Cryptococcosis among hospitalised patients with COVID‐19: A multicentre research network study

Abstract

It is unclear if there is an association between COVID‐19 and cryptococcosis. Therefore, this study aimed to describe the clinical features, risk factors, and outcomes associated with cryptococcosis in hospitalised patients with COVID‐19. The objectives of this study were to determine the incidence of and examine factors associated with cryptococcosis after a diagnosis of COVID‐19. We used TriNetX to identify and sort patients 18 years and older hospitalised with COVID‐19 into two cohorts based on the presence or absence of a diagnosis of cryptococcosis following diagnosis of COVID‐19. Outcomes of interest included the incidence of cryptococcosis following the diagnosis of COVID‐19 as well as the proportion of patients in each group who had underlying comorbidities, received immunomodulatory therapy, required ICU admission or mechanical ventilation (MV), or died. Propensity score matching was used to adjust for confounding. Among 212,479 hospitalised patients with COVID‐19, 65 developed cryptococcosis. The incidence of cryptococcosis following COVID‐19 was 0.022%. Patients with cryptococcosis were more likely to be male and have underlying comorbidities. Among cases, 32% were people with HIV. Patients with cryptococcosis were more likely to have received tocilizumab (p < .0001) or baricitinib (p < .0001), but not dexamethasone (p = .0840). ICU admission (38% vs 29%), MV (23% vs 11%), and mortality (36% vs 14%) were significantly higher among patients with cryptococcosis. Mortality remained elevated after adjusted propensity score matching. Cryptococcosis occurred most often in hospitalised patients with COVID‐19 who had traditional risk factors, comparable to findings in patients without COVID‐19. Cryptococcosis was associated with increased ICU admission, MV, and mortality.

COVID-19 Associated with Cryptococcosis: A New Challenge during the Pandemic

“…To determine the incidence of and examine factors associated with cryptococcosis after a diagnosis of COVID-19, Chastain and his colleagues used TriNetX—a global federated research network that captures anonymous data from electronic medical records of 57 healthcare organizations and included a total of 212,479 hospitalized patients with COVID-19 [ 18 ]. Based on ICD-10-CM diagnosis codes, they identified 65 patients with cryptococcosis, and the overall incidence and prevalence of cryptococcosis among hospitalized patients with COVID-19 were 0.022% and 0.059%, respectively [ 18 ]. Compared to non-Hispanic patients, the incidence and prevalence were higher among Hispanic or Latino populations (incidence: 0.029% vs. 0.022%; prevalence: 0.063% vs. 0.061).…”

“…Compared to non-Hispanic patients, the incidence and prevalence were higher among Hispanic or Latino populations (incidence: 0.029% vs. 0.022%; prevalence: 0.063% vs. 0.061). In addition, male patients had a higher incidence (0.029%) and prevalence (0.063%) of cryptococcosis after COVID-19 than female patients [ 18 ]. Finally, a higher prevalence of cryptococcosis was observed in two specific groups, including the elderly group (0.043% among patients 60–64 years and 0.035% among those 70–74 years) and patients with critical COVID-19 requiring ICU admission (0.123%) [ 18 ].…”

“…In addition, male patients had a higher incidence (0.029%) and prevalence (0.063%) of cryptococcosis after COVID-19 than female patients [ 18 ]. Finally, a higher prevalence of cryptococcosis was observed in two specific groups, including the elderly group (0.043% among patients 60–64 years and 0.035% among those 70–74 years) and patients with critical COVID-19 requiring ICU admission (0.123%) [ 18 ]. Another small series of 13 patients with confirmed cryptococcal infection following COVID-19 reported a similar finding that 12 (92.3%) patients had severe COVID-19 [ 16 ].…”

“…However, the COVID-19-associated fungal infections caused by Candida , Aspergillus , and Mucor ales cannot be neglected [ 5 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Recently, several cases of COVID-19 with Cryptococcus co- or secondary infection as opportunistic infections have been reported [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ], However, many issues about the epidemiology, pathogenesis, clinical and microbiological manifestations, and treatment of COVID-19-associated cryptococcosis remained unclear due to limited studies. Therefore, we did a literature search using the keywords—“cryptococcus,” “opportunistic infection,” “COVID-19,” and “SARS-CoV-2,” and conducted this review to provide updated and comprehensive information about this rare COVID-19-associated cryptococcosis.…”

Clinical challenges of managing advanced AIDS in the tropics: Histoplasmosis, COVID-19, and shigellosis coinfections

“…Coinfections in HIV-positive patients are common [ 1 ]. These coinfections can translate into fatal outcomes, especially for COVID-19 and invasive fungal infections [ 2 , 3 ]. Herein, we report a case of advanced HIV/AIDS complicated by disseminated histoplasmosis and Shigella flexneri bacteremia with an incidental COVID-19 infection.…”