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Review
. 2021 Dec 4;13(4):1018-1035.
doi: 10.3390/idr13040093.

Root Causes of Fungal Coinfections in COVID-19 Infected Patients

Arman Amin  1 , Artin Vartanian  2 , Nicole Poladian  1 , Alexander Voloshko  1 , Aram Yegiazaryan  1 , Abdul Latif Al-Kassir  1 , Vishwanath Venketaraman  1
Affiliations
Review

Root Causes of Fungal Coinfections in COVID-19 Infected Patients

Arman Amin et al. Infect Dis Rep. .

Abstract

COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has infected over 200 million people, causing over 4 million deaths. COVID-19 infection has been shown to lead to hypoxia, immunosuppression, host iron depletion, hyperglycemia secondary to diabetes mellitus, as well as prolonged hospitalizations. These clinical manifestations provide favorable conditions for opportunistic fungal pathogens to infect hosts with COVID-19. Interventions such as treatment with corticosteroids and mechanical ventilation may further predispose COVID-19 patients to acquiring fungal coinfections. Our literature review found that fungal coinfections in COVID-19 infected patients were most commonly caused by Aspergillus, Candida species, Cryptococcus neoformans, and fungi of the Mucorales order. The distribution of these infections, particularly Mucormycosis, was found to be markedly skewed towards low- and middle-income countries. The purpose of this review is to identify possible explanations for the increase in fungal coinfections seen in COVID-19 infected patients so that physicians and healthcare providers can be conscious of factors that may predispose these patients to fungal coinfections in order to provide more favorable patient outcomes. After identifying risk factors for coinfections, measures should be taken to minimize the dosage and duration of drugs such as corticosteroids, immunosuppressants, and antibiotics.

Keywords: Aspergillosis; COVID-19; Candidiasis; Cryptococcosis; co-infection risk factors; fungal infection.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart outlining the number of articles accessed from online biomedical databases.
Figure 2
Figure 2
Income grouping of countries facing human resources for health crisis (HRH) according to World Health Organization (WHO) [32,33,34,35].
Figure 3
Figure 3
Therapies, clinical conditions, and pre-existing conditions that put patients with COVID-19 at risk for developing Fungal Coinfections.
Figure 4
Figure 4
Factors contributing to the pathogenesis of Mucormycosis coinfections in patients with severe COVID-19 [54,63,64,65,66,67,68].
See this image and copyright information in PMC

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