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Multicenter Study
. 2020 Apr-Jun;37(2):41-46.
doi: 10.1016/j.riam.2020.07.001. Epub 2020 Sep 14.

Fungal co-infection in COVID-19 patients: Should we be concerned?

Javier Pemán  1 , Alba Ruiz-Gaitán  2 , Carolina García-Vidal  3 , Miguel Salavert  4 , Paula Ramírez  5 , Francesc Puchades  6 , Marta García-Hita  7 , Ana Alastruey-Izquierdo  8 , Guillermo Quindós  9
Affiliations
Multicenter Study

Fungal co-infection in COVID-19 patients: Should we be concerned?

Javier Pemán et al. Rev Iberoam Micol. 2020 Apr-Jun.

Abstract
in English, Spanish

Critically ill COVID-19 patients have higher pro-inflammatory (IL-1, IL-2, IL-6, tumor necrosis alpha) and anti-inflammatory (IL-4, IL-10) cytokine levels, less CD4 interferon-gamma expression, and fewer CD4 and CD8 cells. This severe clinical situation increases the risk of serious fungal infections, such as invasive pulmonary aspergillosis, invasive candidiasis or Pneumocystis jirovecii pneumonia. However, few studies have investigated fungal coinfections in this population. We describe an update on published reports on fungal coinfections and our personal experience in three Spanish hospitals. We can conclude that despite the serious disease caused by SARS-CoV-2 in many patients, the scarcity of invasive mycoses is probably due to the few bronchoscopies and necropsies performed in these patients because of the high risk in aerosol generation. However, the presence of fungal markers in clinically relevant specimens, with the exception of bronchopulmonary colonization by Candida, should make it advisable to early implement antifungal therapy.

Los pacientes gravemente enfermos con COVID-19 presentan concentraciones más elevadas de citoquinas pro-inflamatorias (IL-1, IL-2, IL-6 y factor de necrosis tumoral alfa) y anti-inflamatorias (IL-4 e IL-10), menor expresión de interferón-gama y un número más bajo de células CD4 y CD8. Esta grave situación clínica aumenta el riesgo de padecer coinfecciones fúngicas, como la aspergilosis pulmonar invasora, la candidiasis invasora o la neumonía por Pneumocystis jirovecii. Sin embargo, pocos estudios han investigado las coinfecciones fúngicas en esta población. En esta revisión describimos una actualización de las publicaciones sobre coinfecciones fúngicas en esta población de pacientes y nuestra experiencia personal en tres hospitales españoles. Podemos concluir que a pesar de la grave enfermedad causada por el SARS-CoV-2 en muchos pacientes, la baja frecuencia de micosis invasoras se debe probablemente a las pocas broncoscopias y necropsias realizadas en estos pacientes debido al alto riesgo de producción de aerosoles. Sin embargo, la presencia de marcadores fúngicos en muestras clínicas relevantes, con la excepción de la colonización broncopulmonar por Candida, debería aconsejar la instauración precoz de una terapia antifúngica.

Keywords: Aspergillosis; Aspergilosis; COVID-19; Candidiasis; Coinfección fúngica; Fungal coinfection; Invasive mycoses; Micosis invasiva; Neumocistosis; Pneumocystosis; SARS-CoV-2.

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