Casalini Giacomo, Giacomelli Andrea, Ridolfo Annalisa, Gervasoni Cristina, Antinori Spinello
Luigi Sacco Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy.
III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy.
J Fungi (Basel). 2021 Oct 29;7(11):921. doi: 10.3390/jof7110921.
Invasive fungal infections (IFIs) can complicate the clinical course of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients admitted to an intensive care unit (ICU). This narrative review concerns 4099 cases of IFIs in 58,784 COVID-19 patients involved in 168 studies. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is a diagnostic challenge because its non-specific clinical/imaging features and the fact that the proposed clinically diagnostic algorithms do not really apply to COVID-19 patients. Forty-seven observational studies and 41 case reports have described a total of 478 CAPA cases that were mainly diagnosed on the basis of cultured respiratory specimens and/or biomarkers/molecular biology, usually without histopathological confirmation. Candidemia is a widely described secondary infection in critically ill patients undergoing prolonged hospitalisation, and the case reports and observational studies of 401 cases indicate high crude mortality rates of 56.1% and 74.8%, respectively. COVID-19 patients are often characterised by the presence of known risk factors for candidemia such as in-dwelling vascular catheters, mechanical ventilation, and broad-spectrum antibiotics. We also describe 3185 cases of mucormycosis (including 1549 cases of rhino-orbital mucormycosis (48.6%)), for which the main risk factor is a history of poorly controlled diabetes mellitus (>76%). Its diagnosis involves a histopathological examination of tissue biopsies, and its treatment requires anti-fungal therapy combined with aggressive surgical resection/debridement, but crude mortality rates are again high: 50.8% in case reports and 16% in observational studies. The presence of other secondary IFIs usually diagnosed in severely immunocompromised patients show that SARS-CoV-2 is capable of stunning the host immune system: 20 cases of pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to spp., and 1 case of pulmonary infection due to
侵袭性真菌感染（IFI）会使新型冠状病毒肺炎（COVID-19）的临床病程复杂化，并与死亡率显著增加相关，尤其是在入住重症监护病房（ICU）的危重症患者中。本叙述性综述涉及168项研究中的58784例COVID-19患者中的4099例IFI病例。与COVID-19相关的侵袭性肺曲霉病（CAPA）是一项诊断挑战，因为其临床/影像学特征不具特异性，且目前提出的临床诊断算法并不真正适用于COVID-19患者。47项观察性研究和41篇病例报告共描述了478例CAPA病例，这些病例主要基于培养的呼吸道标本和/或生物标志物/分子生物学进行诊断，通常未经组织病理学证实。念珠菌血症是长期住院的危重症患者中广泛描述的继发性感染，401例病例的病例报告和观察性研究表明，其粗死亡率分别高达56.1%和74.8%。COVID-19患者通常具有念珠菌血症的已知危险因素，如留置血管导管、机械通气和使用广谱抗生素。我们还描述了3185例毛霉病病例（包括1549例鼻眶毛霉病病例（48.6%）），其主要危险因素是糖尿病控制不佳病史（>76%）。其诊断需要对组织活检进行组织病理学检查，治疗需要抗真菌治疗并联合积极的手术切除/清创，但粗死亡率仍然很高：病例报告中为50.8%，观察性研究中为16%。通常在严重免疫功能低下患者中诊断出的其他继发性IFI的存在表明，严重急性呼吸综合征冠状病毒-2（SARS-CoV-2）能够使宿主免疫系统受损：20例曲霉肺炎、5例隐球菌病、4例组织胞浆菌病、1例球孢子菌感染、1例因 属引起的肺部感染，以及1例因 引起的肺部感染
