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Fungal co-infections in COVID-19 patients

DISCOVERIES (ISSN 2359-7232), 2021, January-March issue


Bhatt K, Agolli A, Patel MH, Garimella R, Devi M, Garcia E, Amin H, Domingue C, Del Castillo RG, Sanchez-Gonzalez MHigh mortality co-infections of COVID-19 patients: mucormycosis and other fungal infections. Discoveries 2021, 9(1): e126. DOI: 10.15190/d.2021.5

Submitted: February 6, 2021; Revised: March 30, 2021; Accepted: March 31, 2021; Published: March 31, 2021; 

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High mortality co-infections of COVID-19 patients: mucormycosis and other fungal infections

Kinal Bhatt (1,*), Arjola Agolli (1), Mehrie H. Patel (1), Radhika Garimella (1), Madhuri Devi (2), Efrain Garcia (3), Harshad Amin (3), Carlos Domingue (3), Roberto Guerra Del Castillo (3), Marcos Sanchez-Gonzalez (1)

(1) Division of Clinical and Translational Research, Larkin Health System, South Miami, FL, USA

(2) Pakistan Ziauddin Medical College, Karachi, Pakistan

(3) Larkin Community Hospital, Hialeah, FL, USA

*Corresponding authors: Kinal Bhatt, MD, MPH, Division of Clinical and Translational Research, Larkin Health System, South Miami, FL, USA, 7031 SW 62nd Ave, South Miami, FL; Phone: (928) 225 0273; Email: kinalbhatt@gmail.com


Severe COVID-19 disease is associated with an increase in pro-inflammatory markers, such as IL-1, IL-6, and tumor necrosis alpha, less CD4 interferon-gamma expression, and fewer CD4 and CD8 cells, which increase the susceptibility to bacterial and fungal infections. One such opportunistic fungal infection is mucormycosis. Initially, it was debated whether a person taking immunosuppressants, such as corticosteroids, and monoclonal antibodies will be at higher risk for COVID-19 or whether the immunosuppresive state would cause a more severe COVID-19 disease. However, immunosuppressants are currently continued unless the patients are at greater risk of severe COVID-19 infection or are on high-dose corticosteroids therapy. As understood so far, COVID-19 infection may induce significant and persistent lymphopenia, which in turn increases the risk of opportunistic infections. It is also noted that 85% of the COVID-19 patients’ laboratory findings showed lymphopenia. This means that patients with severe COVID-19 have markedly lower absolute number of T lymphocytes, CD4+T and CD8+ T cells and, since the lymphocytes play a major role in maintaining the immune homeostasis, the patients with COVID-19 are highly susceptible to fungal co-infections. This report is intended to raise awareness of the importance of early detection and treatment of mucormycosis and other fungal diseases, such as candidiasis, SARS-CoV-2-associated pulmonary aspergillosis, pneumocystis pneumonia and cryptococcal disease, in COVID-19 patients, to reduce the risk of mortality.

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