Fungal co-infection in COVID-19 patients: Should we be concerned?
Here’s a detailed summary of the study “Fungal co-infection in COVID-19 patients: Should we be concerned?” from the Revista Iberoamericana de Micología:
Background The study addresses concerns about fungal co-infections in critically ill COVID-19 patients, focusing on invasive fungal infections (IFI) such as invasive pulmonary aspergillosis (IPA), invasive candidiasis (IC), and Pneumocystis jirovecii pneumonia (PJP). Due to immune dysregulation and high pro- and anti-inflammatory cytokine levels in severely ill COVID-19 patients, there is an increased risk of these infections. The research highlights the lack of comprehensive studies on fungal co-infections in COVID-19 patients.
COVID-19-Associated Pulmonary Aspergillosis (CAPA)
- CAPA is a growing concern for COVID-19 patients, especially those in intensive care units (ICU) with severe influenza-like symptoms. The study notes that while IPA traditionally occurs in immunocompromised patients, many cases arise in non-neutropenic patients in ICUs. The AspICU algorithm, combining culture and galactomannan detection, is recommended for diagnosing IPA in ICU patients.
- Histologic damage in COVID-19 patients with acute respiratory distress syndrome (ARDS), such as alveolar injury and neutrophilic infiltration, could facilitate secondary infections like CAPA.
- The study indicates that the actual burden of CAPA in ICU-admitted COVID-19 patients might be underestimated due to limited data, with most information coming from single case reports or small series.
Challenges in Diagnosing CAPA
- Diagnosing CAPA is difficult due to non-specific symptoms and limitations in the use of imaging and biomarkers (like galactomannan and β-D-glucan) for distinguishing it from other complications in COVID-19 patients.
Invasive Candidiasis in COVID-19 Patients
- Severely ill COVID-19 patients in ICUs are also at risk for invasive candidiasis due to factors like mechanical ventilation and broad-spectrum antibiotic use.
Pneumocystis Pneumonia in COVID-19 Patients
- Though rare, there has been an observed case of PJP co-infection in a COVID-19 patient without traditional risk factors for PJP, highlighting the need for vigilance and potential utility of serum β-D-glucan for diagnosis.
- Despite the severe impact of SARS-CoV-2, cases of IFI are relatively rare in COVID-19 patients, likely due to the reduced frequency of bronchoscopies and necropsies owing to aerosolization risks. However, the presence of fungal markers in respiratory samples should prompt early antifungal therapy.
This study emphasizes the need for heightened awareness and proactive management of potential fungal co-infections in severely ill COVID-19 patients, especially those in ICUs.