Fungal complications with the new coronavirus infection COVID-19
- Authors: Avdeeva M.G.1, Zotov S.V.2, Kulbuzheva M.I.3,2, Moshkova D.Y.3,2, Zhuravleva Y.V.2
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Affiliations:
- Kuban State Medical University
- Specialized Clinical Hospital of Infectious Diseases
- Kuban State Medical University, Krasnodar
- Issue: Vol 26, No 6 (2021)
- Pages: 252-269
- Section: ORIGINAL STUDIES
- URL: https://journals.rcsi.science/1560-9529/article/view/108872
- DOI: https://doi.org/10.17816/EID108872
- ID: 108872
Cite item
Abstract
BACKGROUND: The growth of fungal pathology observed in the last decade, including life-threatening invasive mycoses, is associated with the spread of immunodeficiency states of various etiologies. The COVID-19 pandemic has made a negative contribution, causing a significant increase in the number of patients with fungal complications.
AIM: To characterize the types of fungal complications in the acute period of a new coronavirus infection COVID-19 based on an analysis of the clinical course and therapeutic tactics for managing the underlying disease.
MATERIALS AND METHODS: The results of a bacteriological study of 1284 cultures from sputum samples of patients with suspected secondary pneumonia in COVID-19 are considered. The study included 404 cultures of various types of fungi. The analysis of the clinical picture was carried out in 70 patients with fungal complications of various localization, who were treated in a regional covid hospital. This group included the results of microbiological examination of sputum, bronchoalveolar lavage (BAL), scrapings from lesions in the oropharynx, urine, blood, biopsy and autopsy material. The study was conducted from April 01, 2020 to December 31, 2021. The patients were divided into subgroups depending on the isolated pathogen: Candida spp. ― 64 patients, and fungi (Aspergillus spp. and Mucor spp.) ― 6 patients; outcome of the disease: favorable — 66, lethal — 4.
RESULTS: In the microbial landscape of the respiratory tract in patients with COVID-19, gram-negative microbial flora prevailed, one third of the cultures were represented by fungi. During the two years of the pandemic, the proportion of fungal cultures increased from 26.9% in 2020 to 34.2% in 2021, while maintaining sensitivity to amphotericin B and fluconazole in most cases. In 2021, there was a negative growth trend in the sputum of molds of the species Aspergillus spp. (5 cultures) and Mucor spp. (1 culture).
Typical fungal complications of COVID-19 were: candidiasis stomatitis caused by Candida albicans (71%), candidiasis of other urogenital localizations in the form of candiduria (20%), lung damage of mixed viral-fungal etiology in isolated cases, leading to death due to invasive mycosis. Only fungal flora was isolated in 57.1% of cases, various combinations of fungal and bacterial flora — in 42.9%. Candidiasis stomatitis was diagnosed on average on day 11.6±1.08 of COVID-19, which corresponded to days 2-3 of hospitalization. Preceding outpatient treatment, in most cases, included antibiotics and hormonal therapy with glucocorticosteroids. Urogenital Urogenital fungal infection was diagnosed on the 17.7±5.17 day of illness, on the second week of hospital treatment (8.0±3.11 days). Fungal flora in sputum was determined on average on the 18.5±4.33 day of illness, on the second — third week of hospitalization against the background of intensive immunosuppressive therapy.
CONCLUSION: Risk factors for the development of fungal complications are the age of patients older than 50 years, overweight and hypertension, uncontrolled use of antibiotics and glucocorticosteroids at the prehospital stage. Mycoses are recorded in both severe and moderate COVID-19. An additional factor in their development is immunosuppressive therapy of the underlying disease. The most formidable complication of the course of COVID-19, worsening the prognosis of survival, is the addition of fungi with invasive growth — Aspergillus spp., Mucor, as well as the development of fungal-bacterial associations with damage to the lung tissue.
In the context of the ongoing SARS-CoV-2 pandemic, the use of immunomodulatory agents, including the combined use of corticosteroids and targeted immunosuppressive drugs, it is important to develop a risk-based approach in diagnosis and treatment for patients at risk of generalized and invasive mycoses.
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##article.viewOnOriginalSite##About the authors
Marina G. Avdeeva
Kuban State Medical University
Email: avdeevam@mail.ru
ORCID iD: 0000-0002-4979-8768
SPIN-code: 2066-2690
Scopus Author ID: 6603810508
ResearcherId: P-2254-2017
MD, Dr. Sci. (Med.), Professor
Russian Federation, 4, Sedina str., Krasnodar, 350063Sergey V. Zotov
Specialized Clinical Hospital of Infectious Diseases
Email: bak2554065@yandex.ru
ORCID iD: 0000-0002-7661-6982
SPIN-code: 6376-6170
MD, Cand. Sci. (Med.), Associate Professor
Russian Federation, 4, Sedina str., Krasnodar, 350063Makka I. Kulbuzheva
Kuban State Medical University, Krasnodar; Specialized Clinical Hospital of Infectious Diseases
Email: kulbuzhevamakka@yandex.ru
ORCID iD: 0000-0003-1817-6664
SPIN-code: 8090-3715
MD, Cand. Sci. (Med.), Associate Professor
Russian Federation, 4, Sedina str., Krasnodar, 350063; KrasnodarDaria Yu. Moshkova
Kuban State Medical University, Krasnodar; Specialized Clinical Hospital of Infectious Diseases
Email: mrs_darya@mail.ru
ORCID iD: 0000-0003-1401-6970
SPIN-code: 9489-0057
MD, Cand. Sci. (Med.), Associate Professor
Russian Federation, 4, Sedina str., Krasnodar, 350063; KrasnodarYelena V. Zhuravleva
Specialized Clinical Hospital of Infectious Diseases
Author for correspondence.
Email: bak2554065@yandex.ru
ORCID iD: 0000-0002-0357-6131
Russian Federation, 4, Sedina str., Krasnodar, 350063
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