Abstract
The recent global pandemic of COVID-19 has predisposed a relatively high number of patients to acute respiratory distress syndrome (ARDS), which carries a risk of developing super-infections. Candida species are major constituents of the human mycobiome and the main cause of invasive fungal infections, with a high mortality rate. Invasive yeast infections (IYIs) are increasingly recognized as s complication of severe COVID-19. Despite the marked immune dysregulation in COVID-19, no prominent defects have been reported in immune cells that are critically required for immunity to Candida. This suggests that relevant clinical factors, including prolonged ICU stays, central venous catheters, and broad-spectrum antibiotic use, may be key factors causing COVID-19 patients to develop IYIs. Although data on the comparative performance of diagnostic tools are often lacking in COVID-19 patients, a combination of serological and molecular techniques may present a promising option for the identification of IYIs. Clinical awareness and screening are needed, as IYIs are difficult to diagnose, particularly in the setting of severe COVID-19. Echinocandins and azoles are the primary antifungal used to treat IYIs, yet the therapeutic failures exerted by multidrug-resistant Candida spp. such as C. auris and C. glabrata call for the development of new antifungal drugs with novel mechanisms of action.
Highlights
Yeast species belonging to the Candida genus, including Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida krusei, are the most prevalent fungal species inhabiting various mucosal surfaces, such as the skin and the respiratory, digestive, and urinary tracts [1,2]
acute respiratory distress syndrome (ARDS) [19], may allow commensal Candida to cells to invade internal organs [20,21,22,23,24,25,26,27]. The goals of this manuscript are to review our current knowledge on Candida super-infections among COVID-19 patients, discuss the potential immunological and clinical factors predisposing these patients to invasive candidiasis, and outline what studies are needed to better define the epidemiology of this superinfection
angiotensin-converting enzyme 2 (ACE2) is required for protection from severe acute lung injury in ARDS [30], and the viral-mediated manipulation of this receptor is considered one major mechanism contributing to severe lung injury in selected COVID-19 patients
Summary
Yeast species belonging to the Candida genus, including Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida krusei, are the most prevalent fungal species inhabiting various mucosal surfaces, such as the skin and the respiratory, digestive, and urinary tracts [1,2]. Being commensal within the human host, Candida species are equipped with virulence attributes, enabling them to invade when opportunities arise and cause various infections in humans, especially when the immune system is impaired [2] Superficial infections, such as skin disorders; mucosal infections, including oropharyngeal or vulvovaginitis candidiasis; and invasive candidiasis are established clinical entities of candidiasis [3,4,5,6,7,8]. ARDS [19], may allow commensal Candida to cells to invade internal organs [20,21,22,23,24,25,26,27] The goals of this manuscript are to review our current knowledge on Candida super-infections among COVID-19 patients, discuss the potential immunological and clinical factors predisposing these patients to invasive candidiasis, and outline what studies are needed to better define the epidemiology of this superinfection
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