Table 8.
Studies reporting rarer invasive fungal infections associated with COVID-19.
| Author/ Country/ Study Type |
IFI | Cases | Sex/Age | Underlying Diseases |
COVID-19 Treatment |
Temporal Relationship with COVID-19 |
Microbiological Data Supporting Diagnosis |
Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|---|
| Menon [179]/ USA/ Case report |
PCP | 1 | M/83 | CVD, CPD, UC | Steroids IMV |
Concurrent | Positive P. jirovecii PCR on TA Positive serum BDG |
TMP/SMX | Alive |
| Mang [180]/ Germany/ Case report |
PCP | 1 | M/52 | Obesity, AH, AIDS | IMV | Concurrent | Positive P. jirovecii PCR on BAL | TMP/SMX | Alive |
| Bhat [181]/ USA/ Case report |
PCP | 1 | M/25 | AIDS | Steroids IMV |
Concurrent | Positive P. jirovecii DFA on BAL | TMP/SMX | Alive |
| De Francesco [182]/ Italy/ Case report |
PCP | 1 | M/65 | AH, DM, CVD, SOT, chronic steroids | Steroids TCZ IMV |
Concurrent | Positive P. jirovecci PCR on sputum | TMP/SMX | Dead |
| Alanio [183]/ France/ Prospective |
PCP | 10/108 (9.3%) | 8 M (80%)/ 59 year (46–68) |
Obesity (3), AH (6), DM (3), CVD (1), CPD (1) | Steroids (7) Eculizumab (2) IMV (10) |
Concurrent (10) | Positive P. jirovecii PCR in RS (10) | TMP/SMX: 4 | 3 deaths (30%) |
| Broadhurst [178]/ USA/ Case report |
PCP | 1 | M/54 | AH, DM, AIDS | Steroids | Concurrent | Positive P. jirovecii DFA in sputum Positive serum BDG |
TMP/SMX | Dead |
| Jeican [184]/ Romania/ Case report |
PCP | 1 | M/52 | AH, CVD, liver disease | Steroids IMV |
Concurrent (post-mortem diagnosis) |
Positive HPE upon autopsy | No | Dead |
| Coleman [185]/ United Kingdom/ Case report |
PCP | 1 | M/55 | CPD, HIV | Steroids | Concurrent | Positive P. jirovecii PCR in sputum | TMP/SMX | Alive |
| Rubiano [186]/ USA/ Case report |
PCP | 1 | M/36 | AIDS | IMV | Concurrent | Positive P. jirovecii PCR and DFA in BAL Positive serum BDG |
TMP/SMX | Dead |
| Viceconte [187]/ Italy/ Case report |
PCP | 1 | M/50 | None | Steroids | Concurrent | P. jirovecii DFA on BAL | TMP/SMX | Alive |
| Larzàbal [188]/ Argentina/ Case report |
PCP | 1 | F/46 | AIDS, Raynaud syndrome | Steroids | Concurrent | Positive direct examination of sputum | TMP/SMX | Alive |
| Total | PCP | 20 | 17 M (85%) | Obesity (4), AH (10), DM (5), CVD (4), CPD (3), HIV (6) | Steroids (15) TCZ (1) Eculizumab (1) IMV (16) |
Concurrent (20) | Positive PCR 15: 1 TA, 2 BAL, 2 sputum, 10 RS Positive DFA 4: 3 BAL, 1 sputum Positive serum BDG 3 Histopathology 1 Direct examination 1 |
TMP/SMX 13 | 8 deaths (40%) |
| Khatib [110]/ Qatar/ Case report |
Crypto | 1 | M/60 | AH, DM, CVD | Steroids TCZ IMV |
Concurrent | C. neoformans in blood culture | AMB + flucytosine | Dead |
| Zhang [137]/ China/ Retrospective |
Crypto | 1/38 (2.6%) |
NR | NR | NR | Concurrent | Cryptococcus in blood culture | NR | NR |
| Woldie [189]/ Canada/ Case report |
Crypto | 1 | M/24 | Hemolytic anemia, chronic steroids | Steroids IMV |
Concurrent (post-mortem diagnosis) |
C. neoformans in blood culture | None | Dead |
| Passarelli [190]/ Brazil/ Case report |
Crypto | 1 | M/75 | AH, SOT, chronic steroids | Steroids IMV |
Concurrent | C. neoformans in blood culture | None | Dead |
| Ghanem [191]/ USA/ Case report |
Crypto | 1 | F/73 | None | Steroids | Concurrent | Positive Cryptococcal Ag in cultured CSF | AMB + flucytosine VP derivation |
Alive |
| White [30]/ United Kingdom/ Prospective |
Fungemia | 1/135 (0.7%) |
NR | AH | IMV | Concurrent | Rhodotorula in blood culture | AMB Caspofungin |
Dead |
| Fekkar [45]/ France/ Retrospective |
Fusariosis | 1/260 (0.4%) |
M/57 | DM, AH | IMV | Concurrent |
F. proliferatum in BAL culture Positive GM on BAL (1.7) |
AMB Caspofungin |
Alive |
| Ashour [148]/ Egypt/ Case report |
Fungal sinusitis |
1/8 (12.5%) |
M/47 | DM | IMV | Concurrent | Positive Aspergillus culture of nasal biopsy + HPE | AMB Surgery |
Alive |
| Messina [192]/ Argentina/ Case report |
Disseminated histoplasmosis | 1 | F/36 | AIDS | NR | Post-COVID | Positive sputum DE for Histoplasma
Positive serum Histoplasma Ag Positive urine Histoplasma Ag |
AMB Itraconazole |
Alive |
| De Macedo [193]/ Brazil/ Case report |
Pulmonary histoplasmosis | 1 | M/20 | No | NR | Post-COVID | Positive serum Histoplasma IgM Positive Histoplasma PCR on sputum Positive serum Histoplasma WB Positive serum GM |
Itraconazole | Alive |
| 1 | M/32 | No | Steroids | Post-COVID | Positive Histoplasma PCR on sputum Positive serum Histoplasma WB Positive urine Histoplasma Ag Positive serum GM |
Itraconazole | Alive | ||
| Bertolini [194]/ Argentina/ Case report |
Disseminated histoplasmosis | 1 | M/43 | AIDS | NR | Concurrent | Positive HPE of cutaneous lesions Histoplasma on blood culture |
AMB Itraconazole |
Alive |
| Basso [195]/ Brazil/Case report |
Disseminated histoplasmosis | 1 | F/43 | AIDS | Steroids | Concurrent | Positive sputum DE Positive urine Histoplasma Ag |
Itraconazole | Alive |
| Shah [196]/ USA/ Case report |
CM | 1 | M/48 | Chronic cavitary CM | NR | COVID after CM diagnosis | Positive CM serology | NR | Alive |
| Rabagliati [61]/Chile/ Observational |
Scedosporium infection | 1 | M/89 | DM, AH, CPD | None | Cuncurrent | Positive BAL culture | Isavuconazole | Alive |
Abbreviations: AH, arterial hypertensione; CVD, cardiovascular disease; CPD, chronic pulmonary disease; UC; ulcerative colitis; AIDS, acquired immuno-deficiency syndrome; IMV, invasive mechanical ventilation; TA, tracheal aspirate; BAL, bronchial alveolar lavage; PCP, P. jirovecii pneumoniae; BDG, (1,3)-beta-D-glucan; TMP/SMX, trimethoprim/sulfamothoxazole; SOT; solid organ transplantation; DM, diabetes mellitus; CM, coccidioidiomycosis; Ag, antigen; WB, Western blot, GM, galactomannan; HPE, histopathological examination; VP, ventriculo-peritoneal, DFA, direct fluorescent antigen.