By Denise Baez
A study evaluating a national, enhanced testing strategy to diagnose invasive fungal disease in intensive care patients with coronavirus disease 2019 (COVID-19) found that invasive fungal disease represents a significant complication associated with severe COVID-19 infection, which resulted in increased mortality.
The study, published in Clinical Infectious Diseases, also found that use of early antifungal therapy, directed by strategic mycological testing, inferred a survival benefit.
“Antifungal prophylaxis may be warranted in certain patients,” stated P. Lewis White, PhD, Public Health Wales Microbiology Cardiff, UHW, Cardiff, United Kingdom, and colleagues.
The researchers undertook the study due to an increasing number of small studies describing aspergillosis in patients with COVID-19 with severe respiratory distress. Dr. White and colleagues screened 135 adults with severe COVID-19 who were being treated in intensive care units. All patients that were screened had refractory severe respiratory illness or deterioration of respiratory function 1 week post-COVID diagnosis.
The screening strategy involved obtaining both blood and deep respiratory samples for mycological investigation of both yeast and mould infections. Antifungal therapy was administered at the clinicians’ discretion. The incidence of fungal infections was 26.7% (14.1% aspergillosis, 12.6% yeast infections).
The overall mortality rate was 38%. Among patients with invasive fungal disease, the mortality rate was 53% compared with 31% among patients without fungal disease.
Of the patients who received antifungal therapy, the mortality rate was 38.5% compared with 90% among patients who did not receive therapy.
There was a significant association between patients with positive mycology and patients diagnosed with or treated for a solid malignancy. Among the 57 patients where corticosteroids data was available, there was a strong association between patients with multiple Aspergillus/BDG (≥2) positive results and the use of high-dose systemic corticosteroids. There was also a significant association for patients with an underlying chronic respiratory condition to have multiple positive Aspergillus/BDG tests results.
Procalcitonin, C-reactive protein, total leucocytes, neutrophils and lymphocytes were similar across cohorts.
“The proposed systematic screening programme using a combination of markers from easily obtainable samples provides a sufficiently sensitive and specific way of identifying invasive fungal disease in patients with COVID-19 and has the potential to reduce mortality from this relatively frequent complication,” the authors wrote. “Screening using a strategic diagnostic approach and antifungal prophylaxis of patients with risk factors will likely enhance the management of patients with COVID-19.”