Malays J Pathol. 2026 Apr;48(1):53-61.
ABSTRACT
INTRODUCTION: The COVID-19 pandemic has caused a rise in secondary infections, including invasive fungal diseases (IFDs), which have greatly increased morbidity and mortality. This study aimed to explore the demographics, risk factors and outcomes of IFDs in COVID-19 patients admitted to our centre.
MATERIALS AND METHODS: We retrospectively reviewed data from PCR-confirmed category 4 or 5 COVID-19 patients between 2020 and 2023 who also had positive mycology cultures or serology. Patients with positive fungal tests more than 90 days after their initial COVID-19 diagnosis were excluded.
RESULTS: Among 5,075 PCR-positive COVID-19 patients, 23 (0.45%) met the criteria. Of these, 15 (65.2%) had candidiasis, seven (30.4%) aspergillosis, and one (4.3%) Exophiala fungaemia. No mucormycosis cases were identified. The male-to-female ratio of IFDs was 2.8:1, with ages ranging from 26 to 77 years (mean 59.6). The interval between COVID-19 diagnosis and positive fungal test ranged from 3 to 38 days, averaging 12.6 days for candidiasis and 16 days for aspergillosis (difference not statistically significant). Only acute kidney injury was significantly linked to candidiasis. Common factors across all cases included indwelling vascular catheters (95.7%), ICU admission (91.3%), mechanical ventilation (87%), lung diseases (65.2%), kidney impairment (60.9%), poorly controlled diabetes (34.8%), and liver impairment (26.1%). Overall mortality was 91.3% (100% for aspergillosis and Exophiala fungaemia, 86.7% for candidiasis).
CONCLUSION: Although IFD prevalence in COVID-19 patients is low, its high morbidity and mortality make it a critical concern. Early identification of risk factors may help reduce its occurrence and improve outcomes.
PMID:42059167
