Generic placeholder image

Recent Advances in Anti-Infective Drug Discovery


ISSN (Print): 2772-4344
ISSN (Online): 2772-4352

Research Article

Clinical Profile, Risk Factors, and Therapeutic Outcome of Cavitating Fungal Pneumonia Coinfection in COVID-19 Patients: A Retrospective Analysis

Author(s): Arjun Kumar, Mayank Mishra*, Saikat Banerjee, Lokesh Kumar Saini, Prakhar Sharma, Ruchi Dua and Girish Sindhwani

Volume 17, Issue 3, 2022

Published on: 05 September, 2022

Page: [167 - 177] Pages: 11

DOI: 10.2174/2772434417666220720122042

Price: $65


Background: An end to the novel coronavirus disease 2019 (COVID-19) pandemic appears to be a distant dream. To make matters worse, there has been an alarming upsurge in the incidence of cavitating invasive fungal pneumonia associated with COVID-19, reported from various parts of the world including India. Therefore, it remains important to identify the clinical profile, risk factors, and outcome of this group of patients.

Methods: Out of 50 moderate to severe COVID-19 inpatients with thoracic computed tomographic (CT) evidence of lung cavitation, we retrospectively collected demographic and clinical data of those diagnosed with fungal pneumonia for further investigation. We determined the association between risk factors related to 30-day and 60-day mortality.

Results: Of the 50 COVID-19 patients with cavitating lung lesions, 22 (44 %) were identified to have fungal pneumonia. Most of these patients (n = 16, 72.7 %) were male, with a median (range) age of 56 (38-64) years. On chest CT imaging, the most frequent findings were multiple cavities (n = 13, 59.1 %) and consolidation (n = 14, 63.6 %). Mucormycosis (n = 10, 45.5 %) followed by Aspergillus fumigatus (n = 9, 40.9 %) were the common fungi identified. 30-day and 60-day mortalities were seen in 12 (54.5 %) and 16 (72.7 %) patients, respectively. On subgroup analysis, high cumulative prednisolone dose was an independent risk factor associated with 30-day mortality (p = 0.024).

Conclusion: High cumulative prednisolone dose, baseline neutropenia, hypoalbuminemia, multiple cavities on CT chest, leukopenia, lymphopenia and raised inflammatory markers were associated with poor prognosis in severe COVID-19 patients with cavitating fungal pneumonia.

Keywords: Aspergillosis, COVID-19, fungal infection, mucormycosis, pulmonary cavity, patients.

Graphical Abstract
Shafran N, Shafran I, Ben-Zvi H, et al. Secondary bacterial infection in COVID-19 patients is a stronger predictor for death compared to influenza patients. Sci Rep 2021; 11(1): 12703.
[] [PMID: 34135459]
Fekkar A, Lampros A, Mayaux J, et al. Occurrence of invasive pulmonary fungal infections in patients with severe COVID-19 admitted to the ICU. Am J Respir Crit Care Med 2021; 203(3): 307-17.
[] [PMID: 33480831]
Schauwvlieghe AFAD, Rijnders BJA, Philips N, et al. Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: A retrospective cohort study. Lancet Respir Med 2018; 6(10): 782-92.
[] [PMID: 30076119]
Lamoth F, Glampedakis E, Boillat BN, Oddo M, Pagani JL. Incidence of invasive pulmonary aspergillosis among criti-cally ill COVID-19 patients. Clin Microbiol Infect 2020; 26(12): 1706-8.
[] [PMID: 32659385]
Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Ita-ly. JAMA 2020; 323(18): 1775-6.
[] [PMID: 32203977]
Prakash H, Chakrabarti A. Epidemiology of mucormycosis in India. Microorganisms 2021; 9(3): 523.
[] [PMID: 33806386]
Centers for Disease Control and Prevention. Division of foot borne, water brone and environmental desease (DFWED). Available from:
Soman R, Sunavala A. Post COVID-19 mucormycosis - from the frying pan into the fire. J Assoc Physicians India 2021; 69(1): 13-4.
[PMID: 34227768]
Carotti M, Salaffi F, Sarzi-Puttini P, et al. Chest CT features of coronavirus disease 2019 (COVID-19) pneumonia: key points for radiologists. Radiol Med 2020; 125(7): 636-46.
[] [PMID: 32500509]
Zoumot Z, Bonilla MF, Wahla AS, et al. Pulmonary cavitation: an under-recognized late complication of severe CO-VID-19 lung disease. BMC Pulm Med 2021; 21(1): 24.
[] [PMID: 33435949]
Selvaraj V, Dapaah-Afriyie K. Lung cavitation due to COVID-19 pneumonia. BMJ Case Rep 2020; 13(7): e237245.
[] [PMID: 32636231]
Donnelly JP, Chen SC, Kauffman CA, et al. Revision and update of the consensus definitions of invasive fungal disea-se from the European organization for research and treatment of cancer and the mycoses study group education and research consortium. Clin Infect Dis 2020; 71(6): 1367-76.
[] [PMID: 31802125]
Gao J, Zhong L, Wu M, et al. Risk factors for mortality in critically ill patients with COVID-19: a multicenter retrospec-tive case-control study. BMC Infect Dis 2021; 21(1): 602.
[] [PMID: 34167463]
Obata R, Maeda T, Rizk D, Kuno T. Increased secondary infection in COVID-19 patients treated with steroids in New York City. Jpn J Infect Dis 2021; 74(4): 307-15.
[] [PMID: 33390434]
Pettit NN, Nguyen CT, Mutlu GM, et al. Late onset infectious complications and safety of tocilizumab in the manage-ment of COVID-19. J Med Virol 2021; 93(3): 1459-64.
[] [PMID: 32790075]
Rammaert B, Lanternier F, Zahar J-R, et al. Healthcare-associated mucormycosis. Clin Infect Dis 2012; 54 (Suppl. 1): S44-54.
[] [PMID: 22247444]
Connolly JE Jr, McAdams HP, Erasmus JJ, Rosado-de-Christenson ML. Opportunistic fungal pneumonia. J Thorac Imaging 1999; 14(1): 51-62.
[] [PMID: 9894953]
Orlowski HLP, McWilliams S, Mellnick VM, et al. Imaging spectrum of invasive fungal and fungal-like infections. Radiographics 2017; 37(4): 1119-34.
[] [PMID: 28622118]
Ledoux MP, Guffroy B, Nivoix Y, Simand C, Herbrecht R. Invasive pulmonary aspergillosis. Semin Respir Crit Care Med 2020; 41(1): 80-98.
[] [PMID: 32000286]
Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 2020; 20(4): 425-34.
[] [PMID: 32105637]
Zhang S, Bai W, Yue J, et al. Eight months follow-up study on pulmonary function, lung radiographic, and related phy-siological characteristics in COVID-19 survivors. Sci Rep 2021; 11(1): 13854.
[] [PMID: 34226597]
Alanio A, Dellière S, Fodil S, Bretagne S, Mégarbane B. Prevalence of putative invasive pulmonary aspergillosis in criti-cally ill patients with COVID-19. Lancet Respir Med 2020; 8(6): e48-9.
[] [PMID: 32445626]
Song G, Liang G, Liu W. Fungal co-infections associated with global COVID-19 pandemic: a clinical and diagnostic perspective from China. Mycopathologia 2020; 185(4): 599-606.
[] [PMID: 32737747]
Garg M, Prabhakar N, Muthu V, et al. CT Findings of COVID-19–associated pulmonary mucormycosis: a Case series and literature review 2021; 31: 211583.
Mitaka H, Kuno T, Takagi H, Patrawalla P. Incidence and mortality of COVID-19-associated pulmonary aspergillosis: A systematic review and meta-analysis. Mycoses 2021; 64(9): 993-1001.
[] [PMID: 33896063]
Beamer S. Surgical management of non-mycobacterial fungal infections. J Thorac Dis 2018; 10(28) (Suppl. 28): S3398-407.
[] [PMID: 30505527]
Pihlajamaa K, Anttila VJ, Räsänen JV, Kauppi JT, Hodgson U. The fate of aspergilloma patients after surgical treat-ment-experience from 22 cases. J Thorac Dis 2019; 11(10): 4298-307.
[] [PMID: 31737315]
Zurl C, Hoenigl M, Schulz E, et al. Autopsy proven pulmonary mucormycosis due to Rhizopus microsporus in a criti-cally Ill COVID-19 patient with underlying hematological malignancy. J Fungi 2021; 7(2): 88.
[] [PMID: 33513875]
Krishna V, Morjaria J, Jalandari R, Omar F, Kaul S. Autoptic identification of disseminated mucormycosis in a young male presenting with cerebrovascular event, multi-organ dysfunction and COVID-19 infection. IDCases 2021; 25: e01172.
[] [PMID: 34075329]

Rights & Permissions Print Export Cite as
© 2023 Bentham Science Publishers | Privacy Policy