P4 COVID19-associated fungal infections

PLENARY SESSION 4, SEPTEMBER 22, 2022, 2:00 PM - 2:45 PM: : Coronavirus disease 2019 (COVID-2019) associated invasive fungal infections (IFIs) have emerged as an important complication in a substantial number of critically ill COVID-19 patients, and three groups of fungal pathogens have increasingly been recognized as causes of superinfections: Aspergillus, Mucorales, and Candida. First reports of cases and case series of COVID-19-associated pulmonary aspergillosis (CAPA) have emerged during the first months of the pandemic. Prevalence rates varied widely due to the fact that CAPA was, and still remains, challenging to diagnose in patients with COVID-19-associated acute respiratory failure (ARF). The clinical picture and radiological findings of CAPA are unspecific and the primarily airway invasive growth in non-neutropenic patients and the late occurrence of angioinvasion in the course of the disease may complicate diagnosis. Current guidelines recommend treatment of CAPA during its early airway invasive phase, which may result in some overtreatment (i.e., treatment in patients that may not develop angioinvasive infection), given the independent contribution of CAPA to devastating mortality rates of around 50% that have been shown in multiple studies. This talk will also review the incidence of COVID-19-associated IFIs caused by Mucorales, and Candida, including C. auris, and will discuss—clinical risk factors, predisposing changes in the host environment, and immunological mechanisms involved in the pathogenesis of these coinfections, as well as current and future diagnostics and treatments.