key: cord-0996656-n5jhto5b
authors: Heard, Katie L; Hughes, Stephen; Mughal, Nabeela; Moore, Luke S P
title: COVID-19 and fungal superinfection
date: 2020-07-03
journal: Lancet Microbe
DOI: 10.1016/s2666-5247(20)30065-3
sha: 3c8186c6032eba045cf80f8b4c1dc0e3d473ab88
doc_id: 996656
cord_uid: n5jhto5b

nan

www.thelancet.com/microbe Vol 1 July 2020 e107

The Comment by Paul Verweij and colleagues 1 on diagnosing COVID-19associated pulmonary aspergillosis was insightful and much needed. We note some unanswered questions and review specific details of the studies cited. Zhang antibacterials in the ICU we suggest the addition of an antifungal, liposomal amphotericin B. This recommendation was extrapolated from seasonal influenza findings in the absence of available COVID-19 epidemiology data. 5 Of those patients admitted to the ICU, 24 (42%) of 57 received liposomal amphotericin B (median treatment of 6 days, range 1-16; Heard KL unpublished). No patients grew fungi from invasive samples, but 12 (50%) had fungi from superficial samples (rectal screening swabs, tracheal aspirates, or sputum); one of which had Aspergillus fumigatus in a sputum sample and 11 grew Candida spp from superficial swabs. 14 (58%) patients who started liposomal amphotericin B had a serum (1,3)-β-D-glucan antigen test: all were negative. The one patient who grew Aspergillus spp had a bronchoalveolar lavage 1 day before the sputum sample, which did not grow a fungus and had negative serum (1, 3)-β-D-glucan and galactomannan. Five (21%) patients developed acute kidney injury in the context of liposomal amphotericin B therapy.

Given our findings among patients with COVID-19, which include a notable incidence of Candida spp, minimal definitive invasive fungal infection, and a potential drug toxicity, we would like to add to the research questions posed by Verweij and colleagues. 1 We suggest COVID-19 fungal research should also explore invasive Candida spp as potential pathogens, the environmental factors (rapid changes to ICU capacity and infrastructure) that might increase the risk of COVID-19-associated pulmonary aspergillosis, and the potential harm of treating unproven invasive aspergillosis.

Diagnosing COVID-19-associated pulmonary aspergillosis

Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan

High prevalence of putative invasive pulmonary aspergillosis in critically ill COVID-19 patients

COVID-19 associated pulmonary aspergillosis

Post-influenza aspergillus ventriculitis