Candida spp. co-infection in COVID-19 patients with severe pneumonia: Prevalence study and associated risk factors

Abstract

Background: Invasive fungal infections (IFI) are increasing in prevalence in recent years. In the last few months, the rise of COVID-19 patients has generated a new escalation in patients presenting opportunistic mycoses, mainly by Aspergillus. Candida infections are not being reported yet. Objectives: We aimed to determine the prevalence of systemic candidiasis in patients admitted to ICUs due to severe pneumonia secondary to SARS-CoV-2 infection and the existence of possible associated risk factors that led these patients to develop candidiasis. Patients/methods: We designed a study including patients with a confirmed diagnosis of COVID-19. Results: The prevalence of systemic candidiasis was 14.4%, and the main isolated species were C. albicans and C. parapsilosis. All patients that were tested positive for Candida spp. stayed longer in the ICU in comparison to patients who tested negative. Patients with candidiasis had higher MuLBSTA score and mortality rates and a worse radiological involvement. In our study, Candida spp. isolates were found in patients that were submitted to: tocilizumab, tocilizumab plus systemic steroids, interferon type 1β and Lopinavir-Ritonavir. Conclusions: Results suggested a high prevalence of systemic candidiasis in severe COVID-19-associated pneumonia patients. Patients with Candidiasis had the worst clinical outcomes. Treatment with tocilizumab could potentialize the risk to develop systemic candidiasis.

Prevalence and Clinical Impact of Coinfection in Patients with Coronavirus Disease 2019 in Korea

“…The prevalence of fungal infection was 10.5%, based on our data, including patients admitted to the ICU requiring ventilation. The most commonly detected isolate was C. albicans from respiratory specimens, consistent with the findings of other studies [13,37]. Impaired immune responses due to infection with SARS-CoV-2 and the use of immunosuppressants, including steroids and tocilizumab, for the treatment of COVID-19 could be the cause of increased fungal infection [36,37].…”

“…The most commonly detected isolate was C. albicans from respiratory specimens, consistent with the findings of other studies [13,37]. Impaired immune responses due to infection with SARS-CoV-2 and the use of immunosuppressants, including steroids and tocilizumab, for the treatment of COVID-19 could be the cause of increased fungal infection [36,37]. Early detection of fungal infection and antifungal therapy is associated with better survival [13].…”

“…Fungal infection cases increased during the COVID 19 pandemic [36,37]. The prevalence of fungal infection was 10.5%, based on our data, including patients admitted to the ICU requiring ventilation.…”

Rethinking the CDC's pneumonia secondary bloodstream infection attribution criteria during the COVID-19 pandemic for patients with fungal pneumonia

“…There is increased literature that pneumonia resulting from fungi, including Candida species, is being diagnosed within the COVID-19 patient population. 4 , 5 Consistent with this literature, two cases at a Northeast Florida acute care facility developed fungal pneumonia and fungemia with matching blood cultures. Both patients were vented with primary diagnoses of COVID-19 pneumonia.…”

Biological investigation of N-methyl thiosemicarbazones as antimicrobial agents and bacterial carbonic anhydrases inhibitors

“…In addition, COVID-19 containment campaigns led to an overuse of sanitisers and biocides, promoting cross-resistance and reduction or loss of antibiotic sensitivity 4 , 5 . Several cases of secondary infections from the bacteria Pseudomonas aeruginosa and Staphylococcus aureus 6 , 7 and the opportunistic fungi from Candida species 8 , 9 were recorded and are alerting the scientific community. Moreover, besides systemic fungal infections, mycoses of skin, nails, and hair caused by dermatophytes are generating a great concern, since they are estimated to affect a large percentage of the global population 10 .…”