Candida in COVID-19: Gut-Lung Axis, Dysbiosis, and Infections

Abstract

Purpose of Review This review discusses the connections between the gut-lung axis, gut and respiratory tract dysbiosis, and Candida bloodstream, oral, and respiratory infections in COVID-19 patients. Recent Findings COVID-19–related dysfunction in the intestinal barrier together with gut and lung dysbiosis played an important role in disease pathophysiology, which affected host immune homeostasis giving rise to prominent systemic and respiratory bacterial and fungal infections. Higher incidence of Candida bloodstream infections driven by accumulation of “classic” risk factors in severely ill COVID-19 patients was noted. Moreover, numerous C. auris outbreaks, characterized by high clonality of the strains, were reported from all around the world. Unlike other Candida species, C. auris colonization and infection cases most likely resulted from nosocomial transmission. Summary Infections due to Candida species in severely ill COVID-19 patients reflected the overall immune dysregulation and were largely driven by gut and respiratory tract dysbiosis.