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


Impact Of The COVID-19 Pandemic On IFI Epidemiology And Trends

Share this

this page

The emergence of COVID-19 has resulted in rising incidence of invasive fungal infections (IFIs). Patients infected with COVID-19 often experience lung injury requiring admission to an ICU, where some will also receive treatment with steroids – known risk factors for fungal infection.1 There is also the possibility that the virus and the complex immunopathology it induces may in some way predispose to fungal infections.2 IFIs complicate the management of COVID-19 and are associated with a significant increase in mortality, especially in critically ill patients.3 Of note, 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).1

Since the start of the pandemic, CAPA has been the predominant fungal disease in patients with COVID-19 and acute respiratory distress syndrome.4 As mentioned, several immunological mechanisms may contribute to the development of CAPA in patients with COVID-19 infection. SARS-CoV-2 results in the release of danger-associated molecular patterns (DAMPs), which in turn exacerbate the inflammatory response leading to lung injury.4 Importantly, CAPA was significantly associated with mortality among intubated patients with COVID-19, with cohort studies consistently reporting mortality rates >40% among critically ill patients.4-6

The COVID-19 pandemic has led to a resurgence of mucormycosis, particularly among patients with uncontrolled diabetes. Diabetes and hyperglycemia are often associated with an inflammatory state that could be aggravated by the immune response to SARS-CoV-2, which may lead to secondary infections.7 One retrospective study in India found that the prevalence of CAM increased 2.1-fold compared to the same period in 2019 before the pandemic.8 The study also reported 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.8 Notably, inappropriate glucocorticoid use was independently associated with the development of late CAM. The mortality rate associated with mucormycosis was high and comparable for both CAM and non-CAM patients (44% vs 49%). Factors associated with a greater risk of mortality were older age, ICU admission, and pulmonary or brain involvement.8

In summary, COVID-19-associated IFIs pose a real threat to increasingly burdened healthcare systems, owing to increased hospitalization and mortality rates, or the utilization of existing resources. There is a need to improve awareness of such infections among healthcare professionals and formulate effective practical guidelines to optimize patient outcomes, while minimizing morbidity and mortality among patients.


  1. Kundu R, Singla N. Current Fungal Infection Reports. 2022;16:47-54.
  2. Arastehfar A, et al. J Fungi 2020;6:91
  3. Casalini G, et al. J Fungi (Basel) 2021;7:921.
  4. Hoenigl M. Clinical Infectious Diseases 2021;73:e1645-1648.
  5. Koehler P, et al. Mycoses 2020;63:528-34.
  6. Rutsaert L, et al. Ann Intensive Care 2020;10:71.
  7. Hoenigl M, et al. Lancet Microbe 2022;3:e543-e552.
  8. Patel A, et al. Emerg Infect Dis 2021;27:2349-59.

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