COVID-19 and Fungal Co-Infections

As the SARS-CoV-2 virus, which causes COVID-19, continues to take hold across the globe, a significant risk to patients is that the primary infection can be complicated by secondary infection which may be bacterial or fungal.ⁱ

Early data from Wuhan found that 50% of people with COVID-19 pneumonia who died had also been diagnosed with secondary infections, including identification of Aspergillus and Candida.^i,ii Emerging case reports support a link between COVID-19 and fungal co-infections such as aspergillosis.

Respiratory viral infections are known to predispose patients to co-infections leading to increased disease severity and death. In the case of aspergillosis, influenza associated pulmonary aspergillosis has been reported in 19% of patients with influenza-pneumoniaⁱⁱⁱ and new studies point to significant incidence of COVID-19-associated pulmonary aspergillosis. Unlike other invasive aspergillosis etiologies, influenza-associated cases are observed in immunocompetent patients.

A French single-centre study reported that, of 27 patients ventilated in the ICU, 33% showed signs of Aspergillus co-infection.^iv A German retrospective analysis from two ICUs reported putative invasive pulmonary aspergillosis in 26% of COVID-19 patients (5 of 19) who had moderate to severe ARDS (Acute respiratory distress syndrome), but no underlying immunocompromised status.^v A further report linked invasive pulmonary aspergillosis to COVID-19 in an immunocompetent man who died after presenting with severe COVID-19.^vi

Fungal co-infections are a severe complication in patients admitted to intensive care units (ICU) with COVID-19. Fungal diagnostic tools and multicentre studies assessing the occurrence of fungal co-infections in this pandemic are essential given the lack of current data. There is a need to rapidly identify fungal co-infections in COVID-19 patients, which is especially urgent due to the high case fatality rate typically observed with fungal co-infections.^vii

Invasive aspergillosis is a notoriously challenging disease to diagnose,^vii and is associated with high mortality. There are calls to screen COVID-19 patients with pneumonia for fungal pathogens.^vii Including molecular testing such as PCR alongside other biomarkers and culture can reduce the time to diagnosis and support physicians in optimising patient management.

The Fungiplex^® Aspergillus IVD Real-Time PCR Kit is designed to detect the primary species associated with invasive aspergillosis. It delivers results in less than two hours when performed on DNA extracted from serum, plasma and bronchoalveolar lavage, to support critical clinical decisions on targeted therapy for Aspergillus in ventilated patients.