Post-COVID pulmonary fungal infections: An unanticipated predicament or a ticking time bomb? Clinico-microbiological profile of cases encountered during the second wave of COVID-19 pandemic at a teaching hospital in the Himalayas with a brief literature review.

Abstract

This study attempts to generate preliminary data regarding post-COVID pulmonary fungal infections, namely, COVID-19-associated pulmonary aspergillosis (CAPA), COVID-19-associated pulmonary mucormycosis (CAPM), and mixed infections from the Himalayas and compares the micro-radio-clinical profile and outcomes of the affected patients. A retrospective data analysis was conducted, where clinical profiles, microbiological and radiological reports, and outcomes of <i>n</i> = 16 patients of post-COVID pulmonary infections were compared. Of <i>n</i> = 16 patients, <i>n</i> = 7 had CAPA (<i>n</i> = 5 <i>Aspergillus fumigatu</i>s, <i>n</i> = 1 <i>Aspergillus flavus, and n =</i> 1 <i>Aspergillus niger</i>), <i>n</i> = 5 CAPM (Rhizopus arrhizus)<i>,</i> and <i>n</i> = 4 with mixed infections (<i>n =</i> 3 infected with <i>Aspergillus fumigatus</i> and <i>Rhizopus</i> spp. and <i>n</i> = 1 with <i>Aspergillus flavus</i> and <i>Rhizopus arrhizus</i>). Thick-walled cavitary lesions, air-fluid levels, and multiple centrilobular nodules were some of the common radiological findings reported among these patients. The immuno-compromised state following COVID-19 infection and treatment might be responsible for the progression of regular exposure to the dense Himalayan vegetation into an invasive pulmonary fungal infection. Suspecting post-COVID pulmonary fungal infection is necessary for primary care physicians to ensure timely referral to higher centers. Mixed pulmonary fungal infections (coinfection with <i>Aspergillus</i> spp. and <i>Rhizopus</i> spp.) are also emerging as important sequelae of COVID-19.