The rising burden of invasive fungal infections in COVID-19, can structured CT thorax change the game

Roopak Dubey,Mayank Goyal,Kamal Kumar Sen,Sudhansu Sekhar Mohanty,Sreedhar Mohan Menon,Sangram Panda

doi:10.1186/s43055-022-00694-3

Abstract

BackgroundThe occurrence of invasive fungal infections in COVID-19 patients is on surge in countries like India. Several reports related to rhino-nasal-sinus mucormycosis in COVID patients have been published in recent times; however, very less has been reported about invasive pulmonary fungal infections caused mainly by mucor, aspergillus or invasive candida species. We aimed to present 6 sputum culture proved cases of invasive pulmonary fungal infection (four mucormycosis and two invasive candidiasis) in COVID patients, the clues for the diagnosis of fungal invasion as well as difficulties in diagnosing it due to superimposed COVID imaging features.Case presentationThe HRCT imaging features of the all 6 patients showed signs of fungal invasion in the form of cavities formation in the pre-existing reverse halo lesions or development of new irregular margined soft tissue attenuating growth within the pre-existing or in newly formed cavities. Five out of six patients were diabetics. Cavities in cases 1, 2, 3 and 4 of mucormycosis were aggressive and relatively larger and showed relatively faster progression into cavities in comparison with cases 5 and 6 of invasive candidiasis.ConclusionIn poorly managed diabetics or with other immunosuppressed conditions, invasive fungal infection (mucormycosis, invasive aspergillosis and invasive candidiasis) should be considered in the differential diagnosis of cavitary lung lesions.

Highlights

The occurrence of invasive fungal infections in COVID-19 patients is on surge in countries like India
The victims of COVID-19 are incredibly prone to fungal and bacterial infections, especially those in an intensive care unit (ICU)
High-resolution computed tomography (HRCT) of thorax plays an important role in detecting the varied features of this dreadful condition early, if a follow-up scan for COVID-19 patients is undertaken in about ten days or as per protocol or HRCT undertaken in patients with chest infection and breathlessness with pre-existing risk factors and co-morbidities during this pandemic situation

Summary

Introduction

The occurrence of invasive fungal infections in COVID-19 patients is on surge in countries like India. We aimed to present 6 sputum culture proved cases of invasive pulmonary fungal infection (four mucormycosis and two invasive candidiasis) in COVID patients, the clues for the diagnosis of fungal invasion as well as difficulties in diagnosing it due to superimposed COVID imaging features. Aspergillosis, invasive candidiasis and mucormycosis are the most common associates [1,2,3,4,5,6]. The occurrence of these fungal co-infections is rising [1, 3, 4, 7, 8]. High-resolution computed tomography (HRCT) of thorax plays an important role in detecting the varied features of this dreadful condition early, if a follow-up scan for COVID-19 patients is undertaken in about ten days or as per protocol or HRCT undertaken in patients with chest infection and breathlessness with pre-existing risk factors and co-morbidities during this pandemic situation

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