Fungal co-infections associated with COVID-19: cryptococcosis, mucormycosis, candidiasis and aspergillosis

This article was exclusively written for The European Sting by Ms. Irene Gómez Oropeza is a fourth-year medical student at the Universidad de las Américas Puebla in San Andrés Cholula, Puebla, México. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

COVID-19 is a disease that generally runs a mild course with a full recovery after a few weeks¹, but in some cases, a clinical entity has been associated with especially seriously ill or immunocompromised patients, the invasive fungal disease.²

Increasing case reports of fungal infections in patients with COVID-19 raises a major concern. Infections like Cryptococcosis, Mucormycosis, Candidiasis, and Aspergillosis represent most case reports in patients with COVID-19³, therefore knowledge about its diagnosis and proper management is noteworthy.

Critically ill patients, especially the ones admitted to the intensive care unit (ICU) and required mechanical ventilation, or had a longer duration of hospital stays, are more likely to develop fungal co-infections.^4.  Also, patients with underlying diseases, such as chronic respiratory diseases, cytokine storm, or requiring corticosteroid therapy.

The significant problem is that the fungal co-infections associated with global COVID-19 might be missed or misdiagnosed. However, some governmental efforts, like The French High Council for Public Health, have recommended systematic screening for fungal pathogens in COVID-19 patients. ⁵

As it is known, invasive fungal infections are associated with high morbidity and mortality in critically ill individuals, representing a serious complication of viral infections.⁶ Furthermore, the pathophysiology of COVID-19 may also account for unprecedented co-morbidity with invasive fungal infections. 

It is prudent to assess the patient´s risk factors, CD4 + T and CD8 + T cell counts, inherited or acquired immunodeficiencies, and immunocompromised state like prolonged neutropenia to check susceptibility for fungal co-infection.²

Clinicians and laboratory experts must know how to assist in the management of aspergillosis, candidiasis, mucormycosis, or cryptococcosis as comorbidities in COVID-19 patients.

I acknowledge Jorge Guevara by contributing to this article. 

Refereces

1. Molero-Garcia, J. M., Arranz-Izquierdo, J., Gutiérrez-Pérez, M. I., & Sánchez, J. M. R. (2021). Aspectos básicos de la COVID-19 para el manejo desde atención primaria. Atención Primaria, 53(6), 101966.
2. Song, G., Liang, G., & Liu, W. (2020). Fungal Co-infections Associated with Global COVID-19 Pandemic: A Clinical and Diagnostic Perspective from China. Mycopathologia, 185(4), 599-606. https://doi.org/10.1007/s11046-020-00462-9
3. Abdoli, A., Ealabi, S., & Kenackoobi, A. (2022). COVID-19-associated opportunistic infections: a snapshot on the current reports. Clinical and experimental medicine, 22(3), 327-346. https://doi.org/10.1007/s10238-021-00751-7
4. Yang, X., Yu, Y., Xu, J., Shu, H., Xia, J., Liu, H., Wu, Y., Zhang, L., Yu, Z., Fang, M., Yu, T., Wang, Y., Pan, S., Zou, X., Yuan, S., & Shang, Y. (2020). Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet. Respiratory medicine, 8(5), 475–481. https://doi.org/10.1016/S2213-2600(20)30079-5
5. Gangneux, J. P., Bougnoux, M. E., Dannaoui, E., Cornet, M., & Zahar, J. R. (2020). Invasive fungal diseases during COVID-19: We should be prepared. Journal de mycologie medicale, 30(2), 100971. https://doi.org/10.1016/j.mycmed.2020.100971
6. Segrelles-Calvo, G., de S Araújo, G. R., & Frases, S. (2020). Systemic mycoses: a potential alert for complications in COVID-19 patients. Future Microbiology, 15(14), 1405–1413. doi:10.2217/fmb-2020-0156 
7. About the author
8. Irene Gómez Oropeza is a fourth-year medical student at the Universidad de las Américas Puebla in San Andrés Cholula, Puebla, México. Serving as research sub coordinator in the SCOME national team during the term 2022-2023 in AMMEF Mexico.