

Main Methods:

  • A comprehensive review of published reports on fungal coinfections in COVID-19 patients.
  • Analysis of clinical data and experiences from three Spanish hospitals.
  • Evaluation of diagnostic challenges, including bronchoscopies and necropsies, due to aerosol generation risks.

Main Results:

  • Despite the high risk, the reported incidence of invasive fungal infections in critically ill COVID-19 patients appears low.
  • This scarcity may be attributed to reduced performance of diagnostic procedures like bronchoscopies and necropsies, driven by aerosolization concerns.
  • Detection of fungal markers in relevant clinical specimens (excluding Candida colonization) warrants prompt initiation of antifungal treatment.

Conclusions:

  • The low incidence of diagnosed invasive mycoses in critically ill COVID-19 patients might be an underestimation due to diagnostic limitations.
  • The presence of fungal markers, beyond simple colonization, should prompt early antifungal therapy implementation.
  • Further research and standardized diagnostic approaches are needed to accurately assess the burden of fungal coinfections in this population.
Keywords:
AspergillosisAspergilosisCOVID-19CandidiasisCoinfección fúngicaFungal coinfectionInvasive mycosesMicosis invasivaNeumocistosisPneumocystosisSARS-CoV-2

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