Abstract
We describe four secondary fungal infections caused by Mucorales species in COVID-19 patients. Three COVID-19 associated mucormycosis (CAM) occurred in ICU, one outside ICU. All were men aged > 50 years, three died. Clinical presentations included pulmonary, rhino-orbital cerebral and disseminated infection. Infections occurred in patients with and without diabetes mellitus. CAM is an emerging disease and our observations underscore the need to be aware of invasive mucormycosis, including in COVID-19 patients without (poorly controlled) diabetes mellitus and outside ICU.
Highlights
We describe four secondary fungal infections caused by Mucorales species in COVID-19 patients
Secondary fungal infections were described in critically-ill ventilated COVID-19 patients in the initial reports from Wuhan, and subsequent studies from Europe reported variable frequencies of 3% to 33% of COVID-19 associated pulmonary aspergillosis (CAPA), with reports of azole resistant strains [3,4,5,6,7]
Secondary fungal infections caused by Mucorales in critically ill COVID-19 patients were reported from India, with mortality rates ranging between 24.3% and 81% depending on the clinical manifestation [9,10]
Summary
Case series of four secondary mucormycosis infections in COVID-19 patients, the Netherlands, December 2020 to May 2021. We describe four secondary fungal infections caused by Mucorales species in COVID-19 patients. CAM is an emerging disease and our observations underscore the need to be aware of invasive mucormycosis, including in COVID-19 patients without (poorly controlled) diabetes mellitus and outside ICU. Secondary fungal infections were described in critically-ill ventilated COVID-19 patients in the initial reports from Wuhan, and subsequent studies from Europe reported variable frequencies of 3% to 33% of COVID-19 associated pulmonary aspergillosis (CAPA), with reports of azole resistant strains [3,4,5,6,7]. Secondary fungal infections caused by Mucorales in critically ill COVID-19 patients were reported from India, with mortality rates ranging between 24.3% and 81% depending on the clinical manifestation [9,10]. COVID-19 patients in the Netherlands diagnosed between December 2020 and May 2021, of which three developed the infection during ICU admission and three died
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