Infecções fúngicas em pacientes internados com COVID-19: uma revisão de literatura
Arquivos
Data
2022-03-11
Autores
Toledo, Amanda Grosselli
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Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Em dezembro de 2019 ocorreu a aparição de um grupo de casos de pneumonia, em Wuhan, na China, causados por um agente microbiano não identificado, que posteriormente foi identificado como um β-coronavírus e a doença foi nomeada oficialmente como coronavírus 2019, e seu agente microbiano como SARS-CoV-2. O Coronavírus 2019 pertence a uma família de vírus de RNA de fita simples, com envelope, denominados Coronaviridae e classificados na ordem dos Nidovirales. Esta família de vírus consiste em patógenos de muitas espécies, capazes de infectar animais e humanos, e já são descritos há mais de 50 anos. A cepa mais recente do coronavírus tem como característica ser um vírus altamente patogênico e contagioso na população humana. Inicialmente, o SARS-CoV-2, causa uma rápida ativação da resposta imune inata com um aumento sérico dos níveis circulantes de citocinas no organismo, e em alguns pacientes em estado da doença podem apresentar uma resposta hiper-inflamatória, eventualmente levando à falência de múltiplos órgãos. A fim de reverter essa resposta, é indicada a utilização de drogas imunossupressoras. Uma combinação de imunossupressão induzida por vírus e drogas provavelmente aumenta a suscetibilidade a infecções secundárias. O objetivo desta revisão foi investigar a epidemiologia, a patogênese, as manifestações clínicas e tratamento para as principais infecções fúngicas em pacientes internados com COVID-19, através da pesquisa na base de dados MEDLINE/Pubmed dos estudos elegíveis até 06 de novembro de 2021, sem restrições de idiomas, utilizando termos de pesquisa previamente definidos. Foram excluídos os estudos que não se tratavam apenas de infecções secundárias fúngicas e os que o grupo estudado não se encontravam internados. Foram retornados 250 estudos elegíveis, dos quais 16 enquadraram-se nos parâmetros pré-estabelecidos, oito (50%) tinham como temática principal a aspergilose, três(18,75%) a candidíase, quatro (25%) abordavam as duas doenças e um (6,25%) tem como a temática principal a mucormicose. A espécie mais isolada do gênero Aspergillus foi o A. fumigatus, enquanto nos casos de candidemia foi a C. albicans. Os principais meios de diagnóstico foram pela cultura de amostras respiratórias, hemocultura e teste de galactomanana. Foi possível observar que a maior parte dos pacientes que necessitavam de cuidados intensivos possuíam condições crônicas subjacentes e fizeram tratamento com anticorpos monoclonais, principalmente o Tocilizumabe ou tiveram a prescrição de corticosteróides, aumentando assim os fatores de risco para a infecção fúngica. Mostrou-se necessário um diagnóstico precoce e uma terapia antifúngica adequada para melhorar o prognóstico do paciente e diminuir as taxas de mortalidade.
In December 2019, a group of pneumonia cases appeared in Wuhan, China, caused by an unidentified microbial agent, which was later identified as a β-coronavirus and the disease was officially named coronavirus 2019, and its microbial agent such as SARS-CoV-2. Coronavirus 2019 belongs to a family of single-stranded, enveloped RNA viruses called Coronaviridae and classified in the order Nidovirales. This family of viruses consists of pathogens of many species, capable of infecting animals and humans, and have been described for over 50 years. The most recent strain of the coronavirus is characterized by being a highly pathogenic and contagious virus in the human population. Initially, SARS-CoV-2 causes a rapid activation of the innate immune response with an increase in serum levels of circulating cytokines in the body, and in some patients in a disease state, they may present a hyper-inflammatory response, eventually leading to failure of the immune system. multiple organs. In order to reverse this response, the use of immunosuppressive drugs is indicated. A combination of virus- and drug-induced immunosuppression likely increases susceptibility to secondary infections. The aim of this review was to investigate the epidemiology, pathogenesis, clinical manifestations, and treatment for major fungal infections in hospitalized patients with COVID-19, by searching the MEDLINE/Pubmed database of eligible studies until November 6, 2021, without language restrictions, using previously defined search terms. Studies that were not only about secondary fungal infections and those in which the studied group were not hospitalized were excluded. A total of 250 eligible studies were returned, of which 16 met the pre-established parameters, eight (50%) had aspergillosis as their main theme, three (18.75%) had candidiasis, four (25%) addressed both diseases and one (6.25%) has mucormycosis as the main theme. The most isolated species of the genus Aspergillus was A. fumigatus, while in cases of candidemia it was C. albicans. The main means of diagnosis were the culture of respiratory samples, blood culture and the galactomannan test. It was possible to observe that most of the patients who needed intensive care had underlying chronic conditions and were treated with monoclonal antibodies, mainly tocilizumab, or were prescribed corticosteroids, thus increasing the risk factors for fungal infection. Early diagnosis and adequate antifungal therapy proved necessary to improve patient prognosis and decrease mortality rates.
In December 2019, a group of pneumonia cases appeared in Wuhan, China, caused by an unidentified microbial agent, which was later identified as a β-coronavirus and the disease was officially named coronavirus 2019, and its microbial agent such as SARS-CoV-2. Coronavirus 2019 belongs to a family of single-stranded, enveloped RNA viruses called Coronaviridae and classified in the order Nidovirales. This family of viruses consists of pathogens of many species, capable of infecting animals and humans, and have been described for over 50 years. The most recent strain of the coronavirus is characterized by being a highly pathogenic and contagious virus in the human population. Initially, SARS-CoV-2 causes a rapid activation of the innate immune response with an increase in serum levels of circulating cytokines in the body, and in some patients in a disease state, they may present a hyper-inflammatory response, eventually leading to failure of the immune system. multiple organs. In order to reverse this response, the use of immunosuppressive drugs is indicated. A combination of virus- and drug-induced immunosuppression likely increases susceptibility to secondary infections. The aim of this review was to investigate the epidemiology, pathogenesis, clinical manifestations, and treatment for major fungal infections in hospitalized patients with COVID-19, by searching the MEDLINE/Pubmed database of eligible studies until November 6, 2021, without language restrictions, using previously defined search terms. Studies that were not only about secondary fungal infections and those in which the studied group were not hospitalized were excluded. A total of 250 eligible studies were returned, of which 16 met the pre-established parameters, eight (50%) had aspergillosis as their main theme, three (18.75%) had candidiasis, four (25%) addressed both diseases and one (6.25%) has mucormycosis as the main theme. The most isolated species of the genus Aspergillus was A. fumigatus, while in cases of candidemia it was C. albicans. The main means of diagnosis were the culture of respiratory samples, blood culture and the galactomannan test. It was possible to observe that most of the patients who needed intensive care had underlying chronic conditions and were treated with monoclonal antibodies, mainly tocilizumab, or were prescribed corticosteroids, thus increasing the risk factors for fungal infection. Early diagnosis and adequate antifungal therapy proved necessary to improve patient prognosis and decrease mortality rates.
Descrição
Palavras-chave
COVID-19, Aspergillus spp, Mucormicose, Candida spp., Infecções fúngicas