Every day we inhale thousands of potentially pathogenic fungal spores, but our immune system simply eliminates them. However, in people with compromised immunity, such as transplant and cancer patients, as well as hospitalized patients in intensive care, the interaction between pathogen and host may be quite different.
Fungal infections that emerged during the COVID-19 pandemic, reinforcing the action of SARS-CoV-2 around the world, are a case in point. Mortality reached 80% among severe COVID-19 patients infected with the fungus Aspergillus fumigatus, for example.
A review article by an international group of researchers analyzing SARS-CoV-2/fungus co-infections during the pandemic is published in Nature Microbiology, with warnings relevant to the present and to future pandemics.
"The key issue with fungi is that they're an extremely neglected public health problem with few treatment options. We're currently seeing more deaths caused by fungal diseases than malaria and tuberculosis together, so it's hardly surprising that fungal diseases have taken advantage of the fact that so many people have been hospitalized because of COVID-19," said Gustavo Henrique Goldman, a professor at the University of São Paulo's Ribeirão Preto School of Pharmaceutical Sciences (FCFRP-USP) in Brazil and one of the principal investigators for the study, which was supported by FAPESP.
Besides aspergillosis, the disease caused by fungi of the genus Aspergillus, co-infections concurrently with COVID-19 are caused by two other groups. Fungi of the order Mucorales are responsible for mucormycosis, which occurs mainly in India and Pakistan, while yeasts of the genus Candida cause candidiasis and are present practically the world over.
"COVID-19-associated pulmonary aspergillosis [CAPA] affects on average 10% of patients with acute respiratory insufficiency admitted to intensive care units. Patients with this co-infection are twice as likely to die as patients infected only by SARS-CoV-2," Martin Hoenigl, first author of the study, told Agência FAPESP. Hoenigl is a professor at the University of California San Diego in La…