Invasive fungal infections in COVID-19 are associated with high mortality rates, especially in cases of mucormycosis or aspergillosis. Candidiasis is also a fungal disease but occurs in only 2.4% of patients with COVID-19. Invasive candidiasis worsens the course of the coronavirus. Greek scientists investigated how often invasive candidiasis occurs in patients with coronavirus and how Candida affects mortality from coronavirus.

Scientists examined body tissue samples from 1,536 elderly patients with COVID-19. Candida fungus was found in 4.5% of patients. The most common species were C. albicans, C. tropicalis, and C. glabrata.

Compared to other COVID-19 patients, Candida-positive patients were older and had longer stays in the hospital, with higher overall mortality:

  • the average age of patients with candidiasis is 78;
  • the average duration of hospitalization is 22 days;
  • overall mortality – 34.8%.

Candida in Urine

Candida fungus was often found in the urine in 87% of cases. However, most samples did not indicate an actual infection, as only urine was positive for Candida and not other body tissues. In clinical practice, detecting Candida in the urine can mean contamination and fungal colonization of the perineum or urinary catheter and urinary tract infection and may be associated with invasive candidiasis.

Candida is rarely found in the urine of healthy people but is common in hospitalized patients, especially those with predisposing factors such as:

  • structural anomalies of the kidneys;
  • diabetes;
  • internal urinary catheters;
  • immunosuppression;
  • taking antimicrobials.

Candida in the Blood and Bronchi

0.8% of patients with coronavirus had invasive candidiasis, where the Candida fungus was found in the blood and bronchial secretions.

COVID-19 Increases Susceptibility to Fungal Infection

Several factors increase the likelihood of candidiasis with COVID-19:

  • hospitalization in the intensive care unit;
  • intravenous catheters;
  • taking corticosteroids and antimicrobials;
  • decreased lymphocyte levels were seen in patients with COVID-19.

In addition, hyperinflammation is observed in patients with coronavirus, characterized by high levels of pro-inflammatory cytokines IL-6, IL-1β, and TNF. Excessive production of pro-inflammatory cytokines can lead to hyperactivation of the immune system, promoting tissue damage and fungal invasion.

Findings

Candida fungus is found in 4.5% of hospitalized patients with coronavirus. The most common species are C. albicans, C. tropicalis and C. glabrata. Candida is commonly found in urine samples and may not be associated with invasive candidiasis. However, in 0.8% of patients, Candida is found in the blood and bronchi, which means invasive candidiasis.

In the present study, hospitalized patients with coronavirus positive for Candida were older, had more extended hospital stays, and had higher overall mortality. Therefore, testing for Candida may be necessary for determining the risk of mortality in patients with COVID-19.

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Reference

Candida Species Isolation from Hospitalized Patients with COVID-19 – A Retrospective Study

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