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Observational Study
. 2021 Nov:188:106619.
doi: 10.1016/j.rmed.2021.106619. Epub 2021 Sep 17.

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

Gonzalo Segrelles-Calvo  1 , Glauber R de S Araújo  2 , Estefanía Llopis-Pastor  3 , Javier Carrillo  4 , Marta Hernández-Hernández  3 , Laura Rey  3 , Nestor Rodríguez Melean  3 , Inés Escribano  1 , Esther Antón  3 , Celia Zamarro  3 , Mercedes García-Salmones  4 , Susana Frases  5
Affiliations
Observational Study

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

Gonzalo Segrelles-Calvo et al. Respir Med. 2021 Nov.

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.

Keywords: COVID-19; Candida; Systemic candidiasis; Viral pneumonia.

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Figures

Fig. 1
Fig. 1
Flow chart of patients and samples included in the study. From the 890 COVID-19 patients that were admitted to the Rey Juan Carlos University Hospital (HURJ), from February 1st to April 30th, 2020, 215 individuals needed ICU/RICU support. Among those, 31 patients were Candida spp.-positive (14.419%) and the rest (85.581%) were negative for this fungal pathogen.
See this image and copyright information in PMC

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