Fungal infection profile in critically ill COVID-19 patients: a prospective study at a large teaching hospital in a middle-income country

Abstract

Background Critically ill COVID-19 patients are highly susceptible to opportunistic fungal infection due to many factors, including virus-induced immune dysregulation, host-related comorbidities, overuse and misuse of antibiotics or corticosteroids, immune modulator drugs, and the emergencies caused by the pandemic. This study aimed to assess the incidence, identify the potential risk factors, and examine the impact of fungal coinfection on the outcomes of COVID-19 patients admitted to the intensive care unit (ICU). Methods A prospective cohort study including 253 critically ill COVID-19 patients aged 18 years or older admitted to the isolation ICU of Zagazig University Hospitals over a 4-month period from May 2021 to August 2021 was conducted. The detection of a fungal infection was carried out. Results Eighty-three (83) patients (32.8%) were diagnosed with a fungal coinfection. Candida was the most frequently isolated fungus in 61 (24.1%) of 253 critically ill COVID-19 patients, followed by molds, which included Aspergillus 11 (4.3%) and mucormycosis in five patients (1.97%), and six patients (2.4%) diagnosed with other rare fungi. Poor diabetic control, prolonged or high-dose steroids, and multiple comorbidities were all possible risk factors for fungal coinfection [OR (95% CI) = 10.21 (3.43–30.39), 14.1 (5.67–35.10), 14.57 (5.83–33.78), and 4.57 (1.83–14.88), respectively]. Conclusion Fungal coinfection is a common complication of critically ill COVID-19 patients admitted to the ICU. Candidiasis, aspergillosis, and mucormycosis are the most common COVID-19-associated fungal infections and have a great impact on mortality rates.

Histopathological spectrum of fungal infections in COVID 19 cases – A retrospective observational study

“…5 Critically ill COVID-19 patients who are admitted to the ICU are highly susceptible to secondary infections like CAM. 4 On the basis of its anatomic location, mucormycosis can be classified as isolated nasal, rhino-orbital or rhinoorbital cerebral, pulmonary, gastrointestinal, cutaneous, disseminated and miscellaneous. 8 In a study by Shree Laxmi et al the age of patients ranged from 21 to 80 years with a male preponderance; similar demographic details were noted in the present study.…”

“…The angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2) expressing cells are targeted by the virus which causes expression of integrin. 4 These integrins mediate interactions with proteins on the surface of the Mucorales, Aspergillus, or Candida cell wall, namely the spore-coating (CotH) proteins, the thaumatin-like protein CalA, and mannoproteins, to promote the adhesion and invasion of fungi. 4 The order Mucorales has predominantly Rhizopus species including R. delemar and R. large number of reports of mucormycosis; approximately 50,000 cases.…”

“…4 These integrins mediate interactions with proteins on the surface of the Mucorales, Aspergillus, or Candida cell wall, namely the spore-coating (CotH) proteins, the thaumatin-like protein CalA, and mannoproteins, to promote the adhesion and invasion of fungi. 4 The order Mucorales has predominantly Rhizopus species including R. delemar and R. large number of reports of mucormycosis; approximately 50,000 cases. 5 Western region of India showed the highest number of reported cases followed by the South India.…”

COVID-19, mucormycosis, and the cow: Damned lies!

“…The reported prevalence of COVID-19-associated pulmonary mucormycosis was similar in Chile and India [ 34 , 56 ]. The other countries that reported CAM include Pakistan, Iran, Egypt, Turkey, Egypt, Honduras, Mexico, Russia, Latin America, and several European countries (Romania, France, and others) [ 9 , 53 , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] ]. The occurrence of CAM in such high proportions (up to 1% of critically ill COVID-19 cases in France) in countries where cow dung is not used, points towards the need for a better explanation for CAM rather than India-specific factors [ 55 , 59 ].…”

COVID-19 associated with cryptococcosis: a scoping review

“… 10 , 11 The most common COVID-19-associated fungal infections are candidiasis, aspergillosis, and mucormycosis. 12 , 13 Nonetheless, Cryptococcus , like all opportunistic fungi, is becoming more frequent, especially in patients with COVID-19 admitted to the intensive care unit (ICU) and with an immunosuppression factor according to some reports. 14 – 16 …”