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Aspergillosis in COVID Infection

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Aspergillosis in COVID Infection

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Aspergillosis is reportedly on the rise apart from black fungus with a common etiology but with severe systemic spread of infection. Read the article to know more.

Medically reviewed by

Dr. Chithranjali Ravichandran

Published At July 8, 2021
Reviewed AtAugust 2, 2023

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 black 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?

  • Allergic Bronchopulmonary Aspergillosis (ABPA): Occurs as an inflammatory disease of the lungs and causes symptoms like coughing and wheezing persistently for days together.
  • Azole Resistant Aspergillus Fumigatus: When aspergillus fumigatus, a particular species of aspergillus towards which resistance is developed via medications, it is even difficult to treat through accessory medical line drugs.
  • Allergic Sinusitis Caused by Aspergillus: stuffiness, headache, and blocked nose or blocked sensation of the face and side of the head maybe some common symptoms when the sinus gets infected by aspergillus.
  • Fungus Ball Infection or Aspergilloma: When aspergillus grows in the sinuses or lungs, then it remains limited in its extent of spread (localized to lungs or sinuses) and does not infect other systemic tissues or organs of the body.
  • Chronic Aspergillosis of Lungs or Pulmonary Aspergillosis: when one or more aspergillomas (fungus balls) are present in the lungs causing long-standing infection, then chronic aspergillosis manifests with multiple aspergillomas detection.
  • Cutaneous or Skin Aspergillomas: When the fungal spores of aspergillus invade through a breach of the skin or even after a surgery or a wound that is healing, in the cases especially when the patient’s immunity is compromised then skin infections and lesions due to aspergillus that eventually, later on, spreads to the lungs is cutaneous aspergillosis.
  • Invasive Aspergillosis: This is the most serious and fatal form of aspergillosis that would be potentially life-threatening in the COVID scenario in patients affected by and who are recovering from COVID-19 infection. This kind of invasive aspergillosis infection affects patients who have organ transplantations are done or stem cell transplantations. A weakened host immune response leads the invasive form of this fungal infection to spread systemically.

What Is the Clinical Presentation and Symptoms?

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

  • Fever and chills.
  • Malaise or fatigue.
  • Weight loss.
  • Shortness of breath.
  • Skin irritation, swelling, redness, or erythematous lesions.
  • Coughing with blood (occurs when the infection has spread to the lungs).
  • Eye irritation or pain accompanied by headaches.

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.

Frequently Asked Questions

1.

Can One Have COVID-19 and Fungal Infection at the Same Time?

COVID-19 infection is responsible for the decrease in immunity power. Because of this, different fungal infections may affect the human body during COVID-19 infection. Also, factors like diabetes, depletion of oxygen level, and steroid therapy are associated with this.

2.

Who Can Suffer Risk of Aspergillosis?

Aspergillosis is mainly seen in immunocompromised patients. A lower level of neutrophils, lymphocytes, and diabetes are probable risk factors. Other than this, factors like steroid therapy, radio, or chemotherapy are associated with such infectious conditions.

3.

Which Organ Is Most Commonly Affected by Aspergillosis?

Aspergillosis is an opportunistic pathogen. Such infections mainly affect immunocompromised individuals. Most commonly, this fungal infection involves the lungs and airway tract.

4.

How to Kill Fungal Spores?

Fungal spores are opportunistic pathogens. In natural conditions, normal immunity of the body kills such spores. Anti-fungal medications like Triazoles (for example, Traconazole, Poriconazole, Posiconzaole), Amphotericin B, Posaconazole, and Isavuconazole can be used to kill fungal spores.

5.

What Are the Fungal Diseases Caused by COVID-19?

During COVID-19, various types of fungal infections may attack the human body. The most commonly associated fungal infection is aspergillosis. Other than this, candidiasis, mucormycosis, and cryptococcosis may also be seen during this period.

6.

Is Aspergillus a Mold?

Yes, aspergillosis is a mold. In everyday life, humans are not affected by this mold. As this is an opportunistic pathogen, immunocompromised persons are affected by this most commonly.

7.

What Kills Aspergillus in the Lungs?

In natural conditions, the immunity system in the body provides immunity to the lungs. The presence of natural killer cells in the body, adaptive immune cells, and cytokines are responsible for anti-fungal action. Anti-fungal medications may also kill these organisms.

8.

Can Anyone Survive Aspergillosis?

Yes, aspergillosis during COVID-19 infection can be cured. Drugs like Triazoles (example: Traconazole, Poriconazole, Posiconzaole), Amphotericin B formulations, Posaconazole, and Isavuconazole, can be used to cure this.

9.

How Serious Is the Fungal Infection in the Lungs?

Fungal infection in the lung can be very serious. These infections can destroy lung structures and may cause significant respiratory problems. In some cases, the condition can be life-threatening.

10.

Is Fungal Infection in the Lungs Curable?

Yes, fungal infections can be curable. During COVID-19 infection, judicial use of medications and patient monitoring is required to prevent such conditions. Antifungal drugs can be used to treat this. Surgical resection of the affected portion is done in severe cases.

11.

Can the Immune System Fight Fungus?

Yes, in natural conditions, the immune system can fight fungal infections. Natural killer cells and the adaptive immune system are responsible for immunity against fungal infections. Also, various immune modulators are responsible for proving immunity.

12.

How Long Can Anyone Live With Aspergillosis?

Aspergillosis should be treated as soon as possible. Severe cases of Aspergillosis may cause severe lung damage, sinus infections, facial paralysis, and strike. Delaying in diagnosis may cause significant lung damage.

13.

What Is the Survival Rate of Aspergillus?

The mortality rate is high in pulmonary aspergillus is high. Situations like older age groups, diabetes, and immunocompromised situations may be associated with increased rates of mortality.

14.

Is Aspergillosis Fatal?

Aspergillosis may cause severe damage body and respiratory tract. Such damages can be fatal. Fungal infections are responsible for significant lung damage, such as cystic fibrosis, and the destruction of extrapulmonary tissues, such as the brain, heart, and eyes. As a result, life-threatening conditions may arise.
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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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