Fungal Co-infection Research Articles

Frequency and antimicrobial resistance pattern of bacterial isolates from patients with COVID-19 in two hospitals of Zanjan.

Background and Objectives:The outbreak of COVID-19 has been challenging the global health systems. As one of the major associated concerns, microbial co-infections and antimicrobial resistance play critical roles in the prognosis of the disease. This study aims to evaluate co-infections in COVID-19 patients regarding drug resistance.Materials and Methods:A total number of 5530 Real Time PCR-confirmed COVID-19 cases, who were admitted to two major educational Hospitals in Zanjan, Iran, from February 2019 to February 2020 were included. Respiratory, blood and urine specimens were collected and cultured on selective media. Subsequently, isolates identification, disc diffusion susceptibility tests, and data analysis were carried out.Results:Bacterial and fungal co-infections were confirmed in 423 patients (8.1%). Co-infections were more prevalent among females (53.2%) than males (46.8%). Coinfected patients had a significantly higher mortality rate compared to those without co-infections (54.8% vs. 12.2%, P<0.001). Acinetobacter baumannii was the most prevalent bacteria isolated from respiratory tract (15.4%) and blood (2.1%). Escherichia coli (12.5%) was the most frequent bacteria in urine. Fungal co-infection was confirmed in 174 (3.36%) patients. Gram-negative bacteria were highly sensitive to colistin (97.85%) and widely resistant to cefixime (91.79%) and trimethoprim-sulfamethoxazole (89.64%). Gram-positive bacteria were considerably sensitive to vancomycin (68%) and nitrofurantoin (66%). Tetracycline and ampicillin were the least effective antibiotics for Gram-positive bacteria with respective resistance rates of 90.91% and 83.33%.Conclusion:Given the high incidence of bacterial co-infections in COVID-19 patients, it is important to develop rapid and efficient diagnostic, therapeutic and disinfection guidelines to control these infections in the hospitals.

Worldwide prevalence of microbial agents' coinfection among COVID-19 patients: A comprehensive updated systematic review and meta-analysis.

BackgroundTo provide information about pathogens’ coinfection prevalence with SARS‐CoV‐2 could be a real help to save patients’ lives. This study aims to evaluate the pathogens’ coinfection prevalence among COVID‐19 patients.MethodIn order to find all of the relevant articles, we used systematic search approach. Research‐based databases including PubMed, Web of Science, Embase, and Scopus, without language restrictions, were searched to identify the relevant bacterial, fungal, and viral coinfections among COVID‐19 cases from December 1, 2019, to August 23, 2021. In order to dig deeper, other scientific repositories such as Medrxiv were probed.ResultsA total of 13,023 studies were found through systematic search. After thorough analysis, only 64 studies with 61,547 patients were included in the study. The most common causative agents of coinfection among COVID‐19 patients were bacteria (pooled prevalence: 20.97%; 95% CI: 15.95–26.46; I 2: 99.9%) and less frequent were virus coinfections (pooled prevalence: 12.58%; 95% CI: 7.31–18.96; I 2: 98.7%). The pooled prevalence of fungal coinfections was also 12.60% (95% CI: 7.84–17.36; I 2: 98.3%). Meta‐regression analysis showed that the age sample size and WHO geographic region did not influenced heterogeneity.ConclusionWe identified a high prevalence of pathogenic microorganism coinfection among COVID‐19 patients. Because of this rate of coinfection empirical use of antibacterial, antifungal, and antiviral treatment are advisable specifically at the early stage of COVID‐19 infection. We also suggest running simultaneously diagnostic tests to identify other microbiological agents’ coinfection with SARS‐CoV‐2.

Management of Severe Influenza.

Influenza infection causes severe illness in 3 to 5 million people annually, with up to an estimated 650,000 deaths per annum. As such, it represents an ongoing burden to health care systems and human health. Severe acute respiratory infection can occur, resulting in respiratory failure requiring intensive care support. Herein we discuss diagnostic approaches, including development of CLIA-waived point of care tests that allow rapid diagnosis and treatment of influenza. Bacterial and fungal coinfections in severe influenza pneumonia are associated with worse outcomes, and we summarize the approach and treatment options for diagnosis and treatment of bacterial and Aspergillus coinfection. We discuss the available drug options for the treatment of severe influenza, and treatments which are no longer supported by the evidence base. Finally, we describe the supportive management and ventilatory approach to patients with respiratory failure as a result of severe influenza in the intensive care unit.

Outcomes among critically ill adults with influenza infection.

Influenza infection is a major cause of mortality in critical care units. ata on critically ill adult patients with influenza infection from 2014 to 2019 were retrospectively collected, including mortality and critical care resource utilization. Independent predictors of mortality were identified using Cox regression. ne hundred thirty patients with confirmed influenza infection had a mean age of 56 (SD 16) years; 72 (55%) were male. Mean Acute Physiology and Chronic Health Evaluation (APACHE II) score was 22 (SD 9). One hundred eight (83%) patients had influenza A (46% H1N1pdm09, 33% H3N2); 21 (16%) had influenza B. Fifty-five (42%) patients had bacterial co-infection. Only 5 (4%) had fungal co-infection. One hundred eight (83%) patients required mechanical ventilation; 94 (72%), vasopressor support; 26 (20%), continuous renal replacement therapy (CRRT); and 11 (9%), extracorporeal membrane oxygenation. One hundred twenty one (93%) patients received antiviral therapy (median 5 d). Thirty-day mortality was 23%. Patients who received antiviral treatment were more likely to survive with an adjusted hazard ratio (aHR) of 0.15 (95% CI 0.04 to 0.51, p = 0.003). Other independent predictors of mortality were the need for CRRT (aHR 2.48, 95% CI 1.14 to 5.43, p= 0.023), higher APACHE II score (aHR 1.08, 95% CI 1.02 to 1.14, p = 0.011), and influenza A (aHR 7.10, 95% CI 1.37 to 36.8, p = 0.020) compared with influenza B infection. mong critically ill influenza patients, antiviral therapy was independently associated with survival. CRRT, higher severity of illness, and influenza A infection were associated with mortality.

Assessment of mycoviral diversity in Pakistani fungal isolates revealed infection by 11 novel viruses of a single strain of Fusarium mangiferae isolate SP1.

An extensive screening survey was conducted on Pakistani filamentous fungal isolates for the identification of viral infections. A total of 396 fungal samples were screened, of which 36 isolates were found double-stranded (ds) RNA positive with an overall frequency of 9% when analysed by a classical dsRNA isolation method. One of 36 dsRNA-positive strains, strain SP1 of a plant pathogenic fungus Fusarium mangiferae, was subjected to virome analysis. Next-generation sequencing and subsequent completion of the entire genome sequencing by a classical Sanger sequencing method showed the SP1 strain to be co-infected by 11 distinct viruses, at least seven of which should be described as new taxa at the species level according to the ICTV (International Committee on Taxonomy of Viruses) species demarcation criteria. The newly identified F. mangiferae viruses (FmVs) include two partitivirids, one betapartitivirus (FmPV1) and one gammapartitivirus (FmPV2); six mitovirids, three unuamitovirus (FmMV2, FmMV4, FmMV6), one duamitovirus (FmMV5), and two unclassified mitovirids (FmMV1, FmMV3); and three botourmiavirids, two magoulivirus (FmBOV1, FmBOV3) and one scleroulivirus (FmBOV2). The number of coinfecting viruses is among the largest ones of fungal coinfections. Their molecular features are thoroughly described here. This represents the first large virus survey in the Indian sub-continent.

Abdominal wall fungal co-infection mucormycosis associated with COVID-19: a case report.

Abdominal wall fungal co-infection mucormycosis associated with COVID-19: a case report.

IN VITRO EFFECTIVENESS OF FUNGAL DRUGS ON FUNGAL ISOLATES CAUSING MUCORMYCOSIS IN POSTCOVID PATIENTS

Covid-19 pandemic triggered Mucormycosis as fast progressing dreadful multidrug resistant fungal coinfection in post covid patients. The present study aimed to compare the efficacy of eight commercially available antifungal tablets on fungal pathogen of Mucormycosis isolated from two postcovid patients clinical samples. In this study eight antifungal tablets were used i.e. Zocon 150 mg, Nuforce 150 mg, Flucanzole 150 mg, Fussy 150 mg, Itrostred 200 mg, Candiforce 200 mg, Terbinaforce 250 mg and Grisovin FP 250 mg. Fungal pathogens were isolated on SDS agar by spread plate technique and identified. We observed Multipal Fungal Rare Mix Infection. Along with Mucor spp. and Candida spp. we observed rare Fusarium spp. and Alterneria Spp. and Aspergillus spp. were stored in pure culture on SDS agar slant. The speed of growth of Mucor spp. was reported as one and half times more than usual. The antifungal activity was studied by paper disc diffusion method on the lawn culture of Mucor spp. and Candida spp. The zone of inhibition (ZOI) of above eight antifungal tablets against Mucor spp. was 21mm, 27mm, 32mm, 21mm, 25mm, 11mm, 56mm and 37mm respectively. But for the Candida spp. out of eight tablets only one i.e. Grisovin FP 250mg showed 15mm zone of inhibition, remaining all were resistant. Thus Terbinaforce 250 mg and Grisovin FP 250 mg can be used as alternatives in antifungal therapy of mucormycosis in postcovid patients. Cocktail of Terbinaforce 250 mg and Grisovin FP 250 mg gives very good results against Mucor spp.

Mucormycosis in COVID-19 patients: predisposing factors, prevention and management.

India is considered the diabetes capital of the world and has the highest burden of mucormycosis. Bacterial, viral and fungal co-infections are increasingly being reported in severe acute respiratory syndrome virus 2 (SARSCoV-2) infected patients. India is one of the worst affected countries during the second wave of the COVID-19 pandemic. This combination of diabetes mellitus, COVID-19 and mucormycosis has led to the drastic upsurge of COVID-19-associated mucormycosis (CAM) in India. Immunosuppression, iron disequilibrium, endothelial injury, ketoacidosis and hypoxia are some of the other COVID-19-related risk factors for CAM. There has been an increase in the proportion of mucormycosis affecting paranasal sinuses and central nervous system (CNS) in CAM compared to pre-COVID-19 literature due to the SARSCoV-2-related pathophysiological mechanisms, complications and treatment strategies. CAM is a medical and surgical emergency, and it can present with non-specific symptoms and signs initially resulting in diagnostic delay. High index of suspicion and regular screening for features of CAM are of paramount importance to prevent lethal consequences. Rapid action with a tripod approach consisting of withdrawal of immunomodulators, early antifungal therapy and extensive surgical debridement is considered the best possible treatment model. We review the published data to give a detailed account of the predisposing factors and their mechanisms, diagnostic work-up, treatment modalities and prevention strategies of CAM with special emphasis on CNS mucormycosis.

Pathogenesis of Respiratory Viral and Fungal Coinfections.

SUMMARYIndividuals suffering from severe viral respiratory tract infections have recently emerged as “at risk” groups for developing invasive fungal infections. Influenza virus is one of the most common causes of acute lower respiratory tract infections worldwide. Fungal infections complicating influenza pneumonia are associated with increased disease severity and mortality, with invasive pulmonary aspergillosis being the most common manifestation. Strikingly, similar observations have been made during the current coronavirus disease 2019 (COVID-19) pandemic. The copathogenesis of respiratory viral and fungal coinfections is complex and involves a dynamic interplay between the host immune defenses and the virulence of the microbes involved that often results in failure to return to homeostasis. In this review, we discuss the main mechanisms underlying susceptibility to invasive fungal disease following respiratory viral infections. A comprehensive understanding of these interactions will aid the development of therapeutic modalities against newly identified targets to prevent and treat these emerging coinfections.

COVID-19 in Children Following Hematopoietic Cell Transplantation: A Multinational Study of the European Bone Marrow Transplantation Society (EBMT) and the Spanish Group of Hematopoietic Stem Cell Transplantation (GETH)

COVID-19 in Children Following Hematopoietic Cell Transplantation: A Multinational Study of the European Bone Marrow Transplantation Society (EBMT) and the Spanish Group of Hematopoietic Stem Cell Transplantation (GETH)

Prevalence of Fungal and Bacterial Co-Infection in Pulmonary Fungal Infections: A Metagenomic Next Generation Sequencing-Based Study.

With the widespread use of antibacterial drugs and increasing number of immunocompromised patients, pulmonary fungal infections are becoming more common. However, the incidence of pulmonary fungal and bacterial co-infection is rarely reported. In this study, 119 patients definitively diagnosed with pulmonary fungal infections between July 2018 and March 2020 were assessed using metagenomic next-generation sequencing (mNGS) as well as traditional pathogen detection to gauge the incidence of fungal and bacterial co-infection and evaluate the associated risk factors. We found that of the 119 patients with fungal infections, 48 (40.3%) had pulmonary fungal and bacterial co-infection. We identified immunocompromised status and the presence of one or more pulmonary cavities as risk factors associated with fungal and bacterial co-infection. The most commonly isolated fungi species were Aspergillus, Pneumocystis, and Rhizopus. The most commonly isolated bacterial species were Pseudomonas aeruginosa, Acinetobacter baumannii, and Stenotrophomonas maltophilia. Seventy-nine (66.4%) patients had received empirical antibiotic treatment before their pathogenic test results became available, and 41.7% (fungal infection group) and 38.7% (fungal and bacterial co-infection group) of the patients had their antibacterial drug dosage changed accordingly. This mNGS-based study showed that the incidence of fungal and bacterial co-infection is significant. Our research outcomes can, thus, guide the use of antibacterial drugs in the treatment of clinical fungal infections.

INVASIVE FUNGAL INFECTIONS IN COVID-19 PATIENTS IN THE INTENSIVE CARE UNIT: ABOUT 5 CASES

Covid-19 is a serious pathology it is associated with a deep immunodepression which favors invasive fungal infections especially in patients in intensive care unit. We report in our work a series of five covid-19 patients with fungal co-infection. We conducted a retrospective study including all COVID-19 patients hospitalized in intensive care unit for acute respiratory distress syndrome. Patients who presented a clinical worsening during their hospitalization were sampled with mycological study (bronchoalveolar lavage, serum and fungal blood culture). The diagnosis of fungal superinfection was retained in five patients, two of whom had probable invasive pulmonary aspergillosis. Two other patients had a Cryptoccocusneoformans infection, one of which was disseminated. Candida albicans sepsis was found in only one patient. In the literature, invasive candidiasis and invasive pulmonary aspergillosis. in covid-19 patients are associated with a high morbidity and mortality rate, hence the importance of early diagnosis and management. It should be noted that the clinical presentation of invasive fungal infections is not very specific, especially at the beginning of the infection when antifungal treatment is more effective.

Fungal Central Nervous System Infections in Patients With COVID-19

Recent studies have indicated that fungal co-infections have a major impact on the morbidity and mortality of patients with COVID-19. In these patients, the excessive production of inflammatory cytokines and the reduction in CD4 + T and CD8 + T cell count entails susceptibility to fungal infections.1 In addition to impaired cell-mediated immunity, comorbidities and immunosuppressive medications have a significant role in the development of fungal infections and have serious impacts on clinical outcomes.1-3

Microbial landscape in hospital patients with new coronavirus disease (COVID-19), antibiotic resistance comparison vs. Pre-covid stage: a prospective study

Background. The new coronavirus infection has manifested untypically compared to other acute respiratory agents, posing a major challenge to researchers worldwide. Despite low incidence of bacterial complications, microbial coinfection plays an important role in the onset and development of severe COVID-19 to hamper diagnosis, treatment and prognosis.Objectives. A study of microbial landscape in secondary complications of COVID-19 and prevailing microbial-agent antibiotic resistance dynamics in COVID-19 vs. patients with pre-COVID community-acquired pneumonia.Methods. We analysed 1,113 bacterial sputum cultures in COVID-19 patients from 21 hospital of Krasnodar Krai. The study sample comprised 524 strains isolated from COVID-19 patients in bacteriological assays. The comparison sample included 643 positive sputum strains isolated from community-acquired pneumonia patients developing disease in outcome of acute respiratory infection in 2015–2018. The microbial aetiology landscape and strain antibiotic resistance have been compared in COVID-19 vs. patients with community-acquired pneumonia.Results. Gram-negative bacteria predominated in COVID-19 cultures (58%), followed by Gram-positive bacteria (15%) and fungi (27%). Acinetobacter baumannii (35%) and Klebsiella pneumoniae (33%) were about equally represented in Gram-negative flora, Pseudomonas aeruginosa (19%) and other microorganisms were half as common. Streptococcus pneumonia and Staphylococcus aureus accounted for 48 and 15% Gram-positive strains, respectively. Sputum-isolated fungi were mainly identifi ed as Candida albicans (89%). The Streptoccocus pneumoniae detection rate dropped to 7% in 2020 relative of other flora, which is 10 times less vs. pre-COVID rates, whilst the fungal rate increased dramatically. Antibiotic resistance increased in most isolated microbial strains.Conclusion. A Gram-negative-dominated aetiology of lower respiratory tract lesions, as well as higher risk of fungal and other opportunistic coinfections should be taken into account in patient treatment for a complicated coronavirus infection. A higher antibiotic resistance is induced by active indication-ignorant use of antibiotics, including pre-hospital treatment. A suitable treatment regimen in COVID-19 should avoid undue antibiotic prescriptions in every patient.

A Case Of Disseminated Histoplasmosis In A Patient With Sarcoidosis

Introduction/ObjectiveSarcoidosis is a syndrome of unknown cause that may manifest with clinical, radiographic and pathological findings similar to those seen with histoplasmosis. We present a case of disseminated histoplasmosis in an immunocompetent patient previously diagnosed with sarcoidosis.Methods/Case ReportA 69-year-old obese male with a history of hypertension, diabetes mellitus and long-standing sarcoidosis was admitted to the hospital for several months of intermittent fevers and pancytopenia. His sarcoidosis was diagnosed 21 years prior, initially involving the lungs and eventually showing cardiac involvement, requiring a pacemaker. He had been treated with methotrexate and prednisone. His recent medical history was also significant for COVID-19 infection, diagnosed 3 months before admission. His fevers were initially attributed to sarcoidosis and his pancytopenia to methotrexate. However, his symptoms continued despite discontinuation of his medications, and further workup was initiated.Computed tomography showed hepatomegaly, splenomegaly, and lymphadenopathy, concerning for a lymphoproliferative disorder. The patient underwent a bone marrow biopsy that showed noncaseating granulomas and microorganisms consistent with histoplasmosis on fungal stain. Bone marrow cultures were not possible as the marrow was inaspirable. The patient subsequently underwent a lymph node biopsy with both morphology and culture identifying histoplasmosis. Urine and serum histoplasma antigen also returned positive. The patient’s overall clinical picture was consistent with disseminated histoplasmosis and he was administered intravenous Amphotericin B for 3 weeks followed by oral itraconazole for 1 year. One month follow-up after discharge showed significant improvement in the patient’s condition.Results (if a Case Study enter NA)N/AConclusionSarcoidosis reduces T-cell activity, and treatment with steroids causes further immunosuppression and vulnerability for development of a disseminated infection. COVID-19 also presumably increases the predisposition to acquire bacterial or fungal co-infections. Clinicians and pathologists should be aware of the overlap in clinical, radiologic and pathological presentations of sarcoidosis and histoplasmosis to make the correct diagnosis and administer the appropriate treatment.

Therapeutic Plasma Exchange is Safe and Efficacious in Normalizing Increased Plasma Viscosity Associated with COVID-19

BackgroundCOVID-19 associated hyperviscosity is a potential driver for the increased rates of thrombotic complications and multi-organ failure associated with severe COVID-19. Limited experience suggests a promising role for Therapeutic Plasma Exchange (TPE) in COVID-19 management based on the hypothesis that clinical benefit is derived from reduction in plasma viscosity. However, systematic study evaluating the safety and efficacy of TPE in these patients has not been done.ObjectiveTo evaluate the safety and efficacy of TPE in a subset of critically ill patients with COVID-19 and elevated blood viscosity in a randomized controlled trial (RCT).Study Design and MethodsThis study was conducted in the intensive care units (ICUs) of 3 hospitals in our health system, with a limited initial enrollment target of 20 patients. Participants included adult COVID-19 patients with moderate elevation in plasma viscosity (2.3-3.5 centipoise) or significant hyperfibrinogenemia (>800 mg/dL) that were not improving despite standard supportive care. Patients with bacterial or fungal coinfection or moribund patients were specifically excluded. Upon enrollment, patients were randomized 1:1 to the treatment group (1 plasma volume TPE with frozen plasma (FP) replacement on 2 consecutive days) or control group (continued standard of care (SOC)). Primary measures included the safety/tolerability of TPE and change in plasma viscosity levels after TPE versus SOC. Secondary measures included evaluation of various clinical and laboratory parameters, including fibrinogen and other coagulation-related markers, mortality, bleeding and thromboembolic complications, ICU length of stay and time to discharge after enrollment.ResultsPreliminary analysis of collected data demonstrates that TPE is safe and well-tolerated in these patients, with adverse events limited to one mild occurrence of tachycardia that improved upon decreasing the flow rate. There was significant decrease in plasma viscosity in the TPE treatment group, compared to the SOC control group. Secondary measures of select laboratory parameters also show a significant decrease in fibrinogen, von Willebrand factor (vWF), Factor VIII, and erythrocyte sedimentation rate in the TPE treatment group. No significant differences were seen in levels of fibrin monomer, total IgG, total IgM, total protein, or total albumin between the two groups. Data collection and analysis for clinical parameters are ongoing. Conclusions and RelevanceHere we report preliminary results suggesting that TPE is safe and effective for normalizing plasma viscosity in critically ill COVID-19 patients. Concomitant removal of large plasma proteins (fibrinogen, vWF) hints at their role in driving the increased viscosity associated with severe disease, which may contribute to clotting and end-organ damage in COVID-19. Based on lack of change in total IgG/IgM levels, TPE is not anticipated to hinder the patient’s humoral immunity by removing existing anti-SARS-CoV-2 specific antibodies. These results warrant further studies on the utility of TPE to mitigate critical illness in COVID-19 patients.

Application of mNGS to describe the clinical and microbial characteristics of severe burn a tanker explosion at a tertiary medical center: a retrospective study patients following

BackgroundMultiple organ dysfunction syndrome secondary to infection is the leading cause of death in burn patients. Bloodstream infection (BSI) and the prognosis of burn patients are negatively correlated. Metagenomic next-generation sequencing (mNGS) can detect many potential pathogens and may be more valuable for patients with severe burns.MethodsWe retrospectively explored the utility of mNGS in describing the clinical and microbial characteristics of severely burned patients with BSI. We compared mNGS with blood culture.ResultsFourteen patients (127 blood samples) developed 71 episodes of BSIs with 102 unique causative pathogens. The median total body surface area was 93%. The overall 90-day mortality was 43%. In total, 17 (23.9%) episodes were polymicrobial, and 61 (86.1%) episodes originated from the wound. In total, 62/71 cases (87%) showed positive findings by mNGS, while 42/71 cases (59%) showed positive findings using blood culture. We found that mNGS outperformed culture, especially in terms of fungi (27% vs. 6%, p < 0.0001).ConclusionsThe incidence of BSI and polymicrobial in patients with large-area severe burns is high. mNGS has potential value in the diagnosis of fungal infections and coinfections in such patients. In addition, mNGS may provide unique guidance for antibiotic therapy in complicated BSI.

Species Diversity And Resistance Markers of &lt;i&gt;Candida&lt;/i&gt; Yeasts In COVID Positive and COVID Negative Patients With Community-Acquired Pneumonia

Background. At the height of the novel coronavirus infection, the risk of fungal coinfection increases due to a decrease in the immune status of patients and massive antibacterial therapy, which leads to a complication in the course of the underlying disease and increases the risk of an unfavorable outcome. Therefore, it is necessary not only to identify all associates that cause the infectious process, but also to determine their sensitivity to antibacterial and antifungal drugs in order to select an adequate treatment regimen for a patient.The aim of the study was to investigate the species composition of fungal associates in corona positive and corona negative patients with community-acquired pneumonia (CAP), as well as to determine the spectrum of sensitivity/resistance of yeasts and yeast-like fungi to antimycotic drugs.Material and methods. The species composition of the fungal microflora in sputum samples from 723 patients with CAP, sent from a health care facility in Rostov-on-Don, was investigated. The isolated cultures were identified using bacteriological and mass spectrometric methods. The sensitivity of yeasts to antimycotic drugs was determined by disk-diffusion method.Results. It has been established that yeast and yeast-like fungi were present in sputum samples in 31–32% of patients with CAP in etiologically significant quantities. 10 different types of yeast and yeast-like fungi were identified. Candida albicans was the predominant species in terms of the number of isolated cultures (83%). A re-examination of corona positive patients after their hospital stay revealed a tendency towards an increase in the number and intensity of manifestation of candidal lesions. Moreover, a change in Candida species has been registered, which entails a change in their sensitivity to antifungal drugs. A high percentage of strains resistant to fluconazole was identified after determining the sensitivity of fungi to antimycotics.Conclusion. The data obtained demonstrate that yeast and yeast-like fungi are the dominant associates in complicated forms of CAP. In this regard, it seems appropriate to provide individual microbiological support to patients during their treatment with the identification of all pathogens.

COVID-19-Associated Pulmonary Aspergillosis, Fungemia, and Pneumocystosis in the Intensive Care Unit: a Retrospective Multicenter Observational Cohort during the First French Pandemic Wave.

ABSTRACTThe aim of this study was to evaluate diagnostic means, host factors, delay of occurrence, and outcome of patients with COVID-19 pneumonia and fungal coinfections in the intensive care unit (ICU). From 1 February to 31 May 2020, we anonymously recorded COVID-19-associated pulmonary aspergillosis (CAPA), fungemia (CA-fungemia), and pneumocystosis (CA-PCP) from 36 centers, including results on fungal biomarkers in respiratory specimens and serum. We collected data from 154 episodes of CAPA, 81 of CA-fungemia, 17 of CA-PCP, and 5 of other mold infections from 244 patients (male/female [M/F] ratio = 3.5; mean age, 64.7 ± 10.8 years). CA-PCP occurred first after ICU admission (median, 1 day; interquartile range [IQR], 0 to 3 days), followed by CAPA (9 days; IQR, 5 to 13 days), and then CA-fungemia (16 days; IQR, 12 to 23 days) (P < 10−4). For CAPA, the presence of several mycological criteria was associated with death (P < 10−4). Serum galactomannan was rarely positive (<20%). The mortality rates were 76.7% (23/30) in patients with host factors for invasive fungal disease, 45.2% (14/31) in those with a preexisting pulmonary condition, and 36.6% (34/93) in the remaining patients (P = 0.001). Antimold treatment did not alter prognosis (P = 0.370). Candida albicans was responsible for 59.3% of CA-fungemias, with a global mortality of 45.7%. For CA-PCP, 58.8% of the episodes occurred in patients with known host factors of PCP, and the mortality rate was 29.5%. CAPA may be in part hospital acquired and could benefit from antifungal prescription at the first positive biomarker result. CA-fungemia appeared linked to ICU stay without COVID-19 specificity, while CA-PCP may not really be a concern in the ICU. Improved diagnostic strategy for fungal markers in ICU patients with COVID-19 should support these hypotheses.IMPORTANCE To diagnose fungal coinfections in patients with COVID-19 in the intensive care unit, it is necessary to implement the correct treatment and to prevent them if possible. For COVID-19-associated pulmonary aspergillosis (CAPA), respiratory specimens remain the best approach since serum biomarkers are rarely positive. Timing of occurrence suggests that CAPA could be hospital acquired. The associated mortality varies from 36.6% to 76.7% when no host factors or host factors of invasive fungal diseases are present, respectively. Fungemias occurred after 2 weeks in ICUs and are associated with a mortality rate of 45.7%. Candida albicans is the first yeast species recovered, with no specificity linked to COVID-19. Pneumocystosis was mainly found in patients with known immunodepression. The diagnosis occurred at the entry in ICUs and not afterwards, suggesting that if Pneumocystis jirovecii plays a role, it is upstream of the hospitalization in the ICU.

Post covid-19 fungal infection and its impact on orthodontic practice: A review

As COVID-19 cases are reducing worldwide, the patients recovered from this disease are showing some complications include impact on lungs, kidneys, heart, and cases of a black fungal infection, called mucormycosis. There are a variety of bacterial and fungal co-infections which is associated with poorly controlled diabetes mellitus and other immune impaired condition. The COVID-19 exhibits, a specific pathophysiological feature, which will result in secondary fungal infections. The recent COVID-19 wave showed that many children and young people are testing positive for this disease. There is high chance for some of them can come across an orthodontic clinic. Oral mucormycosis is normally developed from the breathing of spores or through an open contaminated oral wound, affecting mainly immunocompromised patients. Oral mucormycosis is reported in some patient, following tooth extraction. The fungal spore can reach the body when there is a loss of anatomical continuity as can occur after a tooth extraction or in an ulcer. Chance for Post COVID-19 Mucormycosis in orthodontic patients are very rare. However, Orthodontist should take care when doing minor surgical procedure in the patient recovered from severe COVID-19 infection. Orthodontic appliances can increase the number of bacteria and fungus by limiting oral hygiene. Orthodontist should advise patients to the importance of maintaining basic oral hygiene measures, which include simple things like changing the toothbrush once they test negative, oral rinsing and brushing.