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.

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