SARS-CoV-2 related ARDS and invasive fungal infections in intensive care patients

SARS-CoV-2 infection can potentially necessitate intensive care management. An increasing number of case reports are found in the literature indicating patients admitted in an intensive care setting with COVID-19 pneumonitis being complicated with invasive fungal infections. In a retrospective assessment of a three-month period at the national hospital of Malta, examining patients who were suffering from SARS-CoV-2 acute respiratory distress syndrome, 6 out of 63 patients (9.5%) were found to have confirmation or high probability of invasive fungal infection. The consensus definition for invasive fungal disease developed by the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium was utilised to aid in the identification of these patients. In total, 15 patients received treatment with an anti-fungal agent in this three-month period, the decision being led by both clinical suspicion and the use of fungal markers obtained from the serum and bronchoalveolar lavage. Although several risk factors are attributed for the development of invasive fungal disease, the main factors identified in our cohort of patients is the SARS-CoV-2 ARDS in itself, along with the use of high dose corticosteroids. The average period of time between admission in intensive care and diagnosis of invasive fungal infection was noted to be 10.5 days. This high incidence of invasive fungal disease in mechanically ventilated patients suffering from SARS-CoV-2 ARDS, relatively early in their course of disease, should guide the clinician to investigate further with fungal biomarkers and cultures in those patients who are clinically deteriorating despite optimal medical treatment, as well as possibly considering empirical anti-fungal treatment if suspicion remains high.