Rovina Nikoletta, Koukaki Evangelia, Romanou Vasiliki, Ampelioti Sevasti, Loverdos Konstantinos, Chantziara Vasiliki, Koutsoukou Antonia, Dimopoulos George
1st Department of Respiratory Medicine, Medical School, National and Kapodistrian University of Athens and "Sotiria" Chest Disease Hospital, 152 Mesogeion Ave, 11527 Athens, Greece.
J Clin Med. 2022 Apr 4;11(7):2017. doi: 10.3390/jcm11072017.
Patients with severe COVID-19 belong to a population at high risk of invasive fungal infections (IFIs), with a reported incidence of IFIs in critically ill COVID-19 patients ranging between 5% and 26.7%. Common factors in these patients, such as multiple organ failure, immunomodulating/immunocompromising treatments, the longer time on mechanical ventilation, renal replacement therapy or extracorporeal membrane oxygenation, make them vulnerable candidates for fungal infections. In addition to that, SARS-CoV2 itself is associated with significant dysfunction in the patient's immune system involving both innate and acquired immunity, with reduction in both CD4 T and CD8 T lymphocyte counts and cytokine storm. The emerging question is whether SARS-CoV-2 inherently predisposes critically ill patients to fungal infections or the immunosuppressive therapy constitutes the igniting factor for invasive mycoses. To approach the dilemma, one must consider the unique pathogenicity of SARS-CoV-2 with the deranged immune response it provokes, review the well-known effects of immunosuppressants and finally refer to current literature to probe possible causal relationships, synergistic effects or independent risk factors. In this review, we aimed to identify the prevalence, risk factors and mortality associated with IFIs in mechanically ventilated patients with COVID-19.
重症新型冠状病毒肺炎（COVID-19）患者属于侵袭性真菌感染（IFI）的高危人群，据报道，危重症COVID-19患者中IFI的发生率在5%至26.7%之间。这些患者的常见因素，如多器官功能衰竭、免疫调节/免疫抑制治疗、机械通气时间延长、肾脏替代治疗或体外膜肺氧合，使他们成为真菌感染的易感人群。除此之外，严重急性呼吸综合征冠状病毒2（SARS-CoV2）本身与患者免疫系统的显著功能障碍有关，涉及固有免疫和获得性免疫，CD4 T淋巴细胞和CD8 T淋巴细胞计数均减少，并出现细胞因子风暴。新出现的问题是，SARS-CoV-2本身是否使危重症患者易患真菌感染，还是免疫抑制治疗构成了侵袭性真菌病的诱发因素。为了解决这一困境，必须考虑SARS-CoV-2独特的致病性及其引发的紊乱免疫反应，回顾免疫抑制剂的已知作用，最后参考当前文献探讨可能的因果关系、协同效应或独立危险因素。在本综述中，我们旨在确定机械通气的COVID-19患者中IFI的患病率、危险因素和死亡率。
