Abstract

CANDIDA INFECTIONS ASSOCIATED WITH COVID-19: AN UNDERESTIMATED RISK

Cláudia Maria Blanco Moreira Norberg*, Paulo Roberto Blanco Moreira Norberg, Antonio Neres Norberg, Alcemar Antonio Lopes de Matos, Fabiano Guerra Sanches, Fernanda Castro Manhães, Bianca Magnelli Mangiavacchi and Lígia Cordeiro Matos Faial

ABSTRACT

Despite the high risk of developing fungal co-infections in patients infected with SARS-CoV-2, few studies have been conducted on the incidence and risk of these secondary infections. This research aims to analyse the panorama of co-infections and superinfections caused by species of the genus Candida in patients with COVID-19 and possible involved variables by analysing the current scientific literature. There are signs that the use of anti-inflammatory drugs, corticosteroids and immunomodulators used in the treatment of COVID-19 improved systemic colonization by Candida spp., indicating the need to evaluate the risks and benefits of this therapy according to the patient's clinical situation and levels of nosocomial contamination. Candida auris, a species equipped with virulence, antifungal resistance and environmental colonization attributes, represents a latent risk in co-infections. All research that has evaluated the incidence of Candida spp. infections compared to contemporary or historical control groups indicated a higher incidence of concomitant infections between SARS-CoV-2 and Candida spp. All research that recorded mortality rates for patients presenting with co-infection for these two pathogens also indicates higher levels of fatality when compared to control groups of those infected with either the virus alone or those infected just by these fungi. A review of the literature currently available indicates a considerable increase in cases of systemic Candida colonisation among patients with severe clinical forms of COVID-19 in several locations of the world, which may indicate that there are, with due proportion, twin epidemics of SARS-CoV-2 and Candida spp.

Keywords: COVID-19, SARS-CoV-2, Candida, candidemia, secondary infections.