Pemán Javier, Ruiz-Gaitán Alba, García-Vidal Carolina, Salavert Miguel, Ramírez Paula, Puchades Francesc, García-Hita Marta, Alastruey-Izquierdo Ana, Quindós Guillermo
Servicio de Microbiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
Rev Iberoam Micol. 2020 Apr-Jun;37(2):41-46. doi: 10.1016/j.riam.2020.07.001. Epub 2020 Sep 14.
Critically ill COVID-19 patients have higher pro-inflammatory (IL-1, IL-2, IL-6, tumor necrosis alpha) and anti-inflammatory (IL-4, IL-10) cytokine levels, less CD interferon-gamma expression, and fewer CD and CD cells. This severe clinical situation increases the risk of serious fungal infections, such as invasive pulmonary aspergillosis, invasive candidiasis or Pneumocystis jirovecii pneumonia. However, few studies have investigated fungal coinfections in this population. We describe an update on published reports on fungal coinfections and our personal experience in three Spanish hospitals. We can conclude that despite the serious disease caused by SARS-CoV-2 in many patients, the scarcity of invasive mycoses is probably due to the few bronchoscopies and necropsies performed in these patients because of the high risk in aerosol generation. However, the presence of fungal markers in clinically relevant specimens, with the exception of bronchopulmonary colonization by Candida, should make it advisable to early implement antifungal therapy.
危重症新型冠状病毒肺炎（COVID-19）患者的促炎细胞因子（白细胞介素-1、白细胞介素-2、白细胞介素-6、肿瘤坏死因子-α）和抗炎细胞因子（白细胞介素-4、白细胞介素-10）水平较高，干扰素-γ的CD 表达较低，CD 和 CD 细胞较少。这种严重的临床情况增加了严重真菌感染的风险，如侵袭性肺曲霉病、侵袭性念珠菌病或耶氏肺孢子菌肺炎。然而，很少有研究调查该人群中的真菌合并感染情况。我们描述了已发表的关于真菌合并感染报告的最新情况以及我们在西班牙三家医院的个人经验。我们可以得出结论，尽管许多患者感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）导致了严重疾病，但侵袭性真菌病较少可能是由于这些患者因产生气溶胶风险高而进行的支气管镜检查和尸检较少。然而，在临床相关标本中存在真菌标志物（除念珠菌引起的支气管肺定植外），应建议尽早实施抗真菌治疗。
