Role of tocilizumab for concomitant systemic fungal infection in severe COVID-19 patient

Sari, Anggraini Permata; Darnindro, Nikko; Yohanes, Aryan; Mokoagow, Muhammad Ikhsan

doi:10.1097/md.0000000000025173

Cited by 9 publications

(15 citation statements)

References 17 publications

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“…Nine case reports and seven case series were retrieved [108][109][110][111][112][113][114][115][116][117][118][119][120][121][122][123], together reporting 41 cases of candidemia (Table 4; detailed information about the individual studies is given in Table S4). The median time from ICU admission or intubation to the diagnosis of candidemia was 13.5 days (IQR 7.5-29.5), and more than 80% of the patients had an indwelling vascular catheter, received broad-spectrum antibiotics, and underwent mechanical ventilation before its onset.…”

Section: Case Reports and Case Seriesmentioning

confidence: 99%

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

Casalini

Giacomelli

Ridolfo

et al. 2021

JoF

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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 Pneumocystis jirovecii pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to Fusarium spp., and 1 case of pulmonary infection due to Scedosporium.

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Section: Case Reports and Case Seriesmentioning

confidence: 99%

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

Casalini

Giacomelli

Ridolfo

et al. 2021

JoF

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“… Distribution ( a ) and co-occurrence ( b ) of fungal species across randomly selected 50 case studies, prospective and retrospective published reports on fungal co-infections in hospitalized COVID-19 patients [ 5 , 7 , 9 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ] (also see Supplementary Table S1 ). Searches were done on PubMed (Medline) and Google Scholar using query terms such as “Co-infections”, “coinfections”, “fungi” or “Fungal infections” in combination with either “COVID-19” or “SARS-CoV-2”.…”

Section: Figurementioning

confidence: 99%

Risk Factors for Fungal Co-Infections in Critically Ill COVID-19 Patients, with a Focus on Immunosuppressants

Ezeokoli

Gcilitshana

Pohl

2021

JoF

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Severe cases of coronavirus disease 2019 (COVID-19) managed in the intensive care unit are prone to complications, including secondary infections with opportunistic fungal pathogens. Systemic fungal co-infections in hospitalized COVID-19 patients may exacerbate COVID-19 disease severity, hamper treatment effectiveness and increase mortality. Here, we reiterate the role of fungal co-infections in exacerbating COVID-19 disease severity as well as highlight emerging trends related to fungal disease burden in COVID-19 patients. Furthermore, we provide perspectives on the risk factors for fungal co-infections in hospitalized COVID-19 patients and highlight the potential role of prolonged immunomodulatory treatments in driving fungal co-infections, including COVID-19-associated pulmonary aspergillosis (CAPA), COVID-19-associated candidiasis (CAC) and mucormycosis. We reiterate the need for early diagnosis of suspected COVID-19-associated systemic mycoses in the hospital setting.

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“…A total of 23 articles were included in the final review with six studies [12,16,23,25,28,31] describing candida and the rest describing mucormycosis. The total number of patients included was 79 (61 from the candida infection pool and 18 from mucormycosis).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Candida infection was found mostly in the bloodstream -seen in 57 out of the 61 patients. [23,25,28,31] Three patients had the infection in their respiratory tract, [12] and one patient presented with features in bilateral eyes. [16] The infection was noted mostly as worsening of clinical and laboratory parameters of COVID.…”

Section: Outcomes From the Cohort Of Patients Diagnosed With Candidamentioning

confidence: 99%

“…[12] Anticoagulation was achieved mainly by enoxaparin and dexamethasone was the steroid of choice in most of the patients. 26 out of the 61 patients received antibiotics [12,16,23,31] and two of the patients received anti-fungal treatment. [16,31] Four patients had also received IL-6 inhibitor drugs.…”

Section: Outcomes From the Cohort Of Patients Diagnosed With Candidamentioning

confidence: 99%

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Mucormycosis and Candida Infections in Patients of COVID-19 Pneumonia: A Systematic Review

Gupta

Sharma

2021

GJEID

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Introduction:The city of Wuhan in China reported the first case of coronavirus, termed as SARS-CoV-2, in December 2019. To date, 187,827,660 cases have been reported to the WHO (3).With current research focusing on potential therapeutic agents for the coronavirus disease and vaccines, there remain major gaps in our understanding of the pathophysiology and clinical course of this viral pneumonia. Secondary infections are one of them. In this systematic review, we analyze the outcomes of two fungal infections in patients of COVID-19, viz. Mucormycosis and candida. Methodology: A systematic review has been done on secondary infections with mucor and candida fungi in patients of COVID-19. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used. Twenty-three studies were included in the final analysis. Our review included studies from various countries across the globe. The risk of bias was analyzed using the NIH Quality Assessment Tool for Case Series Studies. This study did not require ethical approval as data was obtained from already available databases, and patients were not directly involved. Results: A total of 23 articles were included in the final review and the total number of patients included was 79 Male: female ratio was calculated to be 1.6 and the average age of patients was 52 years (ranging from 24-86 years). Various types of comorbidities were seen in the included patients, the most common being diabetes mellitus. Among the 18 patients in the cohort of mucormycosis, 7 patients died and four studies did not report patient outcomes. Among the 61 patients, 13 patients died and one patient was still ventilated at the time of publication. Conclusion: Secondary infections after COVID-19 are a cause of major concerns. Further studies and case reports are needed to better understand the various other types of secondary infections and also to formulate strategies to prevent these.

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Role of tocilizumab for concomitant systemic fungal infection in severe COVID-19 patient

Cited by 9 publications

References 17 publications

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

Risk Factors for Fungal Co-Infections in Critically Ill COVID-19 Patients, with a Focus on Immunosuppressants

Mucormycosis and Candida Infections in Patients of COVID-19 Pneumonia: A Systematic Review

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