Concerns over fungal infection due to COVID-19

CAPA infection affects the survival of confirmed patients

Need antifungal agents prescribed for infections such as CAM

There is concern about the gap in fungal infections due to the re-proliferation of COVID-19.

 

The most commonly reported fungal infections in COVID-19 patients include COVID-19 associated pulmonic aspergillosis (CAPA), COVID-19 associated mucomycosis (CAM), and Candida auris.

 

These COVID-19-related fungal infections can lead to serious diseases and deaths.

 

If left untreated, CAPA-related morbidity reaches up to 80%, and CAM mortality is close to 100%.

 

CAPA is a secondary fungal infection mentioned as a clinical complication of COVID-19 infection in the government's COVID-19 response guidelines, and CAPA has been confirmed in Korea.

 

◆The number of patients who need antifungal drugs in Korea also surged According to the KSID Autumn Conference presentation data in November last year, 57.8% (126/218) of 218 patients with severe COVID-19 were treated by ICU, and the cumulative incidence rate of CAPA related to COVID-19 was 4.5% (10/218) and 11.2% (10/89) of COVID-19 patients admitted to intensive care units.

 

In-hospital mobility was 11.9% (26/218) in COVID-19 patients and overall mobility in CAPA patients was 50% (5/10).

 

It was found that CAPA secondary infection affected the survival of COVID-19 patients.

 

COVID-19-related CAPA mainly occurs in severe COVID-19 patients who use ventilators in intensive care units, and patients often show non-specific symptoms, and it is difficult to diagnose because samples need to be collected deep in the lungs.

 

Choo Eun-joo (Professor of Infectious Medicine at Bucheon Hospital at Sooncheonhyang University) said, "As experienced through the COVID-19 pandemic, it is important to preemptively secure drugs necessary for treating acute infectious diseases at the government level.

 

New antimicrobial and antifungal drugs, which are essential for treating infectious diseases, are having difficulties in development around the world despite high clinical needs," she said.

 

Surgical surgery and antifungal agents including Amphotericin B, Posaconazole or Isavuconazole can be used for COVID-19-related CAM treatment, and Voriconazole is not recommended for CAM treatment.

 

Posaconazole has indication for the treatment of CAPA patients in Korea, so if CAPA or CAM is suspected in COVID-19 patients, Cresemba (Isavuconazole) is the only drug that can be used preemptively at the same time as fungal culture.

 

Cresemba is an antifungal agent that has indications for both invasive CAPA and invasive CAM.

 

Cresemba was designated as a national essential drug in June 2021.

 

This drug is licensed and used in March and October 2015, respectively, in the United States and Europe (EMA), but it is not reimbursed in Korea.

 

Professor Choo said, "In Korea, new antibiotics are allowed, but insurance benefits have not yet been registered.

 

There are no antibacterial and antifungal drugs that have entered the right to benefit for the past five to seven years.

 

Drugs necessary to treat fatal infectious diseases should not be evaluated only from an economic perspective, as they play a key role in preventing the spread of infectious diseases as well as the survival of individual patients."