Invasive fungal infections and COVID-19 | CRESEMBA® (isavuconazole)| PfizerPro UK

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Invasive fungal infections and risk factors

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Invasive Aspergillosis

Mucormycosis

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Invasive fungal infections in the ICU

Invasive fungal infections and influenza

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Invasive fungal infections and COVID-19 (CAPA/CAM)

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Invasive fungal infections
and COVID-19

An emerging association

Invasive aspergillosis and mucormycosis represent a serious additional threat to COVID-19 patients who develop ARDS or are admitted to the ICU.^1–5 Cases of COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM) are increasingly being reported, with an overall prevalence among ICU patients of 11.1% and 1.6%, respectively.^6,7

Text goes here.The overall incidence of CAPA among ICU patients was shown to be 11.1% across 39 observational studies, but varied widely from 0.7-34.4%⁶

COVID-19 associated pulmonary aspergillosis

The overall incidence of CAPA among ICU patients was shown to be 11.1% across 39 observational studies, but varied widely from 0.7–34.4%⁶

Overall mortality is approximately 50%^6,8

Diagnosis of invasive aspergillosis in COVID-19 patients is usually late
(>7-14 days) after ICU admission^9-11

Less than 10% of patients who develop CAPA are immunocompromised¹⁰

While prolonged corticosteroid treatment preceding COVID-19 could increase the risk of CAPA, the effect of short course treatment on CAPA incidence is still uncertain¹⁰

Positive serum galactomannan is found in <10% cases (cut off optical density varied across studies, the use of which has not been validated)^10–15

Risk factors include severe lung damage during the course of COVID-19, age, extensive use of corticosteroids or tocilizumab, or broad-spectrum antibiotics and the presence of comorbidities such as structural lung defects.^8,16,17

COVID-19 associated mucormycosis

1.6% of ICU COVID-19 patients develop mucormycosis⁷

Overall mortality is approximately 50%¹⁸

Median time to diagnosis of CAM is 18 days after COVID-19 diagnosis⁷

Diabetes mellitus is the most frequent risk factor, as well as trauma, haematological malignancy, prolonged neutropenia and stem cell transplantation or SOT, immunosuppressive therapies and extensive corticosteroid use^7,18–22

CRESEMBA® (isavuconazole) is recommended by the ECMM for the treatment of CAPA and CAM^27,28

When to suspect

Some potential risk factors predisposing COVID-19 patients to secondary invasive fungal infections have been identified:^{7,8,16,19,20,22}

Use of corticosteroids
Widespread use of broad-spectrum antibiotics in the ICU
Immune dysregulation associated with COVID-19
Presence of comorbidities, particularly those causing structural lung damage
Trauma, diabetes mellitus, haemopoietic malignancy, prolonged neutropenia, patients undergoing HSCT/SOT

Risk factors for invasive fungal infections in the ICU

Considerations when treating

Effective management of CAPA and CAM requires prompt diagnosis, treatment of underlying diseases, and aggressive medical intervention^1,23–25. However, clinical and radiological signs of CAPA and CAM can overlap – and there have been cases of mixed infections – which may complicate the diagnosis.^5,26,27

While there are several approved treatments for invasive aspergillosis and a few for mucormycosis, an individualised assessment should be considered for every patient, taking into account differences in coverage, tolerability, drug interaction profile, and PK.^28–31

CRESEMBA^® (isavuconazole) is recommended by the ECMM as an option for the treatment of CAPA and CAM^32,33

CRESEMBA^® is indicated in adults for the treatment of:²⁸

Invasive aspergillosis
Mucormycosis in patients for whom amphotericin B is inappropriate

Consideration should be given to official guidance on the appropriate use of antifungal agents.
Please refer to the Summary of Product Characteristics for more details.

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Fungal infections and influenza

Find out futher information about how invasive fungal infections can affect patients with influenza

Go to fungal infections and influenza

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ARDS, acute respiratory distress syndrome; CAM, COVID-19-associated mucormycosis; CAPA, COVID-19-associated pulmonary aspergillosis; COVID-19, coronavirus disease 2019; ECMM, European Confederation of Medical Mycology; HSCT, haematopoietic stem cell transplantation; ICU, intensive care unit; PK, pharmacokinetics; SOT, solid organ transplantation.

Prescribing Information

Click here for CRESEMBA^® (isavuconazole) and Vfend (voriconazole) prescribing information

References:

Arastehfar A et al. J Fungi (Basel) 2020;6(2):91.

Alanio A et al. Lancet Respir Med 2020;8(6):e48–e49.

Rutsaert L et al. Ann Intensive Care 2020;10(1):71.

Song G et al. Mycopathologia 2020;185(4):599–606.

Hoenigl M et al. SSRN. 2021. [Epub ahead of print]. Available at: https://ssrn.com/abstract=3844587 or http://dx.doi.org/10.2139/ssrn.3844587.

Feys S et al. J Fungi (Basel) 2021;7(12):1067.

Patel A et al. Emerg Infect Dis 2021;27(9):2349–2359.

Verwejj PE et al. Intensive Care Med 2021;47(8):819–834.

Rutsaert L et al. Ann Intenstive Care 2020;10(1):71.

Lamoth F et al. J Infect Dis 2021;224(10):1631–1640.

van Arkel A et al. Am J Respir Crit Care Med 2020;202(1):132–135.

Bartoletti M et al. Clin Infect Dis 2021;73(11):e3606–e3614.

Alanio A et al. Lancet Respir Med 2020;8(6):e48–e49.

Borman A et al. J Clin Microbiol 2020;59(1):e01236-20.

Falces-Romero I et al. Mycoses 2020;63(11):1144–1148.

Arastehfar A et al. J Fungi (Basel) 2020;6(2):91.

Prattes J et al. Intensive Care Med 2021;47(11):1339–1340.

Hoenigl M et al. SSRN 2021;3(7):e543–e552.

Khatri A et al. J Mycol Med 2021;31(2):101125.

Mehta S and Pandey A. Cureus 2020;12(9):e107726.

Jonn TM et al. J Fungi (Basel) 2021;7(4):298.

Sharma S et al. J Laryngol Otol 2021;135(5):442–44723.

do Monte Junior ES et al. Clin Endosc 2020;53(6):746–749.

Sen M et al. Indian J Ophthalmol 2021;69(2):244–252.

Ullmann AJ et al. Clin Microbiol Infect 2018;24(Suppl 1):e1–e38.

Benhadid-Brahmi Y et al. JMM 2022;32(1):101231.

Garg D et al. Mycopathologia 2021;186:289–298.

CRESEMBA Summary of Product Characteristics.

AmBisome Summary of Product Characteristics.

Noxafil Summary of Product Characteristics.

VFEND Summary of Product Characteristics.

Koehler P et al. Lancet Infect Dis 2021;21(6):e149–e162.

Rudramurthy SM et al. Mycoses 2021;64(9):1028–1037.

PP-CRB-GBR-2043. August 2023.

ICU

Meet Anika, our hypothetical ICU patient with suspected COVID-19-associated invasive aspergillosis

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Meet Sanjay, our hypothetical ICU patient with suspected COVID-19-associated mucormycosis

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