Abstract

INVASIVE FUNGAL INFECTIONS AFTER VIRAL PNEUMONIA: COVID-19–ASSOCIATED MUCORMYCOSIS AND CORTICOSTEROID EXPOSURE

T. Sri Saranya*, N. Tejaswi, K. Aparna, Y. Hemalatha, Dr. M. Tabitha Sharon, Dr. K. Padmalatha

ABSTRACT

Invasive fungal infections (IFIs) have recently come to the forefront as a complication of viral pneumonia, especially in the context of the COVID-19 pandemic.[1,2,8] Immune modulation by viral infections, epithelial injury, and metabolic derangements provide a fertile ground for the opportunistic pathogens Mucorales, Aspergillus, and Candida.[9,23,24] COVID-19-associated mucormycosis (CAM) has recently received international attention for its aggressive presentation and high mortality rates, particularly in diabetic patients and those receiving systemic corticosteroids.[1-3] The combined effect of viral infection, immune modulation, and immunosuppressive therapy has been an important factor in the increasing incidence of post-viral fungal infections globally.[2,4] Corticosteroids, while useful in the management of hyperinflammation in severe COVID-19, increase the risk of fungal infections due to their immunosuppressive effects and contributions to hyperglycemia.[19,20,21] The clinical presentation of post-viral IFIs can vary from rhino-orbital disease to systemic disease,making early diagnosis and management challenging.[4,13] This review aims to focus on the epidemiology, pathophysiology, clinical presentation, diagnostic difficulties, and management of IFIs post-viral pneumonia, with special attention to CAM and corticosteroid use. It is important to have a clear understanding of the pathophysiology for better prevention, early diagnosis, and management of viral pneumonia.[4,22]

Keywords: Invasive fungal infections; mucormycosis; viral pneumonia; COVID-19; corticosteroids; immunosuppression; diabetes mellitus; opportunistic infections; antifungal therapy; clinical pharmacy.