Invasive Pulmonary Fungal Infection Risk in Severe SARS-CoV-2-Related Pneumonia

There appears to be a low risk of invasive fungal secondary infection, especially aspergillosis, in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related pneumonia and no underlying immunosuppression, according to study results published in the American Journal of Respiratory and Critical Care Medicine.

Whether coronavirus disease 2019 (COVID-19) is a significant risk factor for the development of invasive fungal superinfections is of great medical interest. Therefore, researchers assessed the occurrence of invasive fungal respiratory superinfections in patients with severe COVID-19 by studying 145 patients with severe SARS-CoV-2-related pneumonia admitted to 5 intensive care units (ICUs) in France. Few patients presented with preexisting host risk factors for invasive fungal infection (n=20; 14%). However, their global severity was high: all patients were on invasive mechanical ventilation and half (n= 73, 54%) were on extracorporeal membrane oxygenation support.

Mycologic analysis included 2815 mycologic tests (culture, galactomannan, beta-glucan, and polymerase chain reaction [PCR]) performed on 475 respiratory samples and 532 sera. Invasive pulmonary fungal infection was diagnosed in 7 patients, amounting to a 4.8% incidence. Multivariate analysis indicates that solid organ transplant recipients appear particularly at risk for developing invasive aspergillosis (P =.004). Contrary to what has previously been reported, the relevant data indicate a low risk of invasive fungal complications in immunocompetent patients admitted to the ICU for severe COVID-19. In these patients, contamination/clinically irrelevant colonization is frequent (17.2% in our series) and should not lead to the initiation of antifungal treatment.

“Our results indicate that patients with severe SARS-CoV-2 related pneumonia and no underlying immunosuppression seem at low risk of pulmonary invasive fungal secondary infection, especially aspergillosis,” stated the authors. “As the outbreak continues to spread, other reports are required to confirm these results.”

Reference

Fekkar A, Lampros A, Mayaux J, et al. Occurrence of invasive pulmonary fungal infections in severe COVID-19 patients admitted to the ICU. Am J Respir Crit Care Med. Published online December 2, 2020. doi:10.1164/rccm.202009-3400OC