{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T06:45:10Z","timestamp":1781073910713,"version":"3.54.1"},"reference-count":46,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T00:00:00Z","timestamp":1661385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Bacterial coinfections, which increase the severity of respiratory viral infections, are frequent causes of mortality in influenza pandemics but have not been well characterized in patients with Coronavirus disease 2019 (COVID-19). Moreover, the association of COVID-19 infection with pulmonary Mycobacterium tuberculosis disease (TB) and concurrent pulmonary fungal infection is not well known. The classification of patients with COVID-19-associated pulmonary aspergillosis (CAPA) using the current definitions for invasive fungal diseases has proven difficult. In this study, we aimed to provide information about three patients with underlying diseases ongoing with COVID-19 and co-infection with pulmonary TB, and with COVID-19-associated pulmonary aspergillosis (CAPA). At the time of hospital admission, each patient presented complications such as decompensated T2DM with diabetic ketoacidosis and\/or hypertension. Findings of chest computed tomography and serum galactomannan by radioimmunoassay were useful for classifying them as possible CAPA. One of the three possible CAPA cases was fatal. These three cases are rare and are the first of their kind reported worldwide. The generation of reliable algorithms, early diagnosis, standardization of classification criteria, and the selection of specific and personalized treatments for COVID-19-associated opportunistic infections, including CAPA, are necessary to improve outcomes in these kinds of patients.<\/jats:p>","DOI":"10.3390\/diagnostics12092058","type":"journal-article","created":{"date-parts":[[2022,8,25]],"date-time":"2022-08-25T21:28:12Z","timestamp":1661462892000},"page":"2058","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["COVID-19 Syndemic: Convergence of COVID-19, Pulmonary Aspergillosis (CAPA), Pulmonary Tuberculosis, Type 2 Diabetes Mellitus, and Arterial Hypertension"],"prefix":"10.3390","volume":"12","author":[{"given":"Jose Isaias","family":"Badillo-Almaraz","sequence":"first","affiliation":[{"name":"Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y C.S., Campus UAZ siglo XXI-L1, Universidad Autonoma de Zacatecas, Zacatecas 98160, Mexico"},{"name":"Hospital General Luz Gonzalez Cosio, Circuito ciudad Gobierno, Zacatecas 98160, Mexico"},{"name":"Clinica San Antonio Memorial Center, Rio Grande, Zacatecas 98400, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4377-5725","authenticated-orcid":false,"given":"Sergio Andres","family":"Cardenas-Cadena","sequence":"additional","affiliation":[{"name":"Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y C.S., Campus UAZ siglo XXI-L1, Universidad Autonoma de Zacatecas, Zacatecas 98160, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fausto Daniel","family":"Gutierrez-Avella","sequence":"additional","affiliation":[{"name":"Hospital General Luz Gonzalez Cosio, Circuito ciudad Gobierno, Zacatecas 98160, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro Javier","family":"Villegas-Medina","sequence":"additional","affiliation":[{"name":"Hospital General Luz Gonzalez Cosio, Circuito ciudad Gobierno, Zacatecas 98160, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6307-1696","authenticated-orcid":false,"given":"Idalia","family":"Garza-Veloz","sequence":"additional","affiliation":[{"name":"Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y C.S., Campus UAZ siglo XXI-L1, Universidad Autonoma de Zacatecas, Zacatecas 98160, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9291-8315","authenticated-orcid":false,"given":"Valentin Badillo","family":"Almaraz","sequence":"additional","affiliation":[{"name":"Unidad Academica de Estudios Nucleares. Universidad Autonoma de Zacatecas, Zacatecas 98000, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1478-9068","authenticated-orcid":false,"given":"Margarita L","family":"Martinez-Fierro","sequence":"additional","affiliation":[{"name":"Molecular Medicine Laboratory, Unidad Academica de Medicina Humana y C.S., Campus UAZ siglo XXI-L1, Universidad Autonoma de Zacatecas, Zacatecas 98160, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1525\/maq.2003.17.4.423","article-title":"Syndemics and public health: Reconceptualizing disease in bio-social context","volume":"17","author":"Singer","year":"2003","journal-title":"Med Anthr. 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