COVID-19-Associated Candidiasis (CAC): An Underestimated Complication in the Absence of Immunological Predispositions?

• Autor(a) principal: Arastehfar, Amir
• Data de Publicação: 2020
• Outros Autores: Carvalho, Agostinho, Nguyen, M. Hong, Hedayati, Mohammad Taghi, Netea, Mihai G., Perlin, David S., Hoenigl, Martin
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/1822/69873
• topic: candidemia; candiduria; oral candidiasis; mycobiome; COVID-19; Ciências Médicas::Ciências da Saúde; Science & Technology

The recent global pandemic of COVID-19 has predisposed a relatively high number of patients to acute respiratory distress syndrome (ARDS), which carries a risk of developing super-infections. <i>Candida</i> species are major constituents of the human mycobiome and the main cause of invasive fungal infections, with a high mortality rate. Invasive yeast infections (IYIs) are increasingly recognized as s complication of severe COVID-19. Despite the marked immune dysregulation in COVID-19, no prominent defects have been reported in immune cells that are critically required for immunity to <i>Candida</i>. This suggests that relevant clinical factors, including prolonged ICU stays, central venous catheters, and broad-spectrum antibiotic use, may be key factors causing COVID-19 patients to develop IYIs. Although data on the comparative performance of diagnostic tools are often lacking in COVID-19 patients, a combination of serological and molecular techniques may present a promising option for the identification of IYIs. Clinical awareness and screening are needed, as IYIs are difficult to diagnose, particularly in the setting of severe COVID-19. Echinocandins and azoles are the primary antifungal used to treat IYIs, yet the therapeutic failures exerted by multidrug-resistant <i>Candida</i> spp. such as <i>C. auris</i> and <i>C. glabrata</i> call for the development of new antifungal drugs with novel mechanisms of action.