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Invasive Respiratory Fungal Infections in COVID-19 Critically Ill Patients

Francesca Raffaelli1, Eloisa Sofia Tanzarella2,3, Gennaro De Pascale2,3

  • 1Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Roma, Italy.

Journal of Fungi (Basel, Switzerland)
|April 21, 2022
PubMed

Insights

Critically ill COVID-19 patients frequently develop serious fungal infections like aspergillosis and mucormycosis. Diagnosing and treating these respiratory fungal infections in ICU patients presents significant challenges.

Area of Science:

  • Critical Care Medicine
  • Infectious Diseases
  • Mycology

Background:

  • Critically ill patients with coronavirus disease 19 (COVID-19) admitted to intensive care units (ICUs) are susceptible to respiratory fungal infections.
  • Common infections include COVID-19-associated pulmonary aspergillosis (CAPA), COVID-19-associated pulmonary mucormycosis (CAPM), and Pneumocystis jirovecii pneumonia (PCP), particularly in those with HIV.

Purpose of the Study:

  • To review the landscape of respiratory fungal infections in critically ill COVID-19 patients.
  • To discuss diagnostic challenges, risk factors, and current therapeutic options.

Main Methods:

  • Literature review of fungal infections in COVID-19 ICU patients.
  • Analysis of risk factors, diagnostic complexities, and treatment strategies.

Main Results:

  • Respiratory fungal infections are common in ICU COVID-19 patients, driven by factors like epithelial damage, mechanical ventilation, and immunosuppression.
  • Distinguishing fungal colonization from infection is difficult due to sampling issues and unreliable diagnostics, requiring integrated clinical, radiological, and microbiological data.
  • Existing antifungal treatments have limitations, highlighting the need for novel agents with improved safety and efficacy profiles.

Conclusions:

  • Respiratory fungal infections pose a significant threat to critically ill COVID-19 patients, complicating management.
  • Accurate diagnosis remains challenging, necessitating a multimodal approach.
  • Further research into new antifungal therapies and the role of prophylaxis is crucial.
Keywords:
CAMCAPACOVID-19SARS-CoV-2pneumocystosisrespiratory fungal infection

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