key: cord-028529-d1g33f1c
authors: Agrifoglio, Alexander; Cachafeiro, Lucía; Figueira, Juan Carlos; Manuel Añón, José; García de Lorenzo, Abelardo
title: COVID-19 and fungal co-infections: we must keep them in mind
date: 2020-07-04
journal: J Mycol Med
DOI: 10.1016/j.mycmed.2020.101012
sha: 
doc_id: 28529
cord_uid: d1g33f1c

nan

Approximately seven months have passed since the pandemic caused by COVID-19 and there are definitely still many questions to be resolved and above all, much to learn.

We have carefully read the editorial titled "Invasive fungal diseases during COVID-19: We should be prepared" [1] and congratulate Pr. J.-P. Gangneux and rest of the authors for such an interesting initiative. As well described in the manuscript, invasive fungal infections are beginning to be described in some series but unfortunately many remain undiagnosed and the actual impact on mortality, hospital stay and other complications is unknown. In this unprecedented situation in which we are involved, early microbiological diagnosis is decisive.

In recent months and following this same line of research, other articles have been published that refer to fungal co-infections developed in critically ill patients COVID-19. How the authors describe, there seems to be an association between COVID-19 and the presence of invasive pulmonary aspergillosis (IPA), which, of course, will require more research to support these preliminary results. With the data discussed above, we decided to perform a retrospective analysis from February 28th to June 28th of critically ill patients diagnosed with COVID-19 viral pneumonia admitted to our ICU and the association with fungal infections. Of 139 critically ill patients admitted, Aspergillus fumigatus complex was isolated in 2 patients, Candida sp. in urine culture in 6, and what caught our attention was the diagnosis of 15 candidaemia (9 C. albicans, 4 C. parapsilosis and 2 C. glabrata). The mean age of the patients with candidaemia was 58.717.5 years and at the time of diagnosis all were under mechanical ventilation, requiring vasopressor therapy, were carriers of central venous catheters, had received parenteral nutrition, and received corticosteroid treatment for ARDS. The mortality was 40%. This overwhelming incidence of candidaemia in 5 months contrasts with the data that we recently published about candidaemia in an observation period of seven years 5.

Therefore, these findings logically need to be confirmed in future clinical trials and to determine the potential role of invasive candidiasis in patients with COVID-19 but according with the data that we currently have and to our series of patients, we share with the authors same recommendations and goals such as epidemiological vigilance, optimizing early diagnosis and the introduction of treatment protocols. Finally, we believe that part of the measures to successfully overcome this pandemic is to share experiences and information, which is why we support all initiatives aimed at that purpose.

Ethics approval and consent participate: Not applicable.

Availability of data and materials: Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Invasive fungal diseases during COVID-19: We should be prepared

COVID-19 associated pulmonary aspergillosis

Invasive pulmonary aspergillosis complicating COVID-19 in the ICU -A case report

Fatal Invasive Aspergillosis and Coronavirus Disease in a Immunocompetent Patient

Impact of candidaemia on mortality of critically ill burned patients

The authors declare that they have no competing interests.