Invasive Fungal Infections Associated with COVID-19

Abstract

The COVID-19 pandemic caused >6 million deaths worldwide, often from respiratory failure. Complications frequently occurred in hospitalized patients, particularly in the intensive care unit. Among these, fungal infections were a cause of high morbidity and mortality. Invasive aspergillosis, candidiasis and mucormycosis were the most serious of these infections. Risk factors included alterations in immune defense mechanisms by COVID-19 itself, as well as immunosuppression due to various therapies utilized in severely ill patients. Diagnosis was often challenging due to lack of sensitivity of current testing. Outcomes were generally poor, due to significant co-morbidities and delayed diagnosis, with mortality rates >50% in some studies. High index of clinical suspicion is needed to facilitate early diagnosis and initiation of appropriate antifungal therapy.

Severe Fatal Mucormycosis in a Patient with Chronic Lymphocytic Leukaemia Treated with Zanubrutinib: A Case Report and Review of the Literature

“…(This last one usually seen as ineffective based on clinical and laboratory experience due to its high minimal inhibiting concentration (MIC) [ 63 , 64 ]). Surprisingly, this combination has shown effectiveness not only in murine models [ 65 ], but also in promising case reports [ 66 , 67 ], even from highly endemic areas [ 28 ], despite being limited to ROCM and diabetic ketoacidosis patients [ 68 ].…”

“…The most prevalent genus causing clinical mucormycosis is Rhizopus (two main species) [ 25 ], followed by the genus Mucor (twelve species up to date) [ 24 ], Lichtheimia , and Rhizomucor ; other less frequent pathogenic species are occasionally reported [ 26 , 27 ]. The fast growth, airborne spores, and the thermotolerance of these ubiquitarian saprotroph moulds enable them to grow at human body temperature: these features explain their pathogenic activity in patients with specific risk factors, including SARS-CoV-2 infection and treatments [ 28 , 29 ], as listed in Table 1 [ 20 , 26 , 30 ].…”

Approach to diagnostic evaluation and prevention of invasive fungal disease in patients prior to allogeneic hematopoietic stem cell transplant

“…[36][37][38]48,50 Patients with significant immunocompromise are also at increased risk of IFD post recent viral infection, likely due to overlapping risk factors and viral-specific factors. Multiple observational studies have demonstrated increased rates of IFD in immunosuppressed patients post respiratory infection with influenza and respiratory syncytial virus [77][78][79] as well as severe acute respiratory syndrome coronavirus-2, 80 while others have shown an association between cytomegalovirus infection and IFD in the post-transplant setting. 81,82…”

Pulmonary Mucormycosis: Beyond Classic COVID-19-Associated Fungal Infections

“…Mucormycosis is a rare angio-invasive fungal infection caused by a group of molds called mucormycetes [1,2]. The estimated global incidence varies from 0.005 to 1.7 cases per million people [2,3].…”

“…The clinical presentation varies according to the organ involvement, although it is well recognized that disease progression is marked by an aggressive and life-threatening course, emphasizing the critical importance of an early diagnosis and intervention [2]. COVID-19 is also associated with an increased risk of secondary fungal infections, such as aspergillosis, invasive candidiasis, and mucormycosis [1]. The pathophysiological and metabolic changes caused by SARS-CoV-2 and its therapeutic strategies have been implicated as facilitators of disease development.…”