Hospitalized Covid-19 with fungal infections were at higher risk of mortality compared to patients with fungal infection but who did not have Covid-19, according to a new study from the CDC published in the journal Emerging Infectious Diseases.1 The mortality rate was nearly 50% for Covid-associated fungal infections compared to 12.3% for fungal infections not associated with Covid-19.

Researchers analysed data of hospitalizations in the United States due to Covid-19-associated fungal infections between January 2019 and December 2021 to determine the annual hospitalization rates according to the type of fungal infection. The annual percentage change in hospitalization rates were also estimated.

A total of 59,212 hospitalizations due to fungal infections were identified between 2019 and 2021. Nearly 60% of them occurred in men. The rate of hospital admissions in 2019 was 22.3 per 10,000 hospitalizations; this rose to 25.0 in 2020 and 26.8 in 2021 indicating an 8.5% increase in hospitalizations each year. Fungal infections in patients with Covid-19 had higher in-hospital mortality rates compared to fungal infections in patients who did not have Covid-19; 48.5% vs 12.3%, respectively.

Patients with Covid-associated fungal infection had a longer duration of hospitalization (21 vs 9 days). They also needed intensive care (70.0% vs 35.5%) and invasive mechanical ventilation (64.4% vs 22.5%) more than patients without Covid-19.

Aspergillosis had the highest mortality (57.6%) followed by invasive candidiasis (55.4%), mucormycosis (44.7%) and unspecified mycoses (59.0%).

These findings highlight the need for better surveillance for fungal infections, “particularly during respiratory virus pandemics”. A high index of suspicion for fungal infection in at-risk patients is necessary.

Reference

1. Gold JAW, et al. Increased hospitalizations involving fungal infections during COVID-19 pandemic, United States, January 2020–December 2021. Emerg Infect Dis. 2023 Jul [date cited]. https://doi.org/10.3201/eid2907.221771.