{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:57:47Z","timestamp":1787165867190,"version":"build-2736575974"},"reference-count":216,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,10,29]],"date-time":"2021-10-29T00:00:00Z","timestamp":1635465600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>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). This narrative review concerns 4099 cases of IFIs in 58,784 COVID-19 patients involved in 168 studies. COVID-19-associated invasive pulmonary aspergillosis (CAPA) is a diagnostic challenge because its non-specific clinical\/imaging features and the fact that the proposed clinically diagnostic algorithms do not really apply to COVID-19 patients. Forty-seven observational studies and 41 case reports have described a total of 478 CAPA cases that were mainly diagnosed on the basis of cultured respiratory specimens and\/or biomarkers\/molecular biology, usually without histopathological confirmation. Candidemia is a widely described secondary infection in critically ill patients undergoing prolonged hospitalisation, and the case reports and observational studies of 401 cases indicate high crude mortality rates of 56.1% and 74.8%, respectively. COVID-19 patients are often characterised by the presence of known risk factors for candidemia such as in-dwelling vascular catheters, mechanical ventilation, and broad-spectrum antibiotics. We also describe 3185 cases of mucormycosis (including 1549 cases of rhino-orbital mucormycosis (48.6%)), for which the main risk factor is a history of poorly controlled diabetes mellitus (&gt;76%). Its diagnosis involves a histopathological examination of tissue biopsies, and its treatment requires anti-fungal therapy combined with aggressive surgical resection\/debridement, but crude mortality rates are again high: 50.8% in case reports and 16% in observational studies. The presence of other secondary IFIs usually diagnosed in severely immunocompromised patients show that SARS-CoV-2 is capable of stunning the host immune system: 20 cases of Pneumocystis jirovecii pneumonia, 5 cases of cryptococcosis, 4 cases of histoplasmosis, 1 case of coccidioides infection, 1 case of pulmonary infection due to Fusarium spp., and 1 case of pulmonary infection due to Scedosporium.<\/jats:p>","DOI":"10.3390\/jof7110921","type":"journal-article","created":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T22:21:34Z","timestamp":1635805294000},"page":"921","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":85,"title":["Invasive Fungal Infections Complicating COVID-19: A Narrative Review"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0740-5361","authenticated-orcid":false,"given":"Giacomo","family":"Casalini","sequence":"first","affiliation":[{"name":"Luigi Sacco Department of Biomedical and Clinical Sciences, Universit\u00e0 degli Studi di Milano, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3685-4289","authenticated-orcid":false,"given":"Andrea","family":"Giacomelli","sequence":"additional","affiliation":[{"name":"Luigi Sacco Department of Biomedical and Clinical Sciences, Universit\u00e0 degli Studi di Milano, 20157 Milan, Italy"},{"name":"III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Ridolfo","sequence":"additional","affiliation":[{"name":"III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Gervasoni","sequence":"additional","affiliation":[{"name":"III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0569-9407","authenticated-orcid":false,"given":"Spinello","family":"Antinori","sequence":"additional","affiliation":[{"name":"Luigi Sacco Department of Biomedical and Clinical Sciences, Universit\u00e0 degli Studi di Milano, 20157 Milan, Italy"},{"name":"III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"m3862","DOI":"10.1136\/bmj.m3862","article-title":"Virology, transmission, and pathogenesis of SARS-CoV-2","volume":"371","author":"Cevik","year":"2020","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.cmi.2020.10.021","article-title":"Secondary infections in patients hospitalized with COVID-19: Incidence and predictive factors","volume":"27","author":"Ripa","year":"2021","journal-title":"Clin. 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