FUNGAL COINFECTIONS IN COVID-19 PATIENTS: A COMPREHENSIVE REVIEW OF MUCORMYCOSIS, ASPERGILLOSIS, AND CANDIDA AURIS

Abstract

The emergence of fungal coinfections in patients with COVID-19 has introduced a new dimension of clinical complexity, particularly in individuals with underlying immunosuppression or comorbidities such as diabetes mellitus. Opportunistic fungal pathogens, including Mucorales (mucormycosis), Aspergillus spp. (COVID-19-associated pulmonary aspergillosis, CAPA), and Candida auris, have shown an alarming rise during the pandemic, often mimicking or compounding COVID-19 respiratory symptoms. These infections are associated with high morbidity and mortality, especially when diagnosis and intervention are delayed. This review highlights the pharmacological aspects of managing fungal infections in COVID-19 patients, emphasizing the challenges in antifungal therapy, drug resistance, and immunomodulatory treatment strategies. Corticosteroid therapy, a cornerstone in severe COVID-19 treatment, has paradoxically increased susceptibility to fungal invasion by impairing host immune responses and elevating blood glucose levels. Mucormycosis, in particular, has seen a dramatic surge in India during the second wave of COVID-19, necessitating aggressive surgical and pharmacological intervention with liposomal amphotericin B, posaconazole, or isavuconazole. Preventive pharmacological measures, such as glycemic control, judicious steroid use, and sterilization of oxygen humidifiers, are crucial to reduce the incidence of these secondary infections. Enhanced diagnostic protocols, antifungal stewardship, and ongoing clinical trials on novel therapeutics are essential for improving patient outcomes. This comprehensive review serves to inform clinicians, pharmacists, and researchers of the evolving fungal landscape in the COVID-19 era and offers pharmacological insights into evidence-based management strategies for these life-threatening coinfections.