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Daliu P, Bogdan I, Rosca O, Licker M, Stanga LC, Hogea E, Vaduva DB, Muntean D. Fungal Pulmonary Coinfections in COVID-19: Microbiological Assessment, Inflammatory Profiles, and Clinical Outcomes. Biomedicines 2025; 13:864. [PMID: 40299432 PMCID: PMC12024551 DOI: 10.3390/biomedicines13040864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2025] [Revised: 03/29/2025] [Accepted: 04/01/2025] [Indexed: 04/30/2025] Open
Abstract
Background and Objectives: Secondary pulmonary fungal infections in coronavirus disease 2019 (COVID-19) remain underexplored despite emerging reports linking them to heightened morbidity. Comorbidities, steroid use, and prolonged hospital stays can predispose patients to opportunistic fungi. This study aimed to evaluate the impact of fungal coinfection on inflammatory markers, disease severity, antifungal resistance profiles, and outcomes in hospitalized COVID-19 patients. Methods: This retrospective observational study enrolled 280 adults (≥18 years) with real-time polymerase chain reaction (RT-PCR)-confirmed COVID-19 admitted to a tertiary care center (January 2023-December 2024). Patients were divided into a COVID-19-only group (n = 216) and a COVID-fungal group (n = 64) based on bronchoalveolar lavage, sputum, and/or blood culture positivity for fungal pathogens. Inflammatory markers (C-reactive protein (CRP), procalcitonin, the neutrophil-to-lymphocyte ratio, and the systemic immune inflammation index) and severity scores (Acute Physiology and Chronic Health Evaluation II, CURB-65 score, and the National Early Warning Score) were measured. We assessed antifungal susceptibilities and recorded ICU admissions, ventilation, hospital length of stay, and mortality. Results:Aspergillus fumigatus (31.3%), Candida albicans (28.1%), Cryptococcus neoformans (7.8%), Pneumocystis jirovecii (6.3%), and Mucorales (6.3%) dominated; Candida glabrata, Candida tropicalis, and mixed infections were also noted. Multidrug-resistant (MDR) isolates or resistance to triazoles occurred in 25.0% of cultures. The COVID-19-fungal group showed significantly higher CRP (85.7 vs. 71.6 mg/L, p < 0.001), procalcitonin (2.4 vs. 1.3 ng/mL, p < 0.001), and APACHE II scores (18.6 vs. 14.8, p < 0.001). intensive-care unit admissions (39.1% vs. 19.9%, p = 0.004) and mechanical ventilation (26.6% vs. 10.2%, p = 0.01) were more frequent with fungal coinfection. Mortality trended at a higher rate (15.6% vs. 7.4%, p = 0.06). Conclusions: Pulmonary fungal coinfections intensify the inflammatory milieu, elevate severity scores, and lead to more frequent ICU-level interventions in COVID-19 patients. Early identification, guided by culture-based and molecular diagnostics, alongside prompt antifungal therapy, could mitigate adverse outcomes. These findings underscore the critical need for proactive fungal surveillance and rigorous stewardship in managing severe COVID-19 pneumonia.
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Affiliation(s)
- Petrinela Daliu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania;
| | - Iulia Bogdan
- Department of Infectious Disease, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (I.B.); (O.R.)
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ovidiu Rosca
- Department of Infectious Disease, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (I.B.); (O.R.)
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Monica Licker
- Discipline of Microbiology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.L.); (D.B.V.); (D.M.)
- Microbiology Laboratory, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Livia Claudia Stanga
- Discipline of Microbiology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.L.); (D.B.V.); (D.M.)
| | - Elena Hogea
- Discipline of Microbiology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.L.); (D.B.V.); (D.M.)
| | - Delia Berceanu Vaduva
- Discipline of Microbiology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.L.); (D.B.V.); (D.M.)
| | - Delia Muntean
- Discipline of Microbiology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (M.L.); (D.B.V.); (D.M.)
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Imparato M, Maione A, Buonanno A, Gesuele R, Gallucci N, Corsaro MM, Paduano L, Casillo A, Guida M, Galdiero E, de Alteriis E. Extracellular Vesicles from a Biofilm of a Clinical Isolate of Candida albicans Negatively Impact on Klebsiella pneumoniae Adherence and Biofilm Formation. Antibiotics (Basel) 2024; 13:80. [PMID: 38247639 PMCID: PMC10812662 DOI: 10.3390/antibiotics13010080] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 01/23/2024] Open
Abstract
The opportunistic human fungal pathogen Candida albicans produces and releases into the surrounding medium extracellular vesicles (EVs), which are involved in some processes as communication between fungal cells and host-pathogen interactions during infection. Here, we have conducted the isolation of EVs produced by a clinical isolate of C. albicans during biofilm formation and proved their effect towards the ability of the Gram-negative bacterial pathogen Klebsiella pneumoniae to adhere to HaCaT cells and form a biofilm in vitro. The results represent the first evidence of an antagonistic action of fungal EVs against bacteria.
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Affiliation(s)
- Marianna Imparato
- Department of Biology, University of Naples ‘Federico II’, Via Cinthia, 80126 Naples, Italy; (M.I.); (A.M.); (A.B.); (R.G.); (M.G.); (E.d.A.)
| | - Angela Maione
- Department of Biology, University of Naples ‘Federico II’, Via Cinthia, 80126 Naples, Italy; (M.I.); (A.M.); (A.B.); (R.G.); (M.G.); (E.d.A.)
| | - Annalisa Buonanno
- Department of Biology, University of Naples ‘Federico II’, Via Cinthia, 80126 Naples, Italy; (M.I.); (A.M.); (A.B.); (R.G.); (M.G.); (E.d.A.)
| | - Renato Gesuele
- Department of Biology, University of Naples ‘Federico II’, Via Cinthia, 80126 Naples, Italy; (M.I.); (A.M.); (A.B.); (R.G.); (M.G.); (E.d.A.)
| | - Noemi Gallucci
- Department of Chemical Sciences, University of Naples “Federico II”, Via Cintia 4, 80126 Naples, Italy; (N.G.); (M.M.C.); (L.P.); (A.C.)
| | - Maria Michela Corsaro
- Department of Chemical Sciences, University of Naples “Federico II”, Via Cintia 4, 80126 Naples, Italy; (N.G.); (M.M.C.); (L.P.); (A.C.)
| | - Luigi Paduano
- Department of Chemical Sciences, University of Naples “Federico II”, Via Cintia 4, 80126 Naples, Italy; (N.G.); (M.M.C.); (L.P.); (A.C.)
| | - Angela Casillo
- Department of Chemical Sciences, University of Naples “Federico II”, Via Cintia 4, 80126 Naples, Italy; (N.G.); (M.M.C.); (L.P.); (A.C.)
| | - Marco Guida
- Department of Biology, University of Naples ‘Federico II’, Via Cinthia, 80126 Naples, Italy; (M.I.); (A.M.); (A.B.); (R.G.); (M.G.); (E.d.A.)
- National Biodiversity Future Center (NBFC), 90133 Palermo, Italy
- Center for Studies on Bioinspired Agro-Environmental Technology (BAT Center), 80055 Portici, Italy
| | - Emilia Galdiero
- Department of Biology, University of Naples ‘Federico II’, Via Cinthia, 80126 Naples, Italy; (M.I.); (A.M.); (A.B.); (R.G.); (M.G.); (E.d.A.)
- Center for Studies on Bioinspired Agro-Environmental Technology (BAT Center), 80055 Portici, Italy
| | - Elisabetta de Alteriis
- Department of Biology, University of Naples ‘Federico II’, Via Cinthia, 80126 Naples, Italy; (M.I.); (A.M.); (A.B.); (R.G.); (M.G.); (E.d.A.)
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Colosi HA, Baciu AM, Costache C, Opris RV, Popp RA, Sabou M, Colosi IA. Prevalence of Azole-Resistant Aspergillus Section Fumigati Strains Isolated from Romanian Vineyard Soil Samples. Antibiotics (Basel) 2023; 12:1695. [PMID: 38136729 PMCID: PMC10741105 DOI: 10.3390/antibiotics12121695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023] Open
Abstract
The relationship between fungal species and their resistance patterns in vineyard soils has important implications for agriculture and medicine. This study explored the prevalence of Aspergillus section Fumigati species and their resistance to azole compounds in Romanian vineyard soils. METHODS A total of 265 soil samples from various Romanian vineyards were screened for fungi resistant to azoles. RESULTS Aspergillus section Fumigati isolates exhibited significant resistance to itraconazole and voriconazole, but no azole-resistant Aspergillus fumigatus strains were detected. Six percent of the samples were positive for Aspergillus section Fumigati strains, all of which were azole-resistant. The strains were mainly Aspergillus udagawae (93.75%) and Aspergillus lentulus (6.25%). The predominant azole-resistant Aspergillus species were Aspergillus section Nigri strains, which were found in 75 soil samples. CONCLUSIONS This study highlights the importance of understanding fungal resistance in vineyard soils for both the agricultural and clinical sectors. The presence of resistant strains may affect vine health and wine production while also constituting a challenge in the selection of effective treatments against severe and potentially fatal fungal infections in humans, stressing the importance of species-specific antifungal resistance knowledge.
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Affiliation(s)
- Horațiu Alexandru Colosi
- Department of Medical Education, Division of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (H.A.C.); (I.A.C.)
| | - Alina Mihaela Baciu
- Division of Microbiology, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Carmen Costache
- Division of Microbiology, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Razvan Vlad Opris
- Division of Microbiology, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Radu Anghel Popp
- Division of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Marcela Sabou
- Laboratoire de Parasitologie et Mycologie Médicale, Les Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France;
- Institut de Parasitologie et de Pathologie Tropicale, UR7292 Dynamique des Interactions hôte Pathogène, Fédération de Médecine Translationnelle, Université de Strasbourg, 67000 Strasbourg, France
| | - Ioana Alina Colosi
- Department of Medical Education, Division of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania; (H.A.C.); (I.A.C.)
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