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Zhou Y, Qiu B, Jiang J, Chen T, Wang L, Yang Y, Ruan S, Chen Y, Fang H, Jin J, Yang N. Case report: Experience and insights on the treatment of two cases of cryptococcal meningitis during the later stages of the COVID-19 pandemic. Front Immunol 2024; 15:1361277. [PMID: 38711522 PMCID: PMC11072183 DOI: 10.3389/fimmu.2024.1361277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/03/2024] [Indexed: 05/08/2024] Open
Abstract
In the late stages of the COVID-19 pandemic, there's an increasing trend in opportunistic infections, including bacterial and fungal infections. This study discusses the treatment process of two cases of cryptococcal meningitis during the COVID-19 pandemic. It highlights the importance of laboratory testing for these co-infections and stresses the need for vigilance, early diagnosis, and proactive treatment to improve patient outcomes in the post-pandemic era.
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Affiliation(s)
- Yuli Zhou
- Department of Laboratory Medicine, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, China
| | - Bingfeng Qiu
- Department of Laboratory Medicine, People’s Hospital of Tonglu County, Hangzhou, Zhejiang, China
| | - Jun Jiang
- Marketing Department, Guilin URIT Medical Electronic Co., Ltd., Guilin, Guangxi, China
| | - Tianwen Chen
- Department of Neurology, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, China
| | - Liqian Wang
- Department of Laboratory Medicine, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, China
| | - Yunxing Yang
- Department of Laboratory Medicine, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, China
| | - Senlin Ruan
- Department of Laboratory Medicine, Affiliated Hangzhou First People’s Hospital, Westlake University School of Medicine, Hangzhou, China
| | - Yanlei Chen
- Department of Laboratory Medicine, People’s Hospital of Tonglu County, Hangzhou, Zhejiang, China
| | - Huanli Fang
- Department of Laboratory Medicine, People’s Hospital of Tonglu County, Hangzhou, Zhejiang, China
| | - Juan Jin
- Department of Nephrology, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Nan Yang
- Department of Nephrology, the First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
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Walker J, McCarty T, McGwin G, Ordaya EE, Vergidis P, Ostrosky-Zeichner L, Mammadova M, Spec A, Rauseo AM, Perfect J, Messina J, Vilchez G, McMullen R, Jones CT, Pappas PG. Description of Cryptococcosis Following SARS-CoV-2 Infection: A Disease Survey Through the Mycosis Study Group Education and Research Consortium (MSG-19). Clin Infect Dis 2024; 78:371-377. [PMID: 37713207 PMCID: PMC10874270 DOI: 10.1093/cid/ciad551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/18/2023] [Accepted: 09/12/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Invasive fungal infections have been described throughout the COVID-19 pandemic. Cryptococcal disease after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported in several isolated case reports and 1 larger case series. We sought to describe cryptococcal infections following SARS-CoV-2 through establishing a database to investigate underlying risk factors, disease manifestations, and outcomes. METHODS We created a crowdsourced call for cases solicited through the Mycoses Study Group Education and Research Consortium, the Centers for Disease Control and Prevention Emerging Infectious Diseases Network, and infectious diseases Twitter groups. Data were collected in a web-based and secure REDCap survey without personal identifiers. RESULTS Sixty-nine cases were identified and submitted by 29 separate institutional sites. Cryptococcosis was diagnosed a median of 22 days (interquartile range, 9-42 days) after SARS-CoV-2 infection. Mortality among those with available follow-up was 72% (26/36) for the immunocompetent group and 48% (15/31) for the immunocompromised group (likelihood ratio, 4.01; P = .045). We observed a correlation between disease manifestation (central nervous system infection, proven/probable disseminated disease, and respiratory) and mortality (P = .002). CONCLUSIONS The mortality rate of 59% for patients with cryptococcosis following SARS-CoV-2 is higher than that of modern Cryptococcus cohorts. There was an association between immunocompromised status and cryptococcal disease manifestations as well as mortality. Moreover, our series emphasizes the need for clinical and laboratory assessment of opportunistic infections beyond 30 days when concerning symptoms develop.
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Affiliation(s)
- Jeremey Walker
- University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama, USA
| | - Todd McCarty
- University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama, USA
| | - Gerald McGwin
- University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama, USA
| | - Eloy E Ordaya
- Mayo Clinic, Infectious Diseases, Rochester, Minnesota, USA
| | | | | | - Mehriban Mammadova
- University of Texas Health Sciences Center, Infectious Disease, Houston, Texas, USA
| | - Andrej Spec
- Washington University, Division of Infectious Diseases, St Louis, Missouri, USA
| | - Adriana M Rauseo
- Washington University, Division of Infectious Diseases, St Louis, Missouri, USA
| | - John Perfect
- Duke University, Infectious Diseases, Durham, North Carolina, USA
| | - Julia Messina
- Duke University, Infectious Diseases, Durham, North Carolina, USA
| | - Gabriel Vilchez
- University of Kentucky, College of Medicine, Lexington, Kentucky, USA
| | - Rachel McMullen
- University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama, USA
| | - Carolynn T Jones
- The Ohio State University, College of Nursing, Columbus, Ohio, USA
| | - Peter G Pappas
- University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama, USA
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Kim H, Kim S, Ahn MY, Oh DH, Choi JP, Yang E. Case Report: Cryptococcal Meningitis in a Previously Immunocompetent Patient with Coronavirus Disease 2019. Am J Trop Med Hyg 2024; 110:270-273. [PMID: 38190753 PMCID: PMC10859789 DOI: 10.4269/ajtmh.23-0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/29/2023] [Indexed: 01/10/2024] Open
Abstract
Cryptococcus neoformans infections occur most frequently in immunocompromised patients. Here, we report a case of cryptococcal meningitis in a previously immunocompetent 78-year-old female patient after treatment of COVID-19. Underlying diseases included hypertension, hyperlipidemia, and diabetes. The patient was critically ill and was treated with remdesivir, baricitinib, and dexamethasone. During hospitalization, her mental state changed, and C. neoformans was detected in the cerebrospinal fluid. She died despite receiving antifungal treatment. Treatment of COVID-19 may be a predisposing factor for C. neoformans infection. There is a need for concern and countermeasures for opportunistic fungal infections that may accompany COVID-19.
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Affiliation(s)
- Hyunkyu Kim
- Department of Internal Medicine, Seoul Medical Center, Seoul, South Korea
| | - Subin Kim
- Division of Infectious Disease, Seoul Medical Center, Seoul, South Korea
| | - Mi Young Ahn
- Division of Infectious Disease, Seoul Medical Center, Seoul, South Korea
| | - Dong Hyun Oh
- Division of Infectious Disease, Seoul Medical Center, Seoul, South Korea
| | - Jae-Phil Choi
- Division of Infectious Disease, Seoul Medical Center, Seoul, South Korea
| | - Eunmi Yang
- Division of Infectious Disease, Seoul Medical Center, Seoul, South Korea
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Cognialli RCR, Fratucci GF, Carneiro BH, Antonio KL, Voidaleski MF, Favarello LM, Vicente VA, Queiroz-Telles F. Case report: First case of fungemia caused by Papiliotrema laurentii in a patient with SARS-CoV-2 infection. Rev Soc Bras Med Trop 2024; 57:e008002023. [PMID: 38324809 PMCID: PMC10852462 DOI: 10.1590/0037-8682-0480-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/14/2023] [Indexed: 02/09/2024] Open
Abstract
Previously considered saprobe and non-pathogenic, the fungus Papiliotrema laurentii (formerly known as Cryptococcus laurentii), is rarely associated with human infection. Nevertheless, there has been an increase in reported infections by non-neoformans cryptococci. After a literature search on the Cochrane Library, LILACS, SciELO, MEDLINE, PubMed, and PMC (PubMed Central) databases, we conclude that this is the first case report of fungemia and probable meningitis caused by Papiliotrema laurentii in a previously immunocompetent host with associated COVID-19.
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Affiliation(s)
| | | | | | | | - Morgana Ferreira Voidaleski
- Universidade Federal do Paraná, Programa de Pós-Graduação em Microbiologia, Parasitologia e Patologia, Curitiba, PR, Brasil
| | | | | | - Flávio Queiroz-Telles
- Universidade Federal do Paraná, Hospital de Clínicas, Departamento de Saúde Coletiva, Curitiba, PR, Brasil
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Meng Y, Ni Y, Li Z, Jiang T, Sun T, Li Y, Gao X, Li H, Suo C, Li C, Yang S, Lan T, Liao G, Liu T, Wang P, Ding C. Interplay between acetylation and ubiquitination of imitation switch chromatin remodeler Isw1 confers multidrug resistance in Cryptococcus neoformans. eLife 2024; 13:e85728. [PMID: 38251723 PMCID: PMC10834027 DOI: 10.7554/elife.85728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/21/2024] [Indexed: 01/23/2024] Open
Abstract
Cryptococcus neoformans poses a threat to human health, but anticryptococcal therapy is hampered by the emergence of drug resistance, whose underlying mechanisms remain poorly understood. Herein, we discovered that Isw1, an imitation switch chromatin remodeling ATPase, functions as a master modulator of genes responsible for in vivo and in vitro multidrug resistance in C. neoformans. Cells with the disrupted ISW1 gene exhibited profound resistance to multiple antifungal drugs. Mass spectrometry analysis revealed that Isw1 is both acetylated and ubiquitinated, suggesting that an interplay between these two modification events exists to govern Isw1 function. Mutagenesis studies of acetylation and ubiquitination sites revealed that the acetylation status of Isw1K97 coordinates with its ubiquitination processes at Isw1K113 and Isw1K441 through modulating the interaction between Isw1 and Cdc4, an E3 ligase. Additionally, clinical isolates of C. neoformans overexpressing the degradation-resistant ISW1K97Q allele showed impaired drug-resistant phenotypes. Collectively, our studies revealed a sophisticated acetylation-Isw1-ubiquitination regulation axis that controls multidrug resistance in C. neoformans.
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Affiliation(s)
- Yang Meng
- College of Life and Health Sciences, Northeastern UniversityShenyangChina
| | - Yue Ni
- College of Life and Health Sciences, Northeastern UniversityShenyangChina
| | - Zhuoran Li
- College of Life and Health Sciences, Northeastern UniversityShenyangChina
| | - Tianhang Jiang
- College of Life and Health Sciences, Northeastern UniversityShenyangChina
| | - Tianshu Sun
- Department of Scientific Research, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yanjian Li
- College of Life and Health Sciences, Northeastern UniversityShenyangChina
| | - Xindi Gao
- College of Life and Health Sciences, Northeastern UniversityShenyangChina
| | - Hailong Li
- NHC Key Laboratory of AIDS Immunology, The First Affiliated Hospital of China Medical UniversityShenyangChina
| | - Chenhao Suo
- College of Life and Health Sciences, Northeastern UniversityShenyangChina
| | - Chao Li
- College of Life and Health Sciences, Northeastern UniversityShenyangChina
| | - Sheng Yang
- College of Life and Health Sciences, Northeastern UniversityShenyangChina
| | - Tian Lan
- College of Life and Health Sciences, Northeastern UniversityShenyangChina
| | - Guojian Liao
- College of Pharmaceutical Sciences, Southwest UniversityChongqingChina
| | - Tongbao Liu
- Medical Research Institute, Southwest UniversityChongqingChina
| | - Ping Wang
- Department of Microbiology, Immunology, and Parasitology, Louisiana State University Health Sciences Center New OrleansNew OrleansUnited States
| | - Chen Ding
- College of Life and Health Sciences, Northeastern UniversityShenyangChina
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Quincho-Lopez A, Poma N, José Montenegro-Idrogo J. COVID-19 associated with cryptococcosis: a scoping review. Ther Adv Infect Dis 2024; 11:20499361241232851. [PMID: 38361915 PMCID: PMC10868154 DOI: 10.1177/20499361241232851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
Background There is growing evidence of fungal infections associated with COVID-19. The development of cryptococcosis in these patients has been infrequently reported. However, it can be life-threatening. Objective To identify cases of COVID-19 patients who developed cryptococcosis and to compare baseline characteristics and management between those who survived and those who died. Methods We conducted a scoping review using PubMed, Scopus, Web of Science, and Embase to identify studies that reported patients with COVID-19 and cryptococcosis. No language restriction was applied. Single case reports, case series, and original articles were included. It is important to note that 'n' refers to the total number of individuals with the specified variable. Results A total of 58 studies were included. Among these studies, 51 included individual patient data, detailing information on a total of 65 patients, whereas eight studies reported the proportion of cryptococcosis in COVID-19 patients. One study provided both individual and aggregate case information. From individual patient data, the majority were male (73.9%; n = 48) with a median age of 60 years (range: 53-70). Severe COVID-19 and multiple comorbidities, led by arterial hypertension and diabetes mellitus, were frequently reported, but few had classic immunosuppression factors. On the other hand, HIV status, either negative or positive, was reported in just over half of the patients (61.5%; n = 40). Most were admitted to the intensive care unit (ICU) (58.5%; n = 31), received mechanical ventilation (MV) (50.0%; n = 26), and developed disseminated cryptococcosis (55.4%; n = 36). Secondary infection, mainly bacterial, was reported in 19 patients (29.2%). Mortality was 47.7% (n = 31). Of the studies that reported the proportion of cryptococcosis in COVID-19 cases, the majority were descriptive studies published as conference abstracts. Conclusion Cryptococcosis in COVID-19 patients has been reported more frequently. However, it is still not as common as other fungal infections associated with COVID-19. Few patients have some classic immunosuppression factors. The factors associated with mortality were male sex, age, ICU admission, MV, secondary infections, and lymphopenia.
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Affiliation(s)
- Alvaro Quincho-Lopez
- Unidad de Investigación en Bibliometría, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | - Nuvith Poma
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Juan José Montenegro-Idrogo
- Clinical Epidemiology and Biostatistics, Universidad Científica del Sur, Lima, Peru
- Infectious Diseases and Tropical Medicine Service, Hospital Nacional Dos de Mayo, Lima, Peru
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Universidad Nacional Mayor de San Marcos, Lima, Peru
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7
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Singh A, Kaur A, Chowdhary A. Fungal pathogens and COVID-19. Curr Opin Microbiol 2023; 75:102365. [PMID: 37625261 DOI: 10.1016/j.mib.2023.102365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023]
Abstract
COVID-19 pandemic highlighted the complications of secondary fungal infections that occurred globally in severe cases of coronavirus disease managed in the intensive care units. Furthermore, varied underlying host factors, such as preexisting immunosuppression, the use of immunomodulatory agents, and invasive procedures predisposing lung tissues to fungal colonization and proliferation, caused increased susceptibility to fungal infections in COVID-19 patient populations. These invasive fungal infections directly impact the overall length of hospitalization and mortality. The most commonly reported fungal infections in patients with COVID-19 include aspergillosis, invasive candidiasis, and mucormycosis. An overall worldwide increase in the prevalence of candidiasis and aspergillosis was observed in COVID-19 patients , whereas outbreaks of mucormycosis were mainly recorded from India. Diagnostic challenges and limited antifungal treatment options make secondary fungal infections among COVID-19 patients more burdensome, which results in improper management and increased mortality.
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Affiliation(s)
- Ashutosh Singh
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India; National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Amtoj Kaur
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Anuradha Chowdhary
- Medical Mycology Unit, Department of Microbiology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India; National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India.
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8
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Messina FA, Benchetrit A, Bocassi A, Romero MDLM, Bauer S, Marín E, Bertera F, Onis G, Enzenhofer M, Sánchez M, Mammana L, Mijalovsky D, Santiso G. Meningeal cryptococcosis and SARS-CoV-2 infection in people living with HIV/AIDS. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:206-216. [PMID: 37721913 PMCID: PMC10586798 DOI: 10.7705/biomedica.6872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/17/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Fungal infections in patients with COVID-19 was one of the most debated topics during the pandemic. OBJECTIVES To analyze the clinical characteristics and evolution of people living with HIV/AIDS and coinfection with cryptococcus and COVID-19 (group A) or without it (group B). MATERIALS AND METHODS This is an analytical and retrospective study. We reviewed medical records of patients with meningeal cryptococcosis between April 2020 and May 2021. RESULTS We studied 65 people living with HIV/AIDS and with cryptococcosis infection diagnosed from April 2020 to May 2021. Fifteen patients with HIV/AIDS suffered from cryptococcosis and COVID-19, and out of these, 14 presented meningitis (group A), while 28 suffered from meningeal cryptococcosis, but did not have COVID-19 (group B). CONCLUSIONS No statistically significant differences were observed between the two groups (A and B) considering: intracranial hypertension, presence of Cryptococcus antigens in cerebrospinal fluid, sensorium deterioration or mortality. The detection of Cryptococcus antigens in serum by lateral flow assay was highly effective to rapidly diagnose cryptococcosis in patients with HIV/AIDS who also developed COVID-19. Patients of both groups consulted for cryptoccocosis sometime after, in comparison with the pre-pandemic cases related to this infection.
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Affiliation(s)
- Fernando Antonio Messina
- Unidad Micología, Hospital de Enfermedades Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina.
| | - Andrés Benchetrit
- Sala 21, Hospital de Enfermedades Infecciosas F. J. Muñiz Hospital, Buenos Aires, Argentina.
| | - Andrea Bocassi
- Laboratorio Central Hospital de Infecciosas, Francisco Javier Muñiz Hospital, Buenos Aires, Argentina.
| | | | - Sofía Bauer
- División SIDA, Hospital de infecciosas Francisco Javier Muñiz Hospital, Buenos Aires, Argentina.
| | - Emmanuel Marín
- Unidad Micología, Hospital de Enfermedades Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina.
| | - Facundo Bertera
- División Farmacia, Hospital de infecciosas Francisco Javier Muñiz Hospital, Buenos Aires, Argentina.
| | - Guillermo Onis
- Sala 20, Hospital de Infecciosas Francisco Javier Muñiz Hospital, Buenos Aires, Argentina.
| | - Matías Enzenhofer
- División SIDA, Hospital de infecciosas Francisco Javier Muñiz Hospital, Buenos Aires, Argentina.
| | - Milagro Sánchez
- División SIDA, Hospital de infecciosas Francisco Javier Muñiz Hospital, Buenos Aires, Argentina.
| | - Lilia Mammana
- Unidad Virología, Hospital de Infecciosas F. J. Muñiz Hospital, Buenos Aires, Argentina.
| | - Dana Mijalovsky
- División SIDA, Hospital de infecciosas Francisco Javier Muñiz Hospital, Buenos Aires, Argentina.
| | - Gabriela Santiso
- Unidad Micología, Hospital de Enfermedades Infecciosas Francisco Javier Muñiz, Buenos Aires, Argentina.
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Sharma A, Bano G, Malik A, Rasool Y, Manzar S, Singh T, Maity M. Opportunistic Fungal Invasion in COVID-19 Pandemic: A Critical Review in Diagnosis and Management. Avicenna J Med 2023; 13:131-137. [PMID: 37799179 PMCID: PMC10550366 DOI: 10.1055/s-0043-1770921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) is the culprit behind the pandemic across the globe in recent decades. Variants of SARS-CoV especially coronavirus disease 2019 (COVID-19)-related fungus might not be identified or might be misdiagnosed on a worldwide scale. Patients of COVID-19 acquired invasive mycoses, especially if they are very ill or immunosuppressed. Clinical intervention based on various standard guidelines would be necessary to guarantee that Aspergillus and Candida -infected COVID-19 patients are adequately treated. To facilitate clinical professionals, doctors, paramedics, and laboratory staff in the treatment of various variants of COVID-19 patients with concurrent aspergillosis, candidiasis, mucormycosis, or cryptococcosis, a tabulation format is drafted in this study. We believe it is prudent to take into account the general nature, and variety of the mycosis that is arriving, the strength and limits of the diagnostic tools, clinical conditions, and the need for standardized or customized therapy in various coronavirus-infected patients.
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Affiliation(s)
- Abhishek Sharma
- Department of Quality Control & Assurance, Hakeem Abdul Hameed Centenary Hospital & Hamdard Institute of Medical Sciences & Research, Jamia Hamdard, New Delhi, India
| | - Gulnaz Bano
- Department of Pharmacology & Pharmacy Practice, School of Pharmaceutical Education and Research, Jamia Hamdard University, New Delhi, India
| | - Abdul Malik
- Department of Pharmacy Practice, Teerthanker Mahaveer College of Pharmacy, Moradabad, Uttar Pradesh, India
| | - Yuman Rasool
- Department of Pharmacy Practice, School of Pharmaceutical Education and Research, Jamia Hamdard University, New Delhi, India
| | - Samrina Manzar
- Department of Pharmacy Practice, School of Pharmaceutical Education and Research, Jamia Hamdard University, New Delhi, India
| | - Tarun Singh
- Department of Pharmacy, Maharishi Markandeshwar College of Pharmacy, MM(DU), Mullana, Haryana, India
| | - Manish Maity
- Department of Pharmacy, Maharishi Markandeshwar College of Pharmacy, MM(DU), Mullana, Haryana, India
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Pulmonary Cryptococcosis Complicating Severe Coronavirus Infectious Disease 2019. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Dioverti V, Boghdadly ZE, Shahid Z, Waghmare A, Abidi MZ, Pergam S, Boeckh M, Dadwal S, Kamboj M, Seo S, Chemaly RF, Papanicolaou GA. Revised Guidelines for Coronavirus Disease 19 Management in Hematopoietic Cell Transplantation and Cellular Therapy Recipients (August 2022). Transplant Cell Ther 2022; 28:810-821. [PMID: 36103987 PMCID: PMC9464362 DOI: 10.1016/j.jtct.2022.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/05/2022] [Indexed: 01/17/2023]
Abstract
This document is intended as a guide for diagnosis and management of Coronavirus Disease 2019 (COVID-19), caused by the virus SARS-CoV-2, in adult and pediatric HCT and cellular therapy patients. This document was prepared using available data and with expert opinion provided by members of the (ASTCT) Infectious Diseases Special Interest Group (ID-SIG) and is an update of pervious publication. Since our original publication in 2020, the NIH and IDSA have published extensive guidelines for management of COVID-19 which are readily accessible ( NIH Guidelines , IDSA Guidelines ). This update focuses primarily on issues pertaining specifically to HCT/cellular therapy recipients. Information provided in this manuscript may change as new information becomes available.
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Affiliation(s)
- Veronica Dioverti
- Assistant Professor of Medicine, Johns Hopkins University, Baltimore, Maryland.
| | - Zeinab El Boghdadly
- Assistant Professor of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Zainab Shahid
- Attending physician, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alpana Waghmare
- Associate Professor of Pediatrics, University of Washington, Seattle, Washington; Fred Hutchinson Cancer Center, Seattle, Washington
| | - Maheen Z Abidi
- Assistant Professor of Medicine, University of Colorado, Denver, Colorado
| | - Steven Pergam
- Professor, Fred Hutchinson Cancer Research Center, Associate Professor, University of Washington, Seattle, Washington
| | - Michael Boeckh
- Fred Hutchinson Cancer Center, Seattle, Washington; Professor of Medicine, University of Washington, Seattle, Washington
| | | | - Mini Kamboj
- Associate Professor of Medicine, Weill Cornell Medical College, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York
| | - Susan Seo
- Memorial Sloan Kettering Cancer Center, New York, New York; Professor of Clinical Medicine, Weill Cornell Medical College, New York, New York
| | - Roy F Chemaly
- Professor of Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Genovefa A Papanicolaou
- Memorial Sloan Kettering Cancer Center, New York, New York; Professor of Medicine, Weill Cornell Medical College, New York, New York
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COVID-19 Associated with Cryptococcosis: A New Challenge during the Pandemic. J Fungi (Basel) 2022; 8:jof8101111. [PMID: 36294675 PMCID: PMC9604822 DOI: 10.3390/jof8101111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/19/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a great threat to global health. In addition to SARS-CoV-2 itself, clinicians should be alert to the possible occurrence of co-infection or secondary infection among patients with COVID-19. The possible co-pathogens include bacteria, viruses, and fungi, but COVID-19-associated cryptococcosis is rarely reported. This review provided updated and comprehensive information about this rare clinical entity of COVID-19-associated cryptococcosis. Through an updated literature search till 23 August 2022, we identified a total of 18 culture-confirmed case reports with detailed information. Half (n = 9) of them were elderly. Fifteen (83.3%) of them had severe COVID-19 and ever received systemic corticosteroid. Disseminated infection with cryptococcemia was the most common type of cryptococcosis, followed by pulmonary and meningitis. Except one case of C. laurentii, all other cases are by C. neoformans. Liposomal amphotericin B and fluconazole were the most commonly used antifungal agents. The overall mortality was 61.1% (11/18) and four of them did not receive antifungal agents before death. Improving the poor outcome requires a physician's high suspicion, early diagnosis, and prompt treatment.
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Abstract
RATIONALE Cryptococcus neoformans (C neoformans) infection typically occurs in immunocompromised patients infected with human immunodeficiency virus (HIV), or those taking immunosuppressive drugs, corticosteroids, or chemotherapy. Recently, there have been an increasing number of reports of cryptococcosis as opportunistic infections in COVID-19 patients, all of which have been related to immunocompromising conditions, underlying medical diseases, immune suppression drugs, or corticosteroids. Here, we report the first case of pulmonary cryptococcosis in an immunocompetent patient with a history of COVID-19 who had no history of underlying diseases or immune modulation drugs. PATIENT CONCERNS A previously healthy 46-year-old man presented with tiny lung nodules. He had quit smoking 6 years prior. He had no significant medical history except for COVID-19 3 months prior, and had not received corticosteroids or cytokine blockers when he had COVID-19. He had been coughing since he recovered from COVID-19. DIAGNOSIS Bronchoalveolar lavage cultures showed the growth of C neoformans. A CT-guided percutaneous needle biopsy of the lung lesion was performed. Histopathology of the biopsy specimen showed granulomas with encapsulated yeast. There was no growth of C neoformans in the CSF or blood. He was diagnosed with pulmonary cryptococcosis. INTERVENTION Antifungal drug (fluconazole) was administered for 6 months in the outside clinic. OUTCOMES The lung lesions disappeared after 6 months medication. LESSONS This case may illustrate the risk of pulmonary cryptococcosis after SARS-CoV-2 infection in an immunocompetent patient. Opportunistic infections can occur even after recovery from COVID-19 for several reasons. First, SARS-CoV-2 infection causes immune dysregulation including lymphocytopenia. Second, T lymphocytes play a principal role against Cryptococcus. Third, these changes in the immune system due to COVID-19 may last for several weeks. Thus, we suggest careful consideration of lung lesions in patients with a history of COVID-19.
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Affiliation(s)
- Hye Sook Choi
- Department of Internal Medicine, Kyung Hee Unversity Medical Center, Seoul, Republic of Korea
- *Correspondence: Hye Sook Choi, MD, Department of Internal Medicine, Kyung Hee Unversity Medical Center, 23 Kyunghee dae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea (e-mail: )
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14
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Antifungal therapy in the management of fungal secondary infections in COVID-19 patients: A systematic review and meta-analysis. PLoS One 2022; 17:e0271795. [PMID: 35901069 PMCID: PMC9333218 DOI: 10.1371/journal.pone.0271795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 07/07/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The prevalence of fungal secondary infections among COVID-19 patients and efficacy of antifungal therapy used in such patients is still unknown. Hence, we conducted this study to find the prevalence of fungal secondary infections among COVID-19 patients and patient outcomes in terms of recovery or all-cause mortality following antifungal therapy (AFT) in such patients. Methods We performed a comprehensive literature search in PubMed®, Scopus®, Web of Sciences™, The Cochrane Library, ClinicalTrial.gov, MedRxiv.org, bioRxiv.org, and Google scholar to identify the literature that used antifungal therapy for the management fungal secondary infections in COVID-19 patients. We included case reports, case series, prospective & retrospective studies, and clinical trials. Mantel Haenszel random-effect model was used for estimating pooled risk ratio for required outcomes. Results A total of 33 case reports, 3 case series, and 21 cohort studies were selected for final data extraction and analysis. The prevalence of fungal secondary infections among COVID-19 patients was 28.2%. Azoles were the most commonly (65.1%) prescribed AFT. Study shows that high survival frequency among patients using AFT, received combination AFT and AFT used for >28 days. The meta-analysis showed, no significant difference in all-cause mortality between patients who received AFT and without AFT (p = 0.17), between types of AFT (p = 0.85) and the duration of AFT (p = 0.67). Conclusion The prevalence of fungal secondary infections among COVID-19 patients was 28.2%. The survival frequency was high among patients who used AFT for fungal secondary infections, received combination AFT and AFT used for >28 days. However, meta-analysis results found that all-cause mortality in COVID-19 patients with fungal secondary infections is not significantly associated with type and duration of AFT, mostly due to presence of confounding factors such as small number of events, delay in diagnosis of fungal secondary infections, presence of other co-infections and multiple comorbidities.
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15
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Shishido AA, Mathew M, Baddley JW. Overview of COVID-19-Associated Invasive Fungal Infection. CURRENT FUNGAL INFECTION REPORTS 2022; 16:87-97. [PMID: 35846240 PMCID: PMC9274633 DOI: 10.1007/s12281-022-00434-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 12/04/2022]
Abstract
Purpose of Review Invasive fungal infections are a complication of COVID-19 disease. This article reviews literature characterizing invasive fungal infections associated with COVID-19. Recent Findings Multiple invasive fungal infections including aspergillosis, candidiasis, pneumocystosis, other non-Aspergillus molds, and endemic fungi have been reported in patients with COVID-19. Risk factors for COVID-19-associated fungal disease include underlying lung disease, diabetes, steroid or immunomodulator use, leukopenia, and malignancy. COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) are the most common fungal infections described. However, there is variability in the reported incidences related to use of differing diagnostic algorithms. Summary Fungal pathogens are important cause of infection in patients with COVID-19, and the diagnostic strategies continue to evolve. Mortality in these patients is increased, and providers should operate with a high index of suspicion. Further studies will be required to elucidate the associations and pathogenesis of these diseases and best management and prevention strategies.
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16
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Kundu R, Singla N. COVID-19 and Plethora of Fungal Infections. CURRENT FUNGAL INFECTION REPORTS 2022; 16:47-54. [PMID: 35432691 PMCID: PMC8994097 DOI: 10.1007/s12281-022-00432-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 12/15/2022]
Abstract
Purpose of Review Severe-acute respiratory coronavirus 2 (SARS-CoV-2) causing corona virus disease 2019 (COVID-19) has been the single most important pathogen driving health care delivery system for the last one and half years. Now, as the time is passing, many issues related to co-infections/secondary infections/superinfections in COVID-19 patients are emerging. The literature is getting enriched everyday by addition of reports from all over the world for the same. The purpose of this review is to decipher the plethora of fungal infections in COVID-19. Recent Findings COVID-19 infection along with it brought many risk factors namely lung injury, immunosuppression, need for oxygen therapy, monoclonal antibodies, steroid therapy, etc. which are known predisposing factors for fungal infections. Rather the extent and severity of fungal pathogens has been so much that it has led to new terminologies like CAC (COVID-19-associated Candida), CAPA (COVID-19-associated pulmonary aspergillosis) and CAM (COVID-19-associated mucormycosis). There is increase in invasiveness of Candida, prevalence of aspergillosis in COVID-19 damaged lung and outbreak of mucormycosis in COVID-19 patients resulting in “double trouble,” keeping laboratory personnel, clinicians, and intensivists on their toes in managing these patients. Summary Awareness and understanding regarding these possible complications is necessary to decrease the morbidity and mortality among patients. The COVID-19 and fungal coinfections may bring more insight into ways of pathogenesis of fungal infections, need for better antifungal agents, quick diagnostic modalities, and better management policies in the near future.
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Affiliation(s)
- Reetu Kundu
- Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nidhi Singla
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
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17
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Rovina N, Koukaki E, Romanou V, Ampelioti S, Loverdos K, Chantziara V, Koutsoukou A, Dimopoulos G. Fungal Infections in Critically Ill COVID-19 Patients: Inevitabile Malum. J Clin Med 2022; 11:jcm11072017. [PMID: 35407625 PMCID: PMC8999371 DOI: 10.3390/jcm11072017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 02/04/2023] Open
Abstract
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.
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18
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Rathore SS, Sathiyamoorthy J, Lalitha C, Ramakrishnan J. A holistic review on Cryptococcus neoformans. Microb Pathog 2022; 166:105521. [DOI: 10.1016/j.micpath.2022.105521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 12/21/2022]
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19
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Regalla D, VanNatta M, Alam M, Malek AE. COVID-19-associated Cryptococcus infection (CACI): a review of literature and clinical pearls. Infection 2022; 50:1007-1012. [PMID: 35322336 PMCID: PMC8942802 DOI: 10.1007/s15010-022-01805-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/09/2022] [Indexed: 02/08/2023]
Abstract
Background Cryptococcal infection has been increasingly reported in patients with COVID-19 infection, but the epidemiological factors, presentation, diagnostic certainty, and outcome have not been well-described. Methods We reviewed the published cases of COVID-19-associated Cryptococcus infections (CACI) to shed the light on the burden of this infection. Results We identified 13 patients with confirmed cryptococcal infection. Cryptococcus infection was primarily seen in patients with severe COVID-19 disease who received corticosteroids therapy and admitted to the intensive care unit. Pulmonary CACI was the most common reported infection followed by cryptococcal meningitis. Conclusion In light of the high mortality rate, clinicians should maintain a high clinical suspicion of CACI in critically ill patients.
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Affiliation(s)
- Dinesh Regalla
- Division of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Mollie VanNatta
- Department of Pharmacy, Ochsner LSU Health Shreveport, Shreveport, LA, USA
| | - Mohammad Alam
- Division of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Alexandre E Malek
- Division of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
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20
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Traver EC, Malavé Sánchez M. Pulmonary aspergillosis and cryptococcosis as a complication of COVID-19. Med Mycol Case Rep 2022; 35:22-25. [PMID: 35018279 PMCID: PMC8734106 DOI: 10.1016/j.mmcr.2022.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/17/2021] [Accepted: 01/03/2022] [Indexed: 12/19/2022] Open
Abstract
Invasive fungal infections may complicate infection by SARS-CoV-2 and increase morbidity and mortality. A 59-year-old man with multiple medical comorbidities was transferred to our hospital for worsening hypoxic respiratory failure due to COVID-19 and received high-dose corticosteroids and 2 doses of cyclophosphamide. He was diagnosed with pulmonary aspergillosis and cryptococcosis by culture of a bronchoalveolar lavage sample. This patient's secondary infections were likely due to treatment with immunosuppressants, his comorbidities, and his prolonged critical illness.
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Affiliation(s)
- Edward C. Traver
- University of Maryland Medical Center, Division of Infectious Diseases, Baltimore, 21201, USA
| | - Melanie Malavé Sánchez
- University of Maryland School of Medicine, Division of Infectious Disease, Baltimore, 21201, USA
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21
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Cryptococcal Protease(s) and the Activation of SARS-CoV-2 Spike (S) Protein. Cells 2022; 11:cells11030437. [PMID: 35159253 PMCID: PMC8834071 DOI: 10.3390/cells11030437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 12/04/2022] Open
Abstract
In this contribution, we report on the possibility that cryptococcal protease(s) could activate the SARS-CoV-2 spike (S) protein. The S protein is documented to have a unique four-amino-acid sequence (underlined, SPRRAR↓S) at the interface between the S1 and S2 sites, that serves as a cleavage site for the human protease, furin. We compared the biochemical efficiency of cryptococcal protease(s) and furin to mediate the proteolytic cleavage of the S1/S2 site in a fluorogenic peptide. We show that cryptococcal protease(s) processes this site in a manner comparable to the efficiency of furin (p > 0.581). We conclude the paper by discussing the impact of these findings in the context of a SARS-CoV-2 disease manifesting while there is an underlying cryptococcal infection.
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22
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Sharma S, Agrawal G, Das S. COVID-19-associated Pulmonary Cryptococcosis: A Rare Case Presentation. Indian J Crit Care Med 2022; 26:129-132. [PMID: 35110857 PMCID: PMC8783228 DOI: 10.5005/jp-journals-10071-24084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Multiple case reports and case series report a surge in opportunistic infections like aspergillosis, mucormycosis, and reactivation of cytomegalovirus infection in coronavirus disease-2019 (COVID-19) patients. We hereby report the first case to the best of our knowledge of pulmonary cryptococcosis in a patient who had successfully recovered from severe COVID-19 illness. The pulmonary cryptococcosis spectrum ranges from asymptomatic infection to frank acute respiratory distress syndrome leading to respiratory failure. Pulmonary cryptococcosis is often underdiagnosed because its clinical presentation, radiographic features, and serologic laboratory investigations are generally inconclusive. The saprophytic colonization of fungus as opposed to invasive disease cannot be assessed from either culture of sputum or currently available serologic tests. Pulmonary cryptococcosis close association with COVID-19 can be further established with reporting of more cases. Hereby, we propose the term CAPC (COVID-19-associated pulmonary cryptococcosis) for such cases. How to cite this article: Sharma S, Agrawal G, Das S. COVID-19-associated Pulmonary Cryptococcosis: A Rare Case Presentation. Indian J Crit Care Med 2022;26(1):129–132.
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Affiliation(s)
- Smita Sharma
- Department of Respiratory and Critical Care Medicine, Jaypee Hospital, Noida, Uttar Pradesh, India
- Smita Sharma, Department of Respiratory and Critical Care Medicine, Jaypee Hospital, Noida, Uttar Pradesh, India, Phone: +91 9891349072, e-mail:
| | - Gyanendra Agrawal
- Department of Respiratory and Critical Care Medicine, Jaypee Hospital, Noida, Uttar Pradesh, India
| | - Suryasnata Das
- Department of Laboratory Medicine, Jaypee Hospital, Noida, Uttar Pradesh, India
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23
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Karnik K, Wu Y, Ruddy S, Quijano-Rondan B, Urban C, Turett G, Yung L, Prasad N, Yoon J, Segal-Maurer S. Fatal case of disseminated cryptococcal infection and meningoencephalitis in the setting of prolonged glucocorticoid use in a Covid-19 positive patient. IDCases 2022; 27:e01380. [PMID: 35013707 PMCID: PMC8734083 DOI: 10.1016/j.idcr.2022.e01380] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 12/15/2022] Open
Abstract
Based on the RECOVERY trial, glucocorticoids have become the mainstay of treatment for COVID-19, thus increasing the risk of opportunistic infections. We report a case of disseminated Cryptococcus neoformans with documented meningoencephalitis in a patient with severe COVID-19 in the setting of prolonged glucocorticoid administration with poor outcome likely due to adrenal involvement.
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Affiliation(s)
- Krupa Karnik
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - Yuexiu Wu
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - Samantha Ruddy
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - Bladimir Quijano-Rondan
- The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - Carl Urban
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,Weill Cornell Medicine, Cornell University, New York, New York 10065, United States
| | - Glenn Turett
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - Lok Yung
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - Nishant Prasad
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - James Yoon
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States
| | - Sorana Segal-Maurer
- Department of Medicine, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,The Dr. James J. Rahal, Jr. Division of Infectious Diseases, NewYork-Presbyterian Queens, 56-45 Main St, Flushing, New York 11355, United States.,Weill Cornell Medicine, Cornell University, New York, New York 10065, United States
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24
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Pipitone G, Spicola D, Abbott M, Sanfilippo A, Onorato F, Di Lorenzo F, Ficalora A, Buscemi C, Alongi I, Imburgia C, Ciusa G, Agrenzano S, Gizzi A, Guida Marascia F, Granata G, CimÒ F, Verde MS, Di Bernardo F, Scafidi A, Mazzarese V, Sagnelli C, Petrosillo N, Cascio A, Iaria C. Invasive cryptococcal disease in COVID-19: systematic review of the literature and analysis. LE INFEZIONI IN MEDICINA 2022; 31:6-12. [PMID: 36908394 PMCID: PMC9994830 DOI: 10.53854/liim-3101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/25/2023] [Indexed: 03/07/2023]
Abstract
During the Coronavirus Disease 2019 (COVID-19) pandemic, an increasing number of fungal infections associated with SARS-CoV-2 infection have been reported. Among them, cryptococcosis could be a life-threatening disease. We performed a Systematic Review (PRISMA Statement) of cryptococcosis and COVID-19 co-infection, case report/series were included: a total of 34 cases were found, then we added our case report. We collected patients' data and performed a statistical analysis comparing two groups of patients sorted by outcome: "dead" and "alive". Three cases were excluded for lack of information. To compare categorical data, we used a Fisher-exact test (α=0.05). To compare quantitative variables a U Mann-Whitney test was used (α=0.05), with a 95% Confidence Interval. A total of 32 co-infected patients were included in the statistical analysis. Mortality rate was 17/32 (53.1%): these patients were included in "dead" group, and 15/32 (46.9%) patients survived and were included in "alive" group. Overall, males were 25/32 (78.1%), the median age was 60 years (IQR 53-70) with non-statistically significant difference between groups (p=0.149 and p=0.911, respectively). Three variables were associated with mortality: ARDS, ICU admission and inadequate treatment. Overall, 21 out of 24 (87.5%) patients were in ARDS with a statistically significant difference among two groups (p=0.028). ICU admission for COVID-19 was observed in 18/26 (69.2%), more frequently among dead group (p=0.034). Finally, 15/32 (46.9%) patients had adequate treatment (amphotericin B + flucytosine for invasive cryptococcosis) mostly among alive patients (p=0.039). In conclusion, mortality due to cryptococcal infection among COVID-19 patients remains high but an early diagnosis and appropriate treatment could reduce mortality.
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Affiliation(s)
- Giuseppe Pipitone
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Daria Spicola
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Michelle Abbott
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy.,Infectious Diseases Unit, University Hospital Policlinic "Paolo Giaccone", Palermo, Italy
| | - Adriana Sanfilippo
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Francesco Onorato
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Francesco Di Lorenzo
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Antonio Ficalora
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Calogero Buscemi
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Ilenia Alongi
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Claudia Imburgia
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Giacomo Ciusa
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Stefano Agrenzano
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Andrea Gizzi
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy.,Infectious Diseases Unit, University Hospital Policlinic "Paolo Giaccone", Palermo, Italy
| | - Federica Guida Marascia
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy.,Infectious Diseases Unit, University Hospital Policlinic "Paolo Giaccone", Palermo, Italy
| | - Guido Granata
- Clinical and Research Department for Infectious Disease, INMI "L. Spallanzani", Rome, Italy
| | - Francesco CimÒ
- Pharmacology Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Maria Stella Verde
- Microbiology Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | | | - Antonino Scafidi
- Intensive Care Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Vincenzo Mazzarese
- Intensive Care Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
| | - Caterina Sagnelli
- Infectious Diseases Unit, University "Luigi Vanvitelli", Naples, Italy
| | - Nicola Petrosillo
- Infection Prevention & Control and Infectious Diseases Unit, University Hospital "Campus Bio-Medico", Rome, Italy
| | - Antonio Cascio
- Infectious Diseases Unit, University Hospital Policlinic "Paolo Giaccone", Palermo, Italy
| | - Chiara Iaria
- Infectious Diseases Unit, ARNAS "Civico-Di Cristina-Benfratelli", Palermo, Italy
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25
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Akhtar N, Khurshid Wani A, Kant Tripathi S, Prakash A, Amin-Ul Mannan M. The role of SARS-CoV-2 immunosuppression and the therapy used to manage COVID-19 disease in the emergence of opportunistic fungal infections: A review. CURRENT RESEARCH IN BIOTECHNOLOGY 2022; 4:337-349. [PMID: 35942223 PMCID: PMC9347179 DOI: 10.1016/j.crbiot.2022.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/02/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022] Open
Abstract
Since December 2019 SARS-CoV-2 infections have affected millions of people worldwide. Along with the increasing number of COVID-19 patients, the number of cases of opportunistic fungal infections among the COVID-19 patients is also increasing. There have been reports of the cases of aspergillosis and candidiasis in the COVID-19 patients. The COVID-19 patients have also been affected by rare fungal infections such as histoplasmosis, pneumocystosis, mucormycosis and cryptococcosis. These fungal infections are prolonging the stay of COVID-19 patients in hospital. In this study several published case reports, case series, prospective and retrospective studies were investigated to explore and report the updated information regarding candidiasis, crytptococcosis, aspergillosis, mucormycosis, histoplasmosis, and pneumocystosis infections in COVID-19 patients. In this review, the risk factors of these co-infections in COVID-19 patients have been reported. There have been reports that the comorbidities and the treatment with corticoids, monoclonal antibodies, use of mechanical ventilation, and use of antibiotics during COVID-19 management are associated with the emergence of fungal infections in the COVID-19 patients. Hence, this review analyses the role of these therapies and comorbidities in the emergence of these fungal infections among COVID-19 patients. This review will help to comprehend if these fungal infections are the result of the co-morbidities, and treatment protocol followed to manage COVID-19 patients or directly due to the SARS-CoV-2 infection. The analysis of all these factors will help to understand their role in fungal infections among COVID-19 patients which can be valuable to the scientific community.
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Affiliation(s)
- Nahid Akhtar
- Department of Molecular Biology and Genetic Engineering, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara 144401, Punjab, India
| | - Atif Khurshid Wani
- Department of Molecular Biology and Genetic Engineering, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara 144401, Punjab, India
| | - Surya Kant Tripathi
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Ajit Prakash
- Department of Biochemistry and Biophysics, University of North Carolina, Chapel Hill, NC 27599, United States
| | - M Amin-Ul Mannan
- Department of Molecular Biology and Genetic Engineering, School of Bioengineering and Biosciences, Lovely Professional University, Phagwara 144401, Punjab, India
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Chastain DB, Henao-Martínez AF, Dykes AC, Steele GM, Stoudenmire LL, Thomas GM, Kung V, Franco-Paredes C. Missed opportunities to identify cryptococcosis in COVID-19 patients: a case report and literature review. Ther Adv Infect Dis 2022; 9:20499361211066363. [PMID: 35070297 PMCID: PMC8771738 DOI: 10.1177/20499361211066363] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/24/2021] [Indexed: 01/08/2023] Open
Abstract
SARS-CoV-2 may activate both innate and adaptive immune responses ultimately leading to a dysregulated immune response prompting the use of immunomodulatory therapy. Although viral pneumonia increases the risk of invasive fungal infections, it remains unclear whether SARS-CoV-2 infection, immunomodulatory therapy, or a combination of both are responsible for the increased recognition of opportunistic infections in COVID-19 patients. Cases of cryptococcosis have previously been reported following treatment with corticosteroids, interleukin (IL)-6 inhibitors, and Janus kinase (JAK) inhibitors, for patients with autoimmune diseases, but their effect on the immunologic response in patients with COVID-19 remains unknown. Herein, we present the case of a patient with COVID-19 who received high-dose corticosteroids and was later found to have cryptococcosis despite no traditional risk factors. As our case and previous cases of cryptococcosis in patients with COVID-19 demonstrate, clinicians must be suspicious of cryptococcosis in COVID-19 patients who clinically deteriorate following treatment with immunomodulatory therapies.
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Affiliation(s)
- Daniel B. Chastain
- Department of Clinical & Administrative Pharmacy, College of Pharmacy, University of Georgia, 1000 Jefferson Street, Albany, GA 31701, USA
| | - Andrés F. Henao-Martínez
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Austin C. Dykes
- Department of Clinical & Administrative Pharmacy, College of Pharmacy, University of Georgia, Albany, GA, USA
| | - Gregory M. Steele
- Infectious Diseases, Phoebe Putney Memorial Hospital, Albany, GA, USA
| | | | - Geren M. Thomas
- Department of Pharmacy, John D. Archbold Memorial Hospital, Thomasville, GA, USA
| | - Vanessa Kung
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Carlos Franco-Paredes
- Division of Infectious Diseases, University of Colorado, Anschutz Medical Campus, Aurora, CO, USAHospital Infantil de México, Federico Gómez, México City, México
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Abdoli A, Falahi S, Kenarkoohi A. COVID-19-associated opportunistic infections: a snapshot on the current reports. Clin Exp Med 2022; 22:327-346. [PMID: 34424451 PMCID: PMC8381864 DOI: 10.1007/s10238-021-00751-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/30/2021] [Indexed: 02/07/2023]
Abstract
Treatment of the novel Coronavirus Disease 2019 (COVID-19) remains a complicated challenge, especially among patients with severe disease. In recent studies, immunosuppressive therapy has shown promising results for control of the cytokine storm syndrome (CSS) in severe cases of COVID-19. However, it is well documented that immunosuppressive agents (e.g., corticosteroids and cytokine blockers) increase the risk of opportunistic infections. On the other hand, several opportunistic infections were reported in COVID-19 patients, including Aspergillus spp., Candida spp., Cryptococcus neoformans, Pneumocystis jiroveci (carinii), mucormycosis, Cytomegalovirus (CMV), Herpes simplex virus (HSV), Strongyloides stercoralis, Mycobacterium tuberculosis, and Toxoplasma gondii. This review is a snapshot about the main opportunistic infections that reported among COVID-19 patients. As such, we summarized information about the main immunosuppressive agents that were used in recent clinical trials for COVID-19 patients and the risk of opportunistic infections following these treatments. We also discussed about the main challenges regarding diagnosis and treatment of COVID-19-associated opportunistic infections (CAOIs).
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Affiliation(s)
- Amir Abdoli
- Zoonoses Research Center, Jahrom University of Medical Sciences, Jahrom, Iran ,Jahrom University of Medical Sciences, Ostad Motahari Ave, POBox 74148-46199, Jahrom, Iran
| | - Shahab Falahi
- Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Azra Kenarkoohi
- Department of Microbiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
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Gil Y, Gil YD, Markou T. The Emergence of Cryptococcemia in COVID-19 Infection: A Case Report. Cureus 2021; 13:e19761. [PMID: 34938636 PMCID: PMC8685839 DOI: 10.7759/cureus.19761] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 12/15/2022] Open
Abstract
Cryptococcus neoformans is a fungus that can cause pulmonary, central nervous system, and dermatological infections, especially in an immunocompromised patient. This is a case report of a patient, who was presumptively immunocompetent that developed isolated cryptococcemia while being treated for coronavirus disease 19 (COVID-19) infection. We report a case of a 59-year-old Hispanic man with a past medical history of hypertension, well-controlled diabetes mellitus, and class I obesity who was admitted for severe acute respiratory distress syndrome coronavirus 2 (SARS-COV-2) and subsequently was diagnosed with cryptococcal fungemia. The patient received 21 days of dexamethasone and during this period, blood and fungal cultures grew C. neoformans. The patient was alert and oriented, did not have focal neurological deficits or meningeal irritation signs; nonetheless, a lumbar puncture was attempted, but not successful. He was treated with intravenous amphotericin B for two weeks, followed by oral fluconazole for six weeks. Repeat blood cultures demonstrated clearance and he improved clinically. In conclusion, this case report describes the possibility of an association between the use of dexamethasone in COVID-19 patients and the development of cryptococcal fungemia. In the review of literature, rare case reports worldwide have discussed this topic. This is clinically challenging as the emergence of opportunistic infections in these debilitated hosts can be detrimental. Maintaining a high clinical suspicion for this opportunistic infection while treating COVID-19 patients is necessary to prevent further mortality associated with this pandemic.
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Affiliation(s)
- Yerandy Gil
- Internal Medicine, Saint Clare's Health, Denville, USA
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Amin A, Vartanian A, Poladian N, Voloshko A, Yegiazaryan A, Al-Kassir AL, Venketaraman V. Root Causes of Fungal Coinfections in COVID-19 Infected Patients. Infect Dis Rep 2021; 13:1018-1035. [PMID: 34940403 PMCID: PMC8701102 DOI: 10.3390/idr13040093] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/01/2021] [Accepted: 12/01/2021] [Indexed: 01/09/2023] Open
Abstract
COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has infected over 200 million people, causing over 4 million deaths. COVID-19 infection has been shown to lead to hypoxia, immunosuppression, host iron depletion, hyperglycemia secondary to diabetes mellitus, as well as prolonged hospitalizations. These clinical manifestations provide favorable conditions for opportunistic fungal pathogens to infect hosts with COVID-19. Interventions such as treatment with corticosteroids and mechanical ventilation may further predispose COVID-19 patients to acquiring fungal coinfections. Our literature review found that fungal coinfections in COVID-19 infected patients were most commonly caused by Aspergillus, Candida species, Cryptococcus neoformans, and fungi of the Mucorales order. The distribution of these infections, particularly Mucormycosis, was found to be markedly skewed towards low- and middle-income countries. The purpose of this review is to identify possible explanations for the increase in fungal coinfections seen in COVID-19 infected patients so that physicians and healthcare providers can be conscious of factors that may predispose these patients to fungal coinfections in order to provide more favorable patient outcomes. After identifying risk factors for coinfections, measures should be taken to minimize the dosage and duration of drugs such as corticosteroids, immunosuppressants, and antibiotics.
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Affiliation(s)
- Arman Amin
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766-1854, USA; (A.A.); (N.P.); (A.V.); (A.Y.); (A.L.A.-K.)
| | - Artin Vartanian
- School of Medicine, St. George’s University, St. George’s 999166, Grenada;
| | - Nicole Poladian
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766-1854, USA; (A.A.); (N.P.); (A.V.); (A.Y.); (A.L.A.-K.)
| | - Alexander Voloshko
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766-1854, USA; (A.A.); (N.P.); (A.V.); (A.Y.); (A.L.A.-K.)
| | - Aram Yegiazaryan
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766-1854, USA; (A.A.); (N.P.); (A.V.); (A.Y.); (A.L.A.-K.)
| | - Abdul Latif Al-Kassir
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766-1854, USA; (A.A.); (N.P.); (A.V.); (A.Y.); (A.L.A.-K.)
| | - Vishwanath Venketaraman
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766-1854, USA; (A.A.); (N.P.); (A.V.); (A.Y.); (A.L.A.-K.)
- Correspondence:
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Alegre-González D, Herrera S, Bernal J, Soriano A, Bodro M. Disseminated Cryptococcus neoformans infection associated to COVID-19. Med Mycol Case Rep 2021; 34:35-37. [PMID: 34703755 PMCID: PMC8531235 DOI: 10.1016/j.mmcr.2021.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 12/12/2022] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a novel coronavirus associated with immune dysregulation. The use of immunosuppressant drugs as part of COVID-19 treatment (such as Tocilizumab or high -dose corticosteroids) increases the risk of opportunistic infections. Here we present a case of a patient without prior immunosuppression that developed a serious fungal infection after the use of high dose corticosteroids in the setting of severe COVID-19 and cryptogenic organizing pneumonia.
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Affiliation(s)
| | - Sabina Herrera
- Department of Infectious Diseases, Hospital Clinic, Barcelona, 08036, Spain
| | - Javier Bernal
- Department of Infectious Diseases, Hospital Clinic, Barcelona, 08036, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic, Barcelona, 08036, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic, Barcelona, 08036, Spain
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31
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Baddley JW, Thompson GR, Chen SCA, White PL, Johnson MD, Nguyen MH, Schwartz IS, Spec A, Ostrosky-Zeichner L, Jackson BR, Patterson TF, Pappas PG. Coronavirus Disease 2019-Associated Invasive Fungal Infection. Open Forum Infect Dis 2021; 8:ofab510. [PMID: 34877364 PMCID: PMC8643686 DOI: 10.1093/ofid/ofab510] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/07/2021] [Indexed: 12/15/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) can become complicated by secondary invasive fungal infections (IFIs), stemming primarily from severe lung damage and immunologic deficits associated with the virus or immunomodulatory therapy. Other risk factors include poorly controlled diabetes, structural lung disease and/or other comorbidities, and fungal colonization. Opportunistic IFI following severe respiratory viral illness has been increasingly recognized, most notably with severe influenza. There have been many reports of fungal infections associated with COVID-19, initially predominated by pulmonary aspergillosis, but with recent emergence of mucormycosis, candidiasis, and endemic mycoses. These infections can be challenging to diagnose and are associated with poor outcomes. The reported incidence of IFI has varied, often related to heterogeneity in patient populations, surveillance protocols, and definitions used for classification of fungal infections. Herein, we review IFI complicating COVID-19 and address knowledge gaps related to epidemiology, diagnosis, and management of COVID-19-associated fungal infections.
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Affiliation(s)
- John W Baddley
- Department of Medicine, University of Maryland School of Medicine and Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases and Department of Medical Microbiology and Immunology, University of California, Davis Medical Center, Sacramento, California, USA
| | - Sharon C -A Chen
- Centre for Infectious Diseases and Microbiology, Westmead Hospital and Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, Australia
| | - P Lewis White
- Public Health Wales Microbiology Cardiff, University Hospital of Wales, Cardiff, United Kingdom
| | - Melissa D Johnson
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - M Hong Nguyen
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ilan S Schwartz
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Andrej Spec
- Division of Infectious Diseases, Department of Medicine, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | | | | | - Thomas F Patterson
- University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Peter G Pappas
- Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Abstract
PURPOSE OF REVIEW This review will comment on the current knowledge for the diagnosis of the main causes of COVID-19-associated invasive fungal disease (IFD); it will discuss the optimal strategies and limitations and wherever available, will describe international recommendations. RECENT FINDINGS A range of secondary IFDs complicating COVID-19 infection have been described and while COVID-19-associated pulmonary aspergillosis was predicted, the presentation of significant numbers of COVID-19-associated candidosis and COVID-19-associated mucormycosis was somewhat unexpected. Given the range of IFDs and prolonged duration of risk, diagnostic strategies need to involve multiple tests for detecting and differentiating various causes of IFD. Although performance data for a range of tests to diagnose COVID-19-associated pulmonary aspergillosis is emerging, the performance of tests to diagnose other IFD is unknown or based on pre-COVID performance data. SUMMARY Because of the vast numbers of COVID-19 infections, IFD in COVID-19 critical-care patients represents a significant burden of disease, even if incidences are less than 5%. Optimal diagnosis of COVID-19-associated IFD requires a strategic approach. The pandemic has highlighted the potential impact of IFD outside of the typical high-risk clinical cohorts, given the ever-increasing population at risk of IFD and enhanced surveillance of fungal infections is required.
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Affiliation(s)
- P Lewis White
- Public Health Wales, Microbiology Cardiff, UHW, Heath Park, Cardiff, UK
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Invasive Fungal Infections Complicating COVID-19: A Narrative Review. J Fungi (Basel) 2021; 7:jof7110921. [PMID: 34829210 PMCID: PMC8620819 DOI: 10.3390/jof7110921] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
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 Pneumocystis jirovecii pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to Fusarium spp., and 1 case of pulmonary infection due to Scedosporium.
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Overview on the Prevalence of Fungal Infections, Immune Response, and Microbiome Role in COVID-19 Patients. J Fungi (Basel) 2021; 7:jof7090720. [PMID: 34575758 PMCID: PMC8466761 DOI: 10.3390/jof7090720] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 01/08/2023] Open
Abstract
Patients with severe COVID-19, such as individuals in intensive care units (ICU), are exceptionally susceptible to bacterial and fungal infections. The most prevalent fungal infections are aspergillosis and candidemia. Nonetheless, other fungal species (for instance, Histoplasma spp., Rhizopus spp., Mucor spp., Cryptococcus spp.) have recently been increasingly linked to opportunistic fungal diseases in COVID-19 patients. These fungal co-infections are described with rising incidence, severe illness, and death that is associated with host immune response. Awareness of the high risks of the occurrence of fungal co-infections is crucial to downgrade any arrear in diagnosis and treatment to support the prevention of severe illness and death directly related to these infections. This review analyses the fungal infections, treatments, outcome, and immune response, considering the possible role of the microbiome in these patients. The search was performed in Medline (PubMed), using the words "fungal infections COVID-19", between 2020-2021.
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Benedict K, Williams S, Beekmann SE, Polgreen PM, Jackson BR, Toda M. Testing Practices for Fungal Respiratory Infections and SARS-CoV-2 among Infectious Disease Specialists, United States. J Fungi (Basel) 2021; 7:jof7080605. [PMID: 34436144 PMCID: PMC8397131 DOI: 10.3390/jof7080605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/23/2021] [Indexed: 12/14/2022] Open
Abstract
In an online poll, 174 infectious disease physicians reported that testing frequencies for coccidioidomycosis, histoplasmosis, blastomycosis, and cryptococcosis were similar before and during the COVID-19 pandemic, indicating that these physicians remain alert for these fungal infections and were generally not concerned about the possibility of under-detection.
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Affiliation(s)
- Kaitlin Benedict
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (S.W.); (B.R.J.); (M.T.)
- Correspondence:
| | - Samantha Williams
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (S.W.); (B.R.J.); (M.T.)
| | - Susan E. Beekmann
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA; (S.E.B.); (P.M.P.)
| | - Philip M. Polgreen
- Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA; (S.E.B.); (P.M.P.)
| | - Brendan R. Jackson
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (S.W.); (B.R.J.); (M.T.)
| | - Mitsuru Toda
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA; (S.W.); (B.R.J.); (M.T.)
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Martins AC, Psaltikidis EM, de Lima TC, Fagnani R, Schreiber AZ, Conterno LDO, Kamei K, Watanabe A, Trabasso P, Resende MR, Moretti ML. COVID-19 and invasive fungal coinfections: A case series at a Brazilian referral hospital. J Mycol Med 2021; 31:101175. [PMID: 34303951 PMCID: PMC8278860 DOI: 10.1016/j.mycmed.2021.101175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/20/2021] [Accepted: 07/13/2021] [Indexed: 12/23/2022]
Abstract
Background COVID-19 co-infections have been described with different pathogens, including filamentous and yeast fungi. Methodology A retrospective case series study conducted from February to December 2020, at a Brazilian university hospital. Data were collected from two hospital surveillance systems: Invasive fungal infection (IFI) surveillance (Mycosis Resistance Program - MIRE) and COVID-19 surveillance. Data from both surveillance systems were cross-checked to identify individuals diagnosed with SARS-CoV-2 (by positive polymerase chain reaction (PCR)) and IFI during hospital stays within the study period. Results During the study period, 716 inpatients with COVID-19 and 55 cases of IFI were identified. Fungal co-infection with SARS-CoV-2 was observed in eight (1%) patients: three cases of aspergillosis; four candidemia and one cryptococcosis. The median age of patients was 66 years (IQR 58-71 years; range of 28-77 years) and 62.5% were men. Diagnosis of IFI occurred a median of 11.5 days (IQR 4.5-23 days) after admission and 11 days (IQR 6.5-16 days) after a positive PCR result for SARS-CoV-2. In 75% of cases, IFI was diagnosed in the intensive care unit (ICU). Cases of aspergillosis emerged earlier than those of candidemia: an average of 8.6 and 28.6 days after a positive PCR for SARS-CoV-2, respectively. All the patients with both infections ultimately died. Conclusion A low rate of COVID-19 co-infection with IFI was observed, with high mortality. Most cases were diagnosed in ICU patients. Aspergillosis diagnosis is highly complex in this context and requires different criteria.
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Affiliation(s)
| | | | | | - Renata Fagnani
- School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
| | | | | | - Katsuhiko Kamei
- Medical Mycology Research Center, Chiba University, Chiba, Japan.
| | - Akira Watanabe
- Medical Mycology Research Center, Chiba University, Chiba, Japan.
| | - Plinio Trabasso
- School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
| | | | - Maria Luiza Moretti
- School of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil.
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Cryptococcus neoformans Meningoencephalitis in an Immunocompetent Patient after COVID-19 Infection. Case Rep Infect Dis 2021; 2021:5597473. [PMID: 34188965 PMCID: PMC8195638 DOI: 10.1155/2021/5597473] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/12/2021] [Accepted: 05/31/2021] [Indexed: 01/08/2023] Open
Abstract
Cryptococcus neoformans is a saprophytic fungus that causes fatal disseminated infections in immunocompromised hosts. Since the onset of the COVID-19 pandemic, multiple cases of secondary viral, bacterial, and fungal infections have been reported in patients after SARS-CoV-2 infection. We describe here a case of severe cryptococcal meningitis that developed in a previously healthy patient one week after treatment of SARS-CoV-2 infection with dexamethasone. This case adds to the growing knowledge of emerging secondary infectious complications including opportunistic pathogens after SARS-CoV-2 infection. While few reports allude to depressed T-cell function and lymphopenia due to SARS-CoV-2 infection, further studies are needed to evaluate the effects of this infection and its treatment on the immune system and its contribution to the emergence of secondary opportunistic infections.
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Bhatt K, Agolli A, Patel MH, Garimella R, Devi M, Garcia E, Amin H, Domingue C, Guerra Del Castillo R, Sanchez-Gonzalez M. High mortality co-infections of COVID-19 patients: mucormycosis and other fungal infections. Discoveries (Craiova) 2021; 9:e126. [PMID: 34036149 PMCID: PMC8137279 DOI: 10.15190/d.2021.5] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/23/2022] Open
Abstract
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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Affiliation(s)
- Kinal Bhatt
- Division of Clinical and Translational Research, Larkin Health System, South Miami, FL, USA
| | - Arjola Agolli
- Division of Clinical and Translational Research, Larkin Health System, South Miami, FL, USA
| | - Mehrie H. Patel
- Division of Clinical and Translational Research, Larkin Health System, South Miami, FL, USA
| | - Radhika Garimella
- Division of Clinical and Translational Research, Larkin Health System, South Miami, FL, USA
| | - Madhuri Devi
- Pakistan Ziauddin Medical College, Karachi, Pakistan
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Hydrocortisone/methylprednisolone/tocilizumab. REACTIONS WEEKLY 2021. [PMCID: PMC7997494 DOI: 10.1007/s40278-021-93201-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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