Opportunistic Fungal Infections in the Epidemic Area of COVID-19: A Clinical and Diagnostic Perspective from Iran
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OPINION ARTICLE
Opportunistic Fungal Infections in the Epidemic Area of COVID-19: A Clinical and Diagnostic Perspective from Iran Mohammadreza Salehi Sadegh Khodavaisy
. Kazem Ahmadikia
. Hamid Badali
.
Received: 20 April 2020 / Accepted: 30 June 2020 / Published online: 31 July 2020 Ó Springer Nature B.V. 2020
Abstract The coronavirus disease 2019 (COVID19) pandemic emerged in Wuhan, China, in late 2109, and has rapidly spread around the world. Until May 25, 2020, there were 133,521 confirmed COVID-19 cases and 7359 deaths in Iran. The role of opportunistic fungal infections in the morbidity and mortality of COVID-19 patients remains less defined. Based on our multicenter experiences, we categorized the risks of opportunistic fungal infections in COVID-19 patients in Iran. The COVID-19 patients at high risk included those with acute respiratory distress syndrome, in
intensive care units, receiving broad-spectrum antibiotics, immunosuppressants or corticosteroid, and supported by invasive or noninvasive ventilation. The patients were most likely to develop pulmonary aspergillosis, oral candidiasis, or pneumocystis pneumonia. Most diagnoses were probable as the accurate diagnosis of opportunistic fungal infections remains challenging in resource-poor settings. We summarize the clinical signs and laboratory tests needed to confirm candidiasis, aspergillosis, or pneumocystosis in our COVID-19 patients.
Handling Editor: Vishnu Chaturvedi.
Keywords COVID-19 Fungal infections Critical patients pneumonia Iran
M. Salehi Department of Infectious Diseases, School of Medicine, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran K. Ahmadikia S. Khodavaisy (&) Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran e-mail: [email protected] H. Badali Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran H. Badali Fungus Testing Laboratory, Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
An enveloped novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), single-stranded RNA betacoronavirus of the family Coronaviridae, has arisen from Wuhan, China, in late 2019 which posed global healthcare and economic threats [1]. Recently, World Health Organization (WHO) named it coronavirus disease 2019 (COVID19) and declared as a pandemic disease. Despite global containment and quarantine attempts, the reports regarding epidemiological and clinical characteristics of the disease are dramatically increased [2–4]. Despite promising preventive measures being taken, commercially there is no antiviral drugs or vaccine approved to prevent or treat the severe COVID-19
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patients. Although numerous common clinical signs of the disease, i.e., dry cough, coryza, sore throat, dyspnea, myalgia, and fatigue
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