Epidemiology of Systemic Mycoses in the COVID-19 Pandemic

Abstract

The physiopathologic characteristics of COVID-19 (high levels of inflammatory cytokines and T-cell reduction) promote fungal colonization and infection, which can go unnoticed because the symptoms in both diseases are very similar. The objective of this work was to study the current epidemiology of systemic mycosis in COVID-19 times. A literature search on the subject (January 2020–February 2021) was performed in PubMed, Embase, Cochrane Library, and LILACS without language restrictions. Demographic data, etiological agent, risk factors, diagnostic methods, antifungal treatment, and fatality rate were considered. Eighty nine publications were found on co-infection by COVID-19 and pneumocystosis, candidiasis, aspergillosis, mucormycosis, coccidioidomycosis, or histoplasmosis. In general, the co-infections occurred in males over the age of 40 with immunosuppression caused by various conditions. Several species were identified in candidiasis and aspergillosis co-infections. For diagnosis, diverse methods were used, from microbiological to molecular. Most patients received antifungals; however, the fatality rates were 11–100%. The latter may result because the clinical picture is usually attributed exclusively to SARS-CoV-2, preventing a clinical suspicion for mycosis. Diagnostic tests also have limitations beginning with sampling. Therefore, in the remainder of the pandemic, these diagnostic limitations must be overcome to achieve a better patient prognosis.

Fungal Colonization and Infections—Interactions with Other Human Diseases

“…Moreover, Aspergillus spp., causes a life-threatening disease-invasive pulmonary aspergillosis (IPA) that is characteristically associated with immune-system dysregulation and affects the respiratory system. IPA chiefly arises due to the prolonged usage of glucocorticoids, immunosuppressive agents, chronic neutropenia, and in transplant recipients [124,125]. Case reports and observational studies have shown that COVID-19-associated pulmonary aspergillosis (CAPA) is of significant concern in hospitalized COVID-19 patients with complications [125,126].…”

“…Case reports show that patients treated with steroids during COVID-19 treatment often developed histoplasmosis caused by a dimorphic fungus Histoplasma capsulatum [127]. Fungus histoplasmosis is highly endemic and has been found in regions of the United States (California), Rio Grande, Southern Brazil, Buenos Aires, and Argentina [124]. This fungus is found in soil containing the excreta of birds or bats [127] and is associated with immunosuppressive conditions [127,128].…”

Coccidioidomycosis: A Contemporary Review

“…While the exact role of COVID in potentially increasing Coccidioides infections or reactivation remains incompletely defined, cases of co-infection have been reported in the literature. A review of systemic mycoses in the setting of SARS-CoV-2 infection reported two coccidioidal cases in California, one treated with fluconazole and the other without; there were no reported fatalities [ 159 ]. An additional case of accelerated progression of disseminated coccidioidomycosis following SARS-CoV-2 has been published [ 160 ].…”

Does the Fetus Limit Antibiotic Treatment in Pregnant Patients with COVID-19?

“…In the High Specialty Regional Hospital of Ixtapaluca, according to the protocol for the care of pregnant women with COVID-19—which is based on the protocol for patients with hospital-acquired and ventilator-associated pneumonia—and before giving treatment with antibiotics, a battery of cultures is carried out at hospital admission (cervicovaginal, blood culture, urine culture, and stool culture). This is since in many of the COVID-19 cases at the beginning of the pandemic, Azithromycin and Doxycycline were used indiscriminately, which in addition to not having given positive results for the intubation and/or death of the patients, it had caused the generation of cross-resistance, as well as superinfection by resistant microorganisms (fungi, bacteria, and parasites) responsible for other infections associated with this pathology [ 53 , 54 , 55 ]. It should be emphasized that none of the patients attended at the hospital were treated with antibiotics before their admission.…”