Chapter 15. Coronavirus Disease-2019 (COVID-19)-Positive Patients as Susceptible Hosts to Severe Fungal Coinfections

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Heloisa Freire Frota1,2, Carolline Margot Albanez Lorentino1, Luca Mokus dos Santos1, Marcos Vinicius Santos1, Nahyara Louize Miranda Siqueira1, Maryam Roudbary3, Lucimar Ferreira Kneipp4,5, Marta Helena Branquinha1,5 and André Luis Souza dos Santos1,2,5
1Laboratório de Estudos Avançados de Microrganismos Emergentes e Resistentes (LEAMER), Departamento de Microbiologia Geral, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
2Programa de Pós-Graduação em Bioquímica, Instituto de Química, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
3Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
4Laboratório de Taxonomia, Bioquímica e Bioprospecção de Fungos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
5Rede Micologia RJ – Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil

Part of the book: The Book of Fungal Pathogens

Abstract

Since the World Health Organization (WHO) declared the pandemic of coronavirus disease-2019 (COVID-19) on March 11th, 2020, the world has faced a health crisis that includes challenges such as its diagnosis, treatment and prevention, resulting in more than 595 million confirmed cases worldwide and more than 6.4 million deaths (August 25th, 2022). The infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leads to the suppression of the immune system, particularly due to the storm of inflammatory cytokines (e.g., TNF-α, IFN-γ, IL-6, IL-2 and IL-1) and the reduction of anti-inflammatory cells (e.g., CD4+ and CD8+ T lymphocytes). These factors, when associated with the use of steroids, prolonged stay in the intensive care unit (ICU), older age, diabetes, cardiovascular and pulmonary diseases as well as inherited and acquired immunodeficiency, contribute to the colonization of other infectious agents, such as respiratory viruses, gram-positive and gram-negative bacteria, yeasts and filamentous fungi. The incidence of opportunistic fungal infections has increased significantly in patients with COVID-19, especially in individuals with critical medical conditions and presenting comorbidities, such as the ones cited above. The main fungal agents causing coinfections in these particular patients are Aspergillus spp., Candida spp. and fungi belonging to the order Mucorales. The similarity of clinical symptoms between COVID[1]19 and fungal infections, such as fever, dry cough, dyspnea, myalgia and headache, makes it harder to get a conclusive laboratory identification and diagnosis, which represents a challenge for treatment. To worsen this bad scenario, the available antifungals are substantially limited and some fungal species are intrinsically resistant to classical chemotherapeutic drugs used in the clinical settings. In parallel, the antifungals can also present drug interactions besides serious and severe side effects, such as hepatotoxicity and nephrotoxicity, which can greatly aggravate the patients’ clinical condition. All these facts highlight the urgent need for early diagnosis of the fungal pathogens for the proper choice of antifungal treatment in order to combat these relevant yet still neglected diseases on a global scale. The present chapter focused on summarizing the main fungal infections reported in COVID-19-positive patients.

Keywords: COVID-19, fungal infections, SARS-CoV-2, coinfections


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