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Aspergillosis in COVID Infection

Published on Jul 08, 2021   -  4 min read

Abstract

In both patients who have been affected by the novel Coronavirus and those who have recovered from it thereafter, the rise in fungal infections can prove fatal in either case. Aspergillosis is now reportedly on the rise apart from black fungus with a common etiology but with severe systemic spread of infection. Read the article to know about the spread of aspergillosis in COVID cases, oral and general symptoms, manifestations, and management by the physician.

Aspergillosis in COVID Infection

Introduction:

Aspergillus is a type of fungus that thrives both indoors and outdoors. However, according to the Center for Disease Control and Prevention (CDC) – people with compromised immunity are prone to contract aspergillosis infection and its associated allergic reactions.

How Is Aspergillosis Linked to COVID?

The use of steroids as treatment for COVID patients also makes the patient recovering from the novel Coronavirus infection susceptible for 3 to 4 weeks time as the immunity is low for this period of recovery. Though aspergillosis does not infect the brain and lungs directly like the blank fungus or mucormycotic infections, it can prove fatal if it turns out to be invasive, according to health experts and researchers. Few COVID-19 patients are currently experiencing a rare form of sinus and pulmonary aspergillosis.

People with compromised immunity are being affected by pulmonary aspergillosis infection. Non-sterile water used for hydrating the oxygen supply is also responsible for its occurrence. One of the main reasons behind the increase in black fungus cases along with other related fungal infections like aspergillosis is attributed by experts to the use of steroids during the treatment of COVID-19 that might lead the patient to be immunosuppressed for a span of time till recovery and post-recovery from SARS-CoV-2 pathogen elimination.

What Is the Pathogenesis of Aspergillosis?

The majority of opportunistic oral mucosal fungal infections are due to Candida albicans and Aspergillus fumigatus species. Mucor and Cryptococcus also have a major role in causing oral infections. The broad spectrum of the clinical presentation includes pseudomembranes, abscesses, ulcers, boils, and extensive tissue necrosis involving bone. In the case of patients affected by the SARS-CoV-2 pathogen (COVID cases) and influenza, the patients exhibit features of hyper inflammation through macrophage activation syndrome characterized by haemophagocytosis and pancytopenia (a reduction in the immune cell numbers with defects) and increased ferritin concentration.

In COVID cases, thus, the pathogenesis may be severe as the SARS COV-2 virus infection primarily results in the lowering of the host immune system, causing immunodeficiency (loss of barrier function and the ability to produce defensive enzymes by the epithelial cells). This severe inflammatory response can be detrimental, causing extensive damage to the tissues and necrosis or cell death, increasing the risk for non-invasive aspergillosis to turn into an invasive infection through the pathway to the lungs (via the trachea or windpipe).

What Are the Types of Aspergillosis?

What Is the Clinical Presentation and Symptoms?

The general symptoms to watch out for an aspergillosis infection are:

How To Prevent and Manage Aspergillosis?

People with a history of organ or stem cell transplants or patients with immunocompromised health conditions (like uncontrolled diabetics, hypertensives, or other systemic disorders) should avoid dusty areas like construction sites, and n95 masks should be worn with full clothing while handling soil or manure.

How Is Aspergillosis Diagnosed?

Diagnosis of invasive aspergillosis can be difficult as the symptoms mimic other kinds of lung infection. This fungus is commonly found in all environments but difficult to distinguish from certain other molds under the microscope. Doctors may generally prescribe a biopsy of sample and test lung tissue. Other tests may involve blood tests to test the fungus molecules, a chest X-ray, a CT scan of the lungs, and a sputum stain and culture to examine the bronchial mucus. Doctors usually recommend the treatment with antifungal drug Voriconazole, but currently, Isavuconazole is also used for aspergillosis. But if the infection is invasive (spreads to the other parts of the body systemically), then surgery may be a final option depending on the extent of spread.

Conclusion:

Tracking an uncommon disease with an increasing incidence because of compromised immunity in COVID patients and recovering COVID cases is indeed challenging to the medical community or team. Patients with lowered immunity and systemic diseases should maintain extra precautions in these times with n95 masks and avoiding dusty or damp environments, while the high-risk COVID cases need to be monitored in a highly sterile and oxygenated environment in the ward by the physicians. Recovering COVID cases also need to be wary of the general symptoms of aspergillosis by following appropriate physical, oral, and environmental hygiene.

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Last reviewed at:
08 Jul 2021  -  4 min read

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