The rising burden of invasive fungal infections in COVID-19, can structured CT thorax change the game

Abstract

Background The occurrence of invasive fungal infections in COVID-19 patients is on surge in countries like India. Several reports related to rhino-nasal-sinus mucormycosis in COVID patients have been published in recent times; however, very less has been reported about invasive pulmonary fungal infections caused mainly by mucor, aspergillus or invasive candida species. We aimed to present 6 sputum culture proved cases of invasive pulmonary fungal infection (four mucormycosis and two invasive candidiasis) in COVID patients, the clues for the diagnosis of fungal invasion as well as difficulties in diagnosing it due to superimposed COVID imaging features. Case presentation The HRCT imaging features of the all 6 patients showed signs of fungal invasion in the form of cavities formation in the pre-existing reverse halo lesions or development of new irregular margined soft tissue attenuating growth within the pre-existing or in newly formed cavities. Five out of six patients were diabetics. Cavities in cases 1, 2, 3 and 4 of mucormycosis were aggressive and relatively larger and showed relatively faster progression into cavities in comparison with cases 5 and 6 of invasive candidiasis. Conclusion In poorly managed diabetics or with other immunosuppressed conditions, invasive fungal infection (mucormycosis, invasive aspergillosis and invasive candidiasis) should be considered in the differential diagnosis of cavitary lung lesions.

Early diagnosis of mucormycosis in COVID-19 patients by computerized tomography scan and biopsy in intensive care unit patients with COVID-19

“…Fungal infection such as aspergillus organism was found in 5 (7.8%) patients and mucor species was found in 50 (78.1%) patients, so mucor species was more common in occurrence than aspergillus organism and bacterial infection. Moreover, Dubey et al, (Dubey et al, 2022) reported a series of 6 covid-19 patients who developed invasive pulmonary fungal infection. They reported that four of them were mucor and remaining two were of candida species.…”

An overview of opportunistic fungal infections associated with COVID-19

“…According to recent studies, it was found that high-resolution computed tomography (HRCT) of the thorax helps in the early detection of these dreadful conditions, following the protocol for patients with chest pain and breathing problems during this pandemic. With the use of HRCT, the cases of the patients were studied, and the following data could be obtained (Dubey 2022 ).…”

“…Diabetes patients frequently have morbidity and mortality, and steroid therapy is used to treat COVID-19, which is the main cause for concern (Dubey 2022 ). One strategy to deal with fungal diseases is to monitor the individuals who have the infection, practice good hygiene, watch for the fungus to develop drug resistance, and research and identify the pathology and clinical manifestations of the diseases (Ravikant 2015 ).…”

Acute Cerebellar Inflammation and Related Ataxia: Mechanisms and Pathophysiology

“…Aspergillus spreads to CNS with a hematogenous spread directly or as a primary intracranial lesion [141]. Notably, fungal infections are increasing at an alarming rate because of the growing number of immunocompromised patients, the widespread use of immunosuppressive drugs, and the spread of infectious diseases such as AIDS and COVID-19 [142,143]. These fungal infections are secondary to other infections elsewhere in the body and spread to the brain through blood circulation [142].…”