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

Reviewed on 5/17/2021
Coronavirus - COVID-19

Fungal infections that can occur in people with COVID-19 are often caused by breathing in fungi in the air or on contaminated objects such as masks.

As the world rolls up its sleeves to combat the COVID-19 pandemic, new challenges are emerging day by day. One of those challenges is that bacterial and fungal infections can occur alongside COVID-19, especially in people whose cases are severe enough to put them in the ICU or who have existing comorbidities like diabetes or HIV.

The presence of fungal infection along with COVID-19 can make prognosis poor, increasing the risk of severe symptoms and even death. In some people, fungal infection can occur even after they have recovered from COVID-19. 

Medical practitioners worldwide are therefore working hard to prevent and treat other infections that may occur along with or following treatment of COVID-19.

What are symptoms of fungal infection with COVID-19?

Timely diagnosis and treatment may be possible if fungal infections occur during hospitalization. If they occur after someone has been discharged, however, diagnosis may be delayed, leading to serious outcomes. So it is crucial to identify the symptoms of fungal infection and seek medical care as soon as possible. 

Symptoms may include

In people who test negative for COVID-19 but present with symptoms such as fever, difficulty breathing, and shortness of breath, doctors must consider ruling out the possibility of fungal pneumonia such as histoplasmosis, valley fever (coccidioidomycosis), and blastomycosis.

What types of fungal infections can occur with COVID-19?

Fungal infections that can occur in people with COVID-19 are often caused by breathing in fungi in the air or on contaminated objects such as masks. The two most common of these fungal infections are aspergillosis and invasive candidiasis. Others include mucormycosis and histoplasmosis. and Candida Auris infection.

Aspergillosis

Caused by the fungus Aspergillus, aspergillosis is typically seen in severe COVID-19 cases and referred to as COVID-19-associated pulmonary aspergillosis (CAPA). Scientists used to think that aspergillosis only occurred in people with very weak immune systems, but recent reports have shown that severe respiratory illnesses can cause the condition as well.

Symptoms are often non-specific and may include fever, cough, shortness of breath, and cough with blood. It can even cause death. Early diagnosis (typically by collecting a specimen from the lungs) and treatment is therefore essential.

Invasive candidiasis

Caused by the fungus Candida Auris, invasive candidiasis has been reported in COVID-19 units of acute care hospitals. The most common symptoms of invasive Candida infection are fever and chills, which don’t improve even after antibiotic or antiviral treatment for a suspected bacterial or viral infection. The fungus is resistant to several conventional antifungal medications and causes serious infection, killing around 1 in 3 infected people. 

The fungus is difficult to identify, requires specialized lab tests for diagnosis, and can live on surfaces for several weeks. Outbreaks of this type of fungal infection may be related to changes in cleaning and disinfection practices in health care facilities, as well as the limited availability or reuse of gowns and gloves.

Mucormycosis

Wreaked havoc in countries such as India, invasive mucormycosis or “black fungus” is a fungal infection that targets the inner lining of sinuses, nasal cavity, gums, and eye. Once it reaches the brain, it is fatal. Presenting symptoms include black discharge from the nose and in the mouth or gums, as well as facial weakness or squinting due to the involvement of the cranial nerves in the face.

The infection can occur even in patients with mild to moderate COVID-19 and a strong predisposing factor is an undiagnosed or uncontrolled diabetes. Steroid use to manage infections may also be a triggering factor.

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References
Benedict, Kailin, et al. "Symptoms in blastomycosis, coccidioidomycosis, and histoplasmosis versus other respiratory illnesses in commercially insured adult outpatients, United States, 2016–2017." Clin Infect Dis Oct. 14, 2020. <https://pubmed.ncbi.nlm.nih.gov/33053180/>.

Soman, Rajeev, and Ayesha Sunavala. "Post COVID-19 Mucormycosis -- from the Frying Pan into the Fire." Journal of the Association of Physicians of India 69 January 2021. <https://www.japi.org/x27464c4/post-covid-19-mucormycosis-from-the-frying-pan-into-the-fire>.

United States. Centers for Disease Control and Prevention. "Fungal Diseases and COVID-19." Jan. 12, 2021. <https://www.cdc.gov/fungal/covid-fungal.html#:~:text=Some%20patients%20can%20have%20COVID,include%20aspergillosis%20or%20invasive%20candidiasis>.

Zhou, Pengcheng, et al. "Bacterial and fungal infections in COVID-19 patients: A matter of concern. Infect Control Hosp Epidemiol Apr. 22, 2020: 1-2. <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184139/>.

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