Abstract
While COVID-19-associated pulmonary aspergillosis is now well described in developed countries, COVID-19-associated mucormycosis (CAM) has seemed to remain quite rare in Europe. A retrospective study was performed between March 2020 to September 2021 among COVID-19 adult patients in the intensive care unit (ICU) at Toulouse Hospital (Southern France). PCR screening on respiratory samples, which target Aspergillus or Mucorales DNA, were performed, and the number of fungal detections was evaluated monthly during the study period. During the 19 months of the study, 44 (20.3%) COVID-19 ICU patients had a positive PCR for Aspergillus, an overall rate in keeping with the incidence of ICU COVID-19 patients. Ten patients (7.1%) had a positive Mucorales PCR over the same period. Surprisingly, 9/10 had a positive Mucor/Rhizopus PCR in August-September 2021, during the fourth Delta SARS-CoV-2 variant wave. Epidemic investigations have identified a probable environmental cause linked to construction works in the vicinity of the ICU (high levels of airborne spores due to the mistaken interruption of preventive humidification and summer temperature). Even if CAM are apparently rare in Europe, a cluster can also develop in industrialised countries when environmental conditions (especially during construction work) are associated with a high number of COVID-19 patients in the ICU.
Highlights
IntroductionReports of secondary fungal infections following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been increasing worldwide
From 1 March 2020 to 30 September 2021, 639 PCR-positive SARS-CoV-2 patients were hospitalised in the intensive care unit (ICU) at Toulouse University Hospital (Figure 1)
We report an alarming increase in Mucor/Rhizopus-positive PCRs in respiratory samples of COVID-19 patients hospitalised in the Toulouse university hospital
Summary
Reports of secondary fungal infections following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been increasing worldwide. COVID-19-associated pulmonary aspergillosis (CAPA) has been described since the beginning of the pandemic [1], especially in patients in the intensive care unit (ICU). CAPA, associated with poor outcomes, is well described in Europe [2]. The recent increase in COVID-19 cases in India have been associated with increasing reports of COVID-19-associated mucormycosis (CAM) [3], and in this country is a notifiable disease [4]. CAM seemed to remain quite rare in Europe, at approximately 1% according to the French multicentre MYCOVID study [5]
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