Conference Calendar
Past Quiz Results
Revisiting ISHAM Asia 2021
The first AFWG CaseClinic is now live!
First-ever Study of Mycology Lab Practices in Asia
New Diagnostic Mycology E-learning Course
Antifungal prophylaxis: Whom, what and when
Fereydounia khargensis: A New Opportunistic Yeast Reported from Malaysia
9 Years of MMTN: Improving Fungal Disease Management in Asia Pacific
Echinocandins: Clinicians' Guide
Five controversies in mycology
Fungemia blood culture media
Deep dermatophytosis
AFWG Education Module 4: Is Antifungal Susceptibility Testing Useful for Clinical Management?
AFWG Education Module 5: TDM of Antifungal Agents - Essential or Optional?
AFWG Education Module 6: Antifungal Stewardship
10 common mistakes in laboratory mycology
Itraconazole: A Quick Guide for Clinicians
Evolving Fungal Landscape in Asia
10 common mistakes in clinical mycology
Laboratory Diagnosis of Pythiosis
ICMR Issues C. auris Advisory
Strengths and Limitations of Imaging for Diagnosis of IFI
Candidemia: Lessons Learned from Asian Studies for Intervention
Spotting invasive pulmonary aspergillosis in COVID-19 patients
Pivotal Asian Invasive Mold Study
Impact of the COVID-19 pandemic on IFI epidemiology and trends
Mycetoma in Asia: Still veiled in mystery
Identifying IFI risk factors in patients with COVID-19
ASID ANZMIG x AFWG: Fungal Frontiers in the Asia Pacific – Webinar 2
New Antifungal Agents
Gilead IFI Masterclass: Current updates on the management of IFIs in immunocompromised hosts
The AFWG Masterclass: Advanced fungal education at your fingertips
A challenging case: A crisis unfolds
The role of antifungal stewardship in improving IFI outcomes
Making Precise Diagnoses: Experience from the Laboratory Skills Enhancement Course
A challenging case: A 68-year-old man with nasal and palatal ulcers
AFWG Online Education Module 3: Optimizing Dosing in IFI Management
AFWG Online Education Module 2: Antifungal Prophylaxis in Solid Organ Transplantation
AFWG Education Module 1: The Value of Clinical Mycology Laboratories
How do I interpret Candida in the urine?
How do I interpret Candida in respiratory tract cultures?
Cryptococcosis in HIV and non-HIV infected patients
Human Pythiosis
AFWGOnline Privacy Policy has been Updated
Management of fungal infections in high-risk patients
Striving for Perfection: Experience from the Laboratory Foundation Training Course
Know your fungal landscape in Vietnam
Recent Advances of Fungal Diagnostics in Asian Laboratories
Deep Dermatophytosis: A Case Report
Management of cryptococcosis and talaromycosis
A challenging case: A 49-year-old woman with sarcoidosis
Emerging yeast infections in Asia
Outbreak of Superbug Candida auris: Asian Scenario and Interventions
Championing Medical Mycology: Thoughts on the AFWG Laboratory Skills Enhancement Course
Mucormycosis and Pythiosis – New Insights
AML and the high risk of multiple infectious complications
Do We Need Modification of Recent IDSA & ECIL Guidelines while Managing Patients in Asia?
A hospital’s experience with candidemia and empirical therapy
Top 5 most viewed AFWG videos on YouTube
Fungal Academy 2015
Fluconazole in 2015
Fungal isolation protocol
Influencing Aspergillus
Fungal Asthma
Laboratory Diagnosis of IPA
Educational Organizations
Literature Updates


Identifying IFI Risk Factors In Patients With COVID-19

Share this

this page

IFIs can complicate the clinical course of COVID-19

Invasive fungal infections (IFIs) can complicate the clinical course of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients admitted to an intensive care unit (ICU). The rising prevalence of IFIs in COVID-19 has led to new terms such as COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated mucormycosis (CAM). A narrative review found that IFIs were present in approximately 7% of patients with COVID-19.1 Importantly, a meta-analysis found that CAPA and CAM were associated with a 75.2% and 13% mortality rate in patients diagnosed with COVID-19, respectively.2

Risk factors for COVID-19-associated IFIs

It remains unknown if SARS-CoV-2 infection is an independent risk factor for IFIs.3 However, patients with COVID-19 often have multiple known risk factors for IFIs, including in-dwelling vascular catheters, mechanical ventilation, and the use of broad-spectrum antibiotics.1 Additionally, treatments for COVID-19 – which regulate the inflammatory response – may also increase the risk of IFIs.4 One study found that chronic corticosteroid treatment was substantially more frequent in patients with CAPA, especially in those who did not survive, compared with non-infected patients.3

Furthermore, many patients infected with CAM who did not have traditional risk factors often had either hypertension or end-stage renal failure, and had received corticosteroid treatment for COVID-19.4 In fact, one retrospective study in India found that uncontrolled diabetes was the most common underlying disease among CAM and non-CAM patients. In 32.6% of patients presenting with CAM, COVID-19 was reported as their only underlying disease – with no other comorbidities – and up to 78.7% of them had received glucocorticoid treatment.5

Table 1. Risk factors for CAPA, CAM and other IFIs in patients with COVID-194

Risk factors



Other IFIs

ICU, mechanical ventilation + clinical deterioration




IL-6 inhibitor therapy



Immunosuppressive therapy




Poorly controlled diabetes




Major trauma




Drugs category




Immune modulators


↓ vasodilation, permeability of capillaries & leukocyte migration

↓ neutrophil apoptosis & demargination



Monoclonal antibodies


Not reported yet

CAPA, COVID-19-associated pulmonary aspergillosis; CAM, COVID-19-associated mucormycosis; IFI, invasive fungal infections
Adapted from Basile K, et al. J Fungi 2022 


An increasing number of observational studies have shown that the clinical course of COVID-19 can be complicated by various IFIs (particularly CAPA and CAM), leading to increased morbidity and mortality, especially among critically ill patients. In the absence of antifungal prophylaxis, screening of COVID-19 patients for IFIs is essential to reduce delays in diagnosis and treatment to help prevent severe illness and death from these infections.6


  1. Casalini G, et al. J Fungi (Basel) 2021;7:921.
  2. Sah SK, et al. PLoS One 2022;17(7):e0271795.
  3. Koehler P, et al. Lancet Infect Dis 2021;21: e149–62.
  4. Basile K, et al. J Fungi 2022;8:58.
  5. Patel A, et al. Emerg Infect Dis 2021;27:2349–2359
  6. CDC – Fungal Diseases and COVID-19

This field is required. Please enter your email address.
Thank you for signing up for the AFWG newsletter.
Your subscription has been updated.