Coronavirus Disease 2019–Associated Invasive Fungal Infection

Abstract

Coronavirus disease 2019 (COVID-19) can become complicated by secondary invasive fungal infections (IFIs), stemming primarily from severe lung damage and immunologic deficits associated with the virus or immunomodulatory therapy. Other risk factors include poorly controlled diabetes, structural lung disease and/or other comorbidities, and fungal colonization. Opportunistic IFI following severe respiratory viral illness has been increasingly recognized, most notably with severe influenza. There have been many reports of fungal infections associated with COVID-19, initially predominated by pulmonary aspergillosis, but with recent emergence of mucormycosis, candidiasis, and endemic mycoses. These infections can be challenging to diagnose and are associated with poor outcomes. The reported incidence of IFI has varied, often related to heterogeneity in patient populations, surveillance protocols, and definitions used for classification of fungal infections. Herein, we review IFI complicating COVID-19 and address knowledge gaps related to epidemiology, diagnosis, and management of COVID-19–associated fungal infections.

Oral Fungal Infections: Past, Present, and Future

“…These viruses will affect the host immune system. SARS-CoV-2, for example, dysregulates the type I interferon response and increases expression of anti-inflammatory cytokine IL-1RA [80], which may make individuals more susceptible to fungal infections [81,82].…”

Absence of candidemia in critically ill patients with COVID-19 receiving selective digestive decontamination

“…Candidemia in critically ill patients with coronavirus disease 2019 (COVID-19) is frequently observed [ 1 ], with incidence rates averaging 5.7% (range 0.8–14%) [ 2 ]. Main risk factors for invasive candidiasis include gastro-intestinal Candida colonization, loss of intestinal epithelium integrity and immunosuppression.…”

“…Main risk factors for invasive candidiasis include gastro-intestinal Candida colonization, loss of intestinal epithelium integrity and immunosuppression. In critically ill COVID-19 patients SARS-CoV-2 infection of enterocytes may compromise the intestinal wall integrity and corticosteroids have been shown to be associated with COVID-19 associated candidemia (CAC) [ 2 , 3 ]. Furthermore, several other risk factors may be present in these patients including prolonged admission in an intensive care unit (ICU), frequent use of broad-spectrum antibiotics, and possibly reduced quality of infection control prevention due to limited staff [ 2 ].…”

“…In critically ill COVID-19 patients SARS-CoV-2 infection of enterocytes may compromise the intestinal wall integrity and corticosteroids have been shown to be associated with COVID-19 associated candidemia (CAC) [ 2 , 3 ]. Furthermore, several other risk factors may be present in these patients including prolonged admission in an intensive care unit (ICU), frequent use of broad-spectrum antibiotics, and possibly reduced quality of infection control prevention due to limited staff [ 2 ]. The mortality of CAC has been reported to be between 40 and 70%, but the attributable mortality of candidemia in these patients remains unknown [ 2 ].…”

“…Furthermore, several other risk factors may be present in these patients including prolonged admission in an intensive care unit (ICU), frequent use of broad-spectrum antibiotics, and possibly reduced quality of infection control prevention due to limited staff [ 2 ]. The mortality of CAC has been reported to be between 40 and 70%, but the attributable mortality of candidemia in these patients remains unknown [ 2 ].…”