Fungal Infections Other Than Invasive Aspergillosis in COVID-19 Patients

Abstract

Invasive fungal disease (IFD) associated with Coronavirus Disease 2019 (COVID-19) has focussed predominantly on invasive pulmonary aspergillosis. However, increasingly emergent are non-Aspergillus fungal infections including candidiasis, mucormycosis, pneumocystosis, cryptococcosis, and endemic mycoses. These infections are associated with poor outcomes, and their management is challenged by delayed diagnosis due to similarities of presentation to aspergillosis or to non-specific features in already critically ill patients. There has been a variability in the incidence of different IFDs often related to heterogeneity in patient populations, diagnostic protocols, and definitions used to classify IFD. Here, we summarise and address knowledge gaps related to the epidemiology, risks, diagnosis, and management of COVID-19-associated fungal infections other than aspergillosis.

Keywords: COVID-19; SARS-CoV-2; fungal infections; non-Aspergillus fungi.

Figure 1

Chest Computer Tomography (CT) scan of a patient who had recovered from COVID-19 two months prior to presenting with new onset right-sided lower chest pain. Abnormalities on CT scan include a large mass lesion in the postero-basal segment of the right lower lobe with the beginnings of possible cavitation (arrow). A pleural effusion is present at the right lung base. The left lung shows consolidation with ground glass opacities. Fine needle aspiration of the right lower lobe mass yielded Rhizopus microsporus on culture with broad, pauci-septate irregular fungal hyphae seen on standard histopathological stains. [A]—anterior; [P]—posterior.