Post-COVID-19-Invasive Pulmonary Mycosis

Abstract

COVID-19 has been associated with myriad manifestations as well as adverse outcomes. One of the less commonly reported consequences of COVID-19 is the occurrence of secondary infections in patients suffering acutely from COVID-19 or in those recuperating. Secondary invasive fungal infections (IFIs) have also been observed earlier in other viral infections such as influenza, parainfluenza, and respiratory syncytial virus infections. Severe lung damage and immunologic derangement resulting from SARS-CoV-2 infection predispose to superinfections. Risk factors for secondary IFI includes immunologic derangement and immunoparalysis resulting from SARS-CoV-2 infection, neutropenia, or lymphopenia, poorly controlled diabetes, structural lung disease fungal colonization, and drugs such as corticosteroids or immunomodulators given as therapies for COVID-19. Invasive aspergillosis following COVID-19 is most commonly described fungal infection but other non-Aspergillus fungal infections (including mucormycosis) has also been reported. Herein we describe two interesting cases of secondary infections developing in patients beyond the acute phase of COVID-19 who had similar presentations but with different diagnoses and requiring different management strategies. Patient in case 1 developed COVID-19-associated subacute invasive pulmonary aspergillosis (SAIA) and patient in case 2 had COVID-19 associated pulmonary mucormycosis (CAPM). We have also described the various postulated immune-pathogenesis of the super-added fungal infections in COVID-19 patients.

Metagenomic insights into fungal community composition of the nasopharyngeal region of COVID‐19 associated mucormycosis patients from India

“…It seems plausible that perturbations in the "cross-talk" between the microbes lead to favorable circumstances for different complications like COVID-19 associated mycoses, secondary bacterial infections, and even death. [18][19][20] Our study suggested that there are qualitative and/or quantitative alterations in the microbial (fungal) composition in COVID-19 patients with severe disease as well as those with CAM.…”

Fungal infections in patients after recovering from COVID-19: a systematic review

“…The search conducted in the databases resulted in 1282 articles, of which 33 met the inclusion criteria 23 – 55 ( Figure 1 ). The reviewed articles are summarized in Table 1 .…”

A study on the morbid histopathological changes in COVID‐19 patients with or without comorbidities using minimally invasive tissue sampling

“…These changes did not differ significantly between patients with different underlying host factors 23 . Patients with severe COVID‐19 are at an increased risk to develop secondary fungal infections with aspergillus or mucor 24–27 . A review showed the prevalence of COVID‐19 associated pulmonary aspergillosis (CAPA) to be around 8.6%.…”

“… 23 Patients with severe COVID‐19 are at an increased risk to develop secondary fungal infections with aspergillus or mucor. 24 , 25 , 26 , 27 A review showed the prevalence of COVID‐19 associated pulmonary aspergillosis (CAPA) to be around 8.6%. Destruction of the bronchial mucosa and alveolar injury, COVID‐19 associated immune‐dysregulation, and immunosuppressive treatment is thought to create favorable conditions for fungal growth.…”