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Clin. Med.","JCM"],"abstract":"<jats:p>From a health perspective, the 21st century has witnessed the emergence and global impact of several major viral diseases, most notably coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2, which has been associated with a substantial burden of secondary fungal infections. Patients suffering from COVID-19 illnesses frequently developed fungal co-infections, which can worsen clinical outcomes and complicate therapeutic efforts. Hospitalized individuals with viral infections are particularly susceptible to invasive fungal pathogens, including Aspergillus, Candida, and Mucorales species. The co-pathogenesis between respiratory virus and fungi is complex, involving dynamic interactions among the pathogens and the host immune system. Opportunistic fungal infections were found to be more prevalent in COVID-19-infected individuals, who require mechanical ventilation, have diabetes, or exhibit neutropenia. This review aims to provide a comprehensive overview of fungal co-infections associated with COVID-19 disease, with a focus on their pathogenesis, biomarkers, diagnostic approaches, and potential treatment strategies. Overall, the available evidence indicates that viral-induced immune dysregulation, epithelial barrier damage, and clinical risk factors contribute to the development and severity of fungal co-infections in COVID-19 patients. Early recognition using reliable biomarkers and standardized diagnostic approaches, together with timely and pathogen-directed antifungal therapy, are essential for improving clinical outcomes.<\/jats:p>","DOI":"10.3390\/jcm15176896","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T12:12:25Z","timestamp":1788783145000},"page":"6896","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["COVID-19-Associated Fungal Co-Infections: Pathogenesis, Diagnostics, Biomarkers, and Therapeutic Strategies"],"prefix":"10.3390","volume":"15","author":[{"given":"Swapnila","family":"Choudhury","sequence":"first","affiliation":[{"name":"Department of Genetic Engineering and Biotechnology, Jagannath University, Dhaka 1100, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nafisa","family":"Nawaar","sequence":"additional","affiliation":[{"name":"Department of Biochemistry and Microbiology, North South University, Dhaka 1229, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woasifur Rahman","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Department of Genetic Engineering and Biotechnology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puja","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of Genetic Engineering and Biotechnology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Auroni Semonti","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Genetic Engineering and Biotechnology, Jagannath University, Dhaka 1100, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sajad","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences, College of Science, King Faisal University, Al-Ahsa 31982, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6145-4837","authenticated-orcid":false,"given":"Randa Mohammed","family":"Zaki","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia"},{"name":"Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Beni-Suef University, Beni-Suef 62514, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Topu","family":"Raihan","sequence":"additional","affiliation":[{"name":"Faculty of Life and Environmental Science, Shimane University, Matsue 690-8504, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meerambika","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease and Immunology, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2497-5219","authenticated-orcid":false,"given":"Muhammad Fazle","family":"Rabbee","sequence":"additional","affiliation":[{"name":"Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6719-9187","authenticated-orcid":false,"given":"Kwang-Hyun","family":"Baek","sequence":"additional","affiliation":[{"name":"Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Piret, J., and Boivin, G. 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