Table 1.
Invasive Fungal Disease | Limitation and Gaps in Knowledge |
---|---|
Aspergillosis | Varied incidence of disease: dependent on diagnostic strategy and disease classification |
Varied confidence in classification of disease: disease classified using varying mycological, potentially associated with colonization, with prognosis not necessarily associated with or lack of antifungal treatment | |
The impact of underlying disease and risk factors for disease, including immunosuppressive COVID-19 treatments: evidence can be conflicting, generally anecdotal or limited to single-center studies | |
Limited proven disease: rates of autopsy-confirmed diagnosis are generally low, but variable—does this reflect overclassification of disease or disease pathogenesis? | |
Limited understanding of disease pathogenesis: disease progression in the patient will affect optimal diagnostic test selection and clinical presentation and possibly prognosis | |
Limited understanding of diagnostic test performance: when tests are used to define disease, it is not possible to define accurate performance and determine an optimal test or combination of tests. Even for tests previously established in ICU patients (eg, GM-EIA on BAL fluid), performance has generally been derived from the non–COVID-19 cohort | |
Management of disease is based on existing knowledge among non–COVID-19 patients | |
Candidiasis | The impact of underlying disease and risk factors for disease, including immunosuppressive COVID-19 treatments, remains unclear |
Limited understanding of disease pathogenesis and relation to candidemia | |
Management of disease is based on existing knowledge among non–COVID-19 patients | |
Mucormycosis | Varied incidence of disease: dependent on diagnostic strategy and risk factors/populations |
The true impact of underlying diseases (diabetes, etc) and risk factors for disease, including immunosuppressive COVID-19 treatments | |
Management of disease is based on existing knowledge among non–COVID-19 patients | |
Pneumocystosis | Varied incidence of disease: dependent on diagnostic strategy and limitation of testing (ie, colonization vs infection) |
The impact of underlying disease (HIV, transplant) and risk factors for disease, including immunosuppressive COVID-19 treatments, are unclear | |
Management of disease is based on existing knowledge among non–COVID-19 patients | |
Endemic mycoses | Varied incidence of disease, with few cases reported to date |
The impact of underlying disease (HIV, transplant) and risk factors for disease, including immunosuppressive COVID-19 treatments, are unclear | |
Management of disease is based on existing knowledge among non–COVID-19 patients | |
Cryptococcosis | Few cases reported to date |
Abbreviations: BAL, bronchoalveolar lavage; COVID-19, coronavirus disease 2019; GM-EIA, galactomannan enzyme immunoassay; HIV, human immunodeficiency virus; ICU, intensive care unit.