Table 1.

COVID-19-associated fungal Infection

Invasive fungal disease	Key points
COVID-19-associated pulmonary aspergillosis (CAPA)	• Disease pathogenesis not fully understood • Knowledge gaps in true incidence, risk factors, and outcomes • Wide variability in reported incidence due to lack of consensus on CAPA definition, differing diagnostic algorithms and surveillance practices • Diagnoses are driven by isolation of Aspergillus species on culture or positive tests (Aspergillus galactomannan, Aspergillus PCR) from upper respiratory samples, which could reflect colonization • Diagnostic tests currently used like serum and BAL Aspergillus galactomannan, Aspergillus PCR have not yet been validated in the COVID-19 population • Most studies report an association of corticosteroids or IL-6 inhibitors with CAPA • Role for prophylaxis or pre-emptive treatment needs to be further explored as it has been shown to reduce CAPA incidence rates but not overall mortality • CAPA is associated with worse outcomes compared to non-CAPA patients
Mucormycosis	• Most commonly reported non-Aspergillus mold infection • Uncontrolled diabetes and corticosteroid use appear associated with a higher risk • Rhino-cerebral CAM is most common, but pulmonary CAM with the highest mortality • Surgical intervention is an important part of management
Other non-Aspergillus molds	• Fusariosis reported in immunocompetent patients • All cases involved lung parenchyma • A single case of scedosporiosis reported in Chile • Additional data are needed
Pneumocystosis	• More often in the elderly and immunocompromised (HIV, malignancy, chronic steroid use) • Can be clinically indistinguishable from COVID-19 pneumonia • Key features: elevated LDH, Beta-D Glucan, and lymphopenia
Candidiasis	• Suspected in patients who receive steroids, long ICU stays, indwelling central venous catheters • Immunomodulators may increase risk
Cryptococcosis	• Patients older than 55 years of age with underlying comorbidities may be at risk • High mortality
Endemic mycoses	• Limited data, but no clear association with COVID-19 • Endemicity is the greatest risk factor

Abbreviations: BAL bronchoalveolar lavage, CAM COVID-19-associated mucormycosis, CKD chronic kidney disease, IL-6 interleukin 6, LDH lactate dehydrogenase, PCR polymerase chain reaction, ICU intensive care unit