Invasive Fungal Infections Complicating COVID-19: A Narrative Review
Invasive fungal infections (IFIs) can complicate the clinical course of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients admitted to an intensive care unit (ICU). This narrative review concerns 4099 cases of IFIs in 58,784 COVID-19 patients...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-10-01
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| Series: | Journal of Fungi |
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| Online Access: | https://www.mdpi.com/2309-608X/7/11/921 |
| _version_ | 1827676362176987136 |
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| author | Giacomo Casalini Andrea Giacomelli Annalisa Ridolfo Cristina Gervasoni Spinello Antinori |
| author_facet | Giacomo Casalini Andrea Giacomelli Annalisa Ridolfo Cristina Gervasoni Spinello Antinori |
| author_sort | Giacomo Casalini |
| collection | DOAJ |
| description | Invasive fungal infections (IFIs) can complicate the clinical course of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients admitted to an intensive care unit (ICU). This narrative review concerns 4099 cases of IFIs in 58,784 COVID-19 patients involved in 168 studies. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is a diagnostic challenge because its non-specific clinical/imaging features and the fact that the proposed clinically diagnostic algorithms do not really apply to COVID-19 patients. Forty-seven observational studies and 41 case reports have described a total of 478 CAPA cases that were mainly diagnosed on the basis of cultured respiratory specimens and/or biomarkers/molecular biology, usually without histopathological confirmation. Candidemia is a widely described secondary infection in critically ill patients undergoing prolonged hospitalisation, and the case reports and observational studies of 401 cases indicate high crude mortality rates of 56.1% and 74.8%, respectively. COVID-19 patients are often characterised by the presence of known risk factors for candidemia such as in-dwelling vascular catheters, mechanical ventilation, and broad-spectrum antibiotics. We also describe 3185 cases of mucormycosis (including 1549 cases of rhino-orbital mucormycosis (48.6%)), for which the main risk factor is a history of poorly controlled diabetes mellitus (>76%). Its diagnosis involves a histopathological examination of tissue biopsies, and its treatment requires anti-fungal therapy combined with aggressive surgical resection/debridement, but crude mortality rates are again high: 50.8% in case reports and 16% in observational studies. The presence of other secondary IFIs usually diagnosed in severely immunocompromised patients show that SARS-CoV-2 is capable of stunning the host immune system: 20 cases of <i>Pneumocystis jirovecii</i> pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to <i>Fusarium</i> spp., and 1 case of pulmonary infection due to <i>Scedosporium.</i> |
| first_indexed | 2024-03-10T05:22:31Z |
| format | Article |
| id | doaj.art-48b4db53cf5949a1801a21e4fb66c0ae |
| institution | Directory Open Access Journal |
| issn | 2309-608X |
| language | English |
| last_indexed | 2024-03-10T05:22:31Z |
| publishDate | 2021-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Fungi |
| spelling | doaj.art-48b4db53cf5949a1801a21e4fb66c0ae2023-11-22T23:55:27ZengMDPI AGJournal of Fungi2309-608X2021-10-0171192110.3390/jof7110921Invasive Fungal Infections Complicating COVID-19: A Narrative ReviewGiacomo Casalini0Andrea Giacomelli1Annalisa Ridolfo2Cristina Gervasoni3Spinello Antinori4Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, ItalyLuigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, ItalyIII Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, ItalyIII Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, ItalyLuigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, ItalyInvasive fungal infections (IFIs) can complicate the clinical course of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients admitted to an intensive care unit (ICU). This narrative review concerns 4099 cases of IFIs in 58,784 COVID-19 patients involved in 168 studies. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is a diagnostic challenge because its non-specific clinical/imaging features and the fact that the proposed clinically diagnostic algorithms do not really apply to COVID-19 patients. Forty-seven observational studies and 41 case reports have described a total of 478 CAPA cases that were mainly diagnosed on the basis of cultured respiratory specimens and/or biomarkers/molecular biology, usually without histopathological confirmation. Candidemia is a widely described secondary infection in critically ill patients undergoing prolonged hospitalisation, and the case reports and observational studies of 401 cases indicate high crude mortality rates of 56.1% and 74.8%, respectively. COVID-19 patients are often characterised by the presence of known risk factors for candidemia such as in-dwelling vascular catheters, mechanical ventilation, and broad-spectrum antibiotics. We also describe 3185 cases of mucormycosis (including 1549 cases of rhino-orbital mucormycosis (48.6%)), for which the main risk factor is a history of poorly controlled diabetes mellitus (>76%). Its diagnosis involves a histopathological examination of tissue biopsies, and its treatment requires anti-fungal therapy combined with aggressive surgical resection/debridement, but crude mortality rates are again high: 50.8% in case reports and 16% in observational studies. The presence of other secondary IFIs usually diagnosed in severely immunocompromised patients show that SARS-CoV-2 is capable of stunning the host immune system: 20 cases of <i>Pneumocystis jirovecii</i> pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to <i>Fusarium</i> spp., and 1 case of pulmonary infection due to <i>Scedosporium.</i>https://www.mdpi.com/2309-608X/7/11/921COVID-19invasive fungal infectionsaspergillosisCAPAcandidemiamucormycosis |
| spellingShingle | Giacomo Casalini Andrea Giacomelli Annalisa Ridolfo Cristina Gervasoni Spinello Antinori Invasive Fungal Infections Complicating COVID-19: A Narrative Review Journal of Fungi COVID-19 invasive fungal infections aspergillosis CAPA candidemia mucormycosis |
| title | Invasive Fungal Infections Complicating COVID-19: A Narrative Review |
| title_full | Invasive Fungal Infections Complicating COVID-19: A Narrative Review |
| title_fullStr | Invasive Fungal Infections Complicating COVID-19: A Narrative Review |
| title_full_unstemmed | Invasive Fungal Infections Complicating COVID-19: A Narrative Review |
| title_short | Invasive Fungal Infections Complicating COVID-19: A Narrative Review |
| title_sort | invasive fungal infections complicating covid 19 a narrative review |
| topic | COVID-19 invasive fungal infections aspergillosis CAPA candidemia mucormycosis |
| url | https://www.mdpi.com/2309-608X/7/11/921 |
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