Fungal complications with the new coronavirus infection COVID-19

Abstract

BACKGROUND: The growth of fungal pathology observed in the last decade, including life-threatening invasive mycoses, is associated with the spread of immunodeficiency states of various etiologies. The COVID-19 pandemic has made a negative contribution, causing a significant increase in the number of patients with fungal complications.

AIM: To characterize the types of fungal complications in the acute period of a new coronavirus infection COVID-19 based on an analysis of the clinical course and therapeutic tactics for managing the underlying disease.

MATERIALS AND METHODS: The results of a bacteriological study of 1284 cultures from sputum samples of patients with suspected secondary pneumonia in COVID-19 are considered. The study included 404 cultures of various types of fungi. The analysis of the clinical picture was carried out in 70 patients with fungal complications of various localization, who were treated in a regional covid hospital. This group included the results of microbiological examination of sputum, bronchoalveolar lavage (BAL), scrapings from lesions in the oropharynx, urine, blood, biopsy and autopsy material. The study was conducted from April 01, 2020 to December 31, 2021. The patients were divided into subgroups depending on the isolated pathogen: Candida spp. ― 64 patients, and fungi (Aspergillus spp. and Mucor spp.) ― 6 patients; outcome of the disease: favorable — 66, lethal — 4.

RESULTS: In the microbial landscape of the respiratory tract in patients with COVID-19, gram-negative microbial flora prevailed, one third of the cultures were represented by fungi. During the two years of the pandemic, the proportion of fungal cultures increased from 26.9% in 2020 to 34.2% in 2021, while maintaining sensitivity to amphotericin B and fluconazole in most cases. In 2021, there was a negative growth trend in the sputum of molds of the species Aspergillus spp. (5 cultures) and Mucor spp. (1 culture).

Typical fungal complications of COVID-19 were: candidiasis stomatitis caused by Candida albicans (71%), candidiasis of other urogenital localizations in the form of candiduria (20%), lung damage of mixed viral-fungal etiology in isolated cases, leading to death due to invasive mycosis. Only fungal flora was isolated in 57.1% of cases, various combinations of fungal and bacterial flora — in 42.9%. Candidiasis stomatitis was diagnosed on average on day 11.6±1.08 of COVID-19, which corresponded to days 2-3 of hospitalization. Preceding outpatient treatment, in most cases, included antibiotics and hormonal therapy with glucocorticosteroids. Urogenital Urogenital fungal infection was diagnosed on the 17.7±5.17 day of illness, on the second week of hospital treatment (8.0±3.11 days). Fungal flora in sputum was determined on average on the 18.5±4.33 day of illness, on the second — third week of hospitalization against the background of intensive immunosuppressive therapy.

CONCLUSION: Risk factors for the development of fungal complications are the age of patients older than 50 years, overweight and hypertension, uncontrolled use of antibiotics and glucocorticosteroids at the prehospital stage. Mycoses are recorded in both severe and moderate COVID-19. An additional factor in their development is immunosuppressive therapy of the underlying disease. The most formidable complication of the course of COVID-19, worsening the prognosis of survival, is the addition of fungi with invasive growth — Aspergillus spp., Mucor, as well as the development of fungal-bacterial associations with damage to the lung tissue.

In the context of the ongoing SARS-CoV-2 pandemic, the use of immunomodulatory agents, including the combined use of corticosteroids and targeted immunosuppressive drugs, it is important to develop a risk-based approach in diagnosis and treatment for patients at risk of generalized and invasive mycoses.

Keywords

new coronavirus infection / COVID-19 / fungal complications / aspergillosis

References

[1] Kuchi Bhotla H, Balasubramanian B, Meyyazhagan A, et al. Opportunistic mycoses in COVID-19 patients/survivors: Epidemic inside a pandemic. J Infect Public Health. 2021;14(11):1720–1726. doi: 10.1016/j.jiph.2021.10.010

[2] Kuchi Bhotla H., Balasubramanian B., Meyyazhagan A., et al. Opportunistic mycoses in COVID-19 patients/survivors: Epidemic inside a pandemic // J Infect Public Health. 2021. Vol. 14, N 11. P. 1720–1726. doi: 10.1016/j.jiph.2021.10.010

[3] Akimkin VG, Tutelyan AV, Shulakova NI. Medical mycological iceberg: recent trends in the epidemiology of mycoses. Infectious Diseases. 2022;20(1):120–126. (In Russ). doi: 10.20953/1729-9225-2022-1-120-126

[4] Акимкин В.Г., Тутельян А.В., Шулакова Н.И. Микологический айсберг: современные сдвиги в эпидемиологии микозов // Инфекционные болезни. 2022. Т. 20, № 1. С. 120–126. doi: 10.20953/1729-9225-2022-1-120-126

[5] Suleyman G, Alangaden GJ. Nosocomial Fungal Infections: Epidemiology, Infection Control, and Prevention. Infect Dis Clin North Am. 2021;35(4):1027–1053. doi: 10.1016/j.idc.2021.08.002

[6] Suleyman G., Alangaden G.J. Nosocomial Fungal Infections: Epidemiology, Infection Control, and Prevention // Infect Dis Clin North Am. 2021. Vol. 35, N 4. P. 1027–1053. doi: 10.1016/j.idc.2021.08.002

[7] Arastehfar A, Carvalho A, Nguyen MH, et al. COVID-19-Associated Candidiasis (CAC): An Underestimated Complication in the Absence of Immunological Predispositions? J Fungi (Basel). 2020;6(4):211. doi: 0.3390/jof6040211

[8] Arastehfar A., Carvalho A., Nguyen M.H., et al. COVID-19-Associated Candidiasis (CAC): An Underestimated Complication in the Absence of Immunological Predispositions? // J Fungi (Basel). 2020. Vol. 6, N 4. P. 211. doi: 0.3390/jof6040211

[9] Posteraro B, Torelli R, Vella A, et al. Pan-Echinocandin-Resistant Candida glabrata Bloodstream Infection Complicating COVID-19: A Fatal Case Report. J Fungi (Basel). 2020;6(3):163. doi: 10.3390/jof6030163

[10] Posteraro B., Torelli R., Vella A., et al. Pan-Echinocandin-Resistant Candida glabrata Bloodstream Infection Complicating COVID-19: A Fatal Case Report // J Fungi (Basel). 2020. Vol. 6, N 3. P. 163. doi: 10.3390/jof6030163

[11] Chong WH, Saha BK, Ananthakrishnan R, Chopra A. State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia. Infection. 2021;49(4):591–605. doi: 10.1007/s15010-021-01602-z

[12] Chong W.H., Saha B.K., Ananthakrishnan R., Chopra A. State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia // Infection. 2021. Vol. 49, N 4. P. 591–605. doi: 10.1007/s15010-021-01602-z

[13] Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect. 2020;81(2):266–275. doi: 10.1016/j.jinf.2020.05.046

[14] Lansbury L., Lim B., Baskaran V., Lim W.S. Co-infections in people with COVID-19: a systematic review and meta-analysis // J Infect. 2020. Vol. 81, N 2. P. 266–275. doi: 10.1016/j.jinf.2020.05.046

[15] Langford BJ, So M, Raybardhan S, et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect. 2020;26(12): 1622–1629. doi: 10.1016/j.cmi.2020.07.016

[16] Langford B.J., So M., Raybardhan S., et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis // Clin Microbiol Infect. 2020. Vol. 26, N 12. P. 1622–1629. doi: 10.1016/j.cmi.2020.07.016

[17] Chen X, Liao B, Cheng L, et al. The microbial coinfection in COVID-19. Appl Microbiol Biotechnol. 2020;104(18):7777–7785. doi: 10.1007/s00253-020-10814-6

[18] Chen X., Liao B., Cheng L., et al. The microbial coinfection in COVID-19 // Appl Microbiol Biotechnol. 2020. Vol. 104, N 18. P. 7777–7785. doi: 10.1007/s00253-020-10814-6

[19] Peng J, Wang Q, Mei H, et al. Fungal co-infection in COVID-19 patients: evidence from a systematic review and meta-analysis. Aging (Albany NY). 2021;13(6):7745–7757. doi: 10.18632/aging.202742.

[20] Peng J., Wang Q., Mei H., et al. Fungal co-infection in COVID-19 patients: evidence from a systematic review and meta-analysis // Aging (Albany NY). 2021. Vol. 13, N 6. P. 7745–7757. doi: 10.18632/aging.202742

[21] Lai CC, Yu WL. COVID-19 associated with pulmonary aspergillosis: A literature review. J Microbiol Immunol Infect. 2020;54(1):46–53. doi: 10.1016/j.jmii.2020.09.004

[22] Lai C.C., Yu W.L. COVID-19 associated with pulmonary aspergillosis: A literature review // J Microbiol Immunol Infect. 2020. Vol. 54, N 1. P. 46–53. doi: 10.1016/j.jmii.2020.09.004

[23] Al-Hatmi AMS, Mohsin J, Al-Huraizi A, Khamis F. COVID-19 associated invasive candidiasis. J Infect. 2021;82(2):e45–e46. doi: 10.1016/j.jinf.2020.08.005

[24] Al-Hatmi A.M.S., Mohsin J., Al-Huraizi A., Khamis F. COVID-19 associated invasive candidiasis // J Infect. 2021. Vol. 82, N 2. P. e45–e46. doi: 10.1016/j.jinf.2020.08.005

[25] Chowdhary A, Tarai B, Singh A, et al. Multidrug-Resistant Candida auris Infections in Critically Ill Coronavirus Disease Patients, India, April-July 2020. Emerg Infect Dis. 2020;26(11):2694–2696. doi: 10.3201/eid2611.203504

[26] Chowdhary A., Tarai B., Singh A., et al. Multidrug-Resistant Candida auris Infections in Critically Ill Coronavirus Disease Patients, India, April-July 2020 // Emerg Infect Dis. 2020. Vol. 26, N 11. P. 2694–2696. doi: 10.3201/eid2611.203504

[27] Mohamed A, Rogers TR, Talento AF. COVID-19 Associated Invasive Pulmonary Aspergillosis: Diagnostic and Therapeutic Challenges. J Fungi (Basel). 2020;6(3):115. doi: 10.3390/jof6030115

[28] Mohamed A., Rogers T.R., Talento A.F. COVID-19 Associated Invasive Pulmonary Aspergillosis: Diagnostic and Therapeutic Challenges // J Fungi (Basel). 2020. Vol. 6, N 3. P. 115. doi: 10.3390/jof6030115

[29] Machado M, Valerio M, Álvarez-Uría A, et al.; COVID-19 Study Group. Invasive pulmonary aspergillosis in the COVID-19 era: An expected new entity. Mycoses. 2021;64(2):132–143. doi: 10.1111/myc.13213

[30] Machado M., Valerio M., Álvarez-Uría A., et al.; COVID-19 Study Group. Invasive pulmonary aspergillosis in the COVID-19 era: An expected new entity // Mycoses. 2021. Vol. 64, N 2. P. 132–143. doi: 10.1111/myc.13213

[31] Song G, Liang G, Liu W. Fungal Co-infections Associated with Global COVID-19 Pandemic: A Clinical and Diagnostic Perspective from China. Mycopathologia. 2020;185(4):599–606. doi: 10.1007/s11046-020-00462-9

[32] Song G., Liang G., Liu W. Fungal Co-infections Associated with Global COVID-19 Pandemic: A Clinical and Diagnostic Perspective from China // Mycopathologia. 2020. Vol. 185, N 4. P. 599–606. doi: 10.1007/s11046-020-00462-9

[33] Heaney AK, Head JR, Broen K, et al. Coccidioidomycosis and COVID-19 Co-Infection, United States, 2020. Emerg Infect Dis. 2021;27(5):1266–1273. doi: 10.3201/eid2705.204661

[34] Heaney A.K., Head J.R., Broen K., et al. Coccidioidomycosis and COVID-19 Co-Infection, United States, 2020 // Emerg Infect Dis. 2021. Vol. 27, N 5. P. 1266–1273. doi: 10.3201/eid2705.204661

[35] Muthu V, Rudramurthy SM, Chakrabarti A, Agarwal R. Epidemiology and Pathophysiology of COVID-19-Associated Mucormycosis: India Versus the Rest of the World. Mycopathologia. 2021;186(6):739–754. doi: 10.1007/s11046-021-00584-8

[36] Muthu V., Rudramurthy S.M., Chakrabarti A., Agarwal R. Epidemiology and Pathophysiology of COVID-19-Associated Mucormycosis: India Versus the Rest of the World // Mycopathologia. 2021. Vol. 186, N 6. P. 739–754. doi: 10.1007/s11046-021-00584-8

[37] Tabassum T, Araf Y, Moin AT, et al. COVID-19-associated-mucormycosis: possible role of free iron uptake and immunosuppression. Mol Biol Rep. 2022;49(1):747–754. doi: 10.1007/s11033-021-06862-4

[38] Tabassum T., Araf Y., Moin A.T., et al. COVID-19-associated-mucormycosis: possible role of free iron uptake and immunosuppression // Mol Biol Rep. 2022. Vol. 49, N 1. P. 747–754. doi: 10.1007/s11033-021-06862-4

[39] Chao CM, Lai CC, Yu WL. COVID-19 associated mucormycosis — An emerging threat. J Microbiol Immunol Infect. 2022;55(2):183–190. doi: 10.1016/j.jmii.2021.12.007

[40] Chao C.M., Lai C.C., Yu W.L. COVID-19 associated mucormycosis — An emerging threat // J Microbiol Immunol Infect. 2022. Vol. 55, N 2. P. 183–190. doi: 10.1016/j.jmii.2021.12.007

[41] Mahalaxmi I, Jayaramayya K, Venkatesan D, et al. Mucormycosis: An opportunistic pathogen during COVID-19. Environ Res. 2021;201:111643. doi: 10.1016/j.envres.2021.111643

[42] Mahalaxmi I., Jayaramayya K., Venkatesan D., et al. Mucormycosis: An opportunistic pathogen during COVID-19 // Environ Res. 2021. Vol. 201. P. 111643. doi: 10.1016/j.envres.2021.111643

[43] Singh K, Kumar S, Shastri S, et al. Black fungus immunosuppressive epidemic with Covid-19 associated mucormycosis (zygomycosis): a clinical and diagnostic perspective from India. Immunogenetics. 2022;74(2):197–206. doi: 10.1007/s00251-021-01226-5

[44] Singh K., Kumar S., Shastri S., et al. Black fungus immunosuppressive epidemic with Covid-19 associated mucormycosis (zygomycosis): a clinical and diagnostic perspective from India // Immunogenetics. 2022. Vol. 74, N 2. P. 197–206. doi: 10.1007/s00251-021-01226-5

[45] Didehdar M, Chegini Z, Moradabadi A, et al. Gastrointestinal mucormycosis: A periodic systematic review of case reports from 2015 to 2021. Microb Pathog. 2022;163:105388. doi: 10.1016/j.micpath.2022.105388

[46] Didehdar M., Chegini Z., Moradabadi A., et al. Gastrointestinal mucormycosis: A periodic systematic review of case reports from 2015 to 2021 // Microb Pathog. 2022. Vol. 163. P. 105388. doi: 10.1016/j.micpath.2022.105388

[47] Bhattacharyya A, Sarma P, Kaur H, et al. COVID-19-associated rhino-orbital-cerebral mucormycosis: A systematic review, meta-analysis, and meta-regression analysis. Indian J Pharmacol. 2021; 53(6):499–510. doi: 10.4103/ijp.ijp_839_21

[48] Bhattacharyya A., Sarma P., Kaur H., et al. COVID-19-associated rhino-orbital-cerebral mucormycosis: A systematic review, meta-analysis, and meta-regression analysis // Indian J Pharmacol. 2021. Vol. 53, N 6. P. 499–510. doi: 10.4103/ijp.ijp_839_21

[49] Sanghvi D, Kale H. Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus”. Clin Radiol. 2021;76(11):812–819. doi: 10.1016/j.crad.2021.07.004

[50] Sanghvi D., Kale H. Imaging of COVID-19-associated craniofacial mucormycosis: a black and white review of the “black fungus” // Clin Radiol. 2021. Vol. 76, N 11. P. 812–819. doi: 10.1016/j.crad.2021.07.004

[51] Al-Tawfiq JA, Alhumaid S, Alshukairi AN, et al.. COVID-19 and mucormycosis superinfection. The perfect storm. Infection. 2021;49(5):833–853. doi: 10.1007/s15010-021-01670-1

[52] Al-Tawfiq J.A., Alhumaid S., Alshukairi A.N., et al. COVID-19 and mucormycosis superinfection. The perfect storm // Infection. 2021. Vol. 49, N 5. P. 833–853. doi: 10.1007/s15010-021-01670-1

[53] Manchanda S, Semalti K, Bhalla AS, et al. Revisiting rhino-orbito-cerebral acute invasive fungal sinusitis in the era of COVID-19: pictorial review. Emerg Radiol. 2021;28(6):1063–1072. doi: 10.1007/s10140-021-01980-9

[54] Manchanda S., Semalti K., Bhalla A.S., et al. Revisiting rhino-orbito-cerebral acute invasive fungal sinusitis in the era of COVID-19: pictorial review // Emerg Radiol. 2021. Vol. 28, N 6. P. 1063–1072. doi: 10.1007/s10140-021-01980-9

[55] Rudrabhatla PK, Reghukumar A, Thomas SV. Mucormycosis in COVID-19 patients: predisposing factors, prevention and management. Acta Neurol Belg. 2022;122(2):273–280. doi: 10.1007/s13760-021-01840-w

[56] Rudrabhatla P.K., Reghukumar A., Thomas S.V. Mucormycosis in COVID-19 patients: predisposing factors, prevention and management // Acta Neurol Belg. 2022. Vol. 122, N 2. P. 273–280. doi: 10.1007/s13760-021-01840-w

[57] Gumashta J, Gumashta R. COVID19 associated mucormycosis: Is GRP78 a possible link? J Infect Public Health. 2021;14(10): 1351–1357. doi: 10.1016/j.jiph.2021.09.004

[58] Gumashta J., Gumashta R. COVID19 associated mucormycosis: Is GRP78 a possible link? // J Infect Public Health. 2021. Vol. 14, N 10. P. 1351–1357. doi: 10.1016/j.jiph.2021.09.004

[59] Avdeev SN, Adamyan LV, Alekseeva EI, et al. Prevention, diagnosis and treatment of novel coronavirus infection (COVID-19): interim guidelines. Version 15 (02/22/2022). Moscow: Ministry of Health of the Russian Federation; 2022. 245 p. (In Russ).

[60] Авдеев С.Н., Адамян Л.В., Алексеева Е.И., и др. Профилактика, диагностика и лечение новой коронавирусной инфекции (COVID-19): временные методические рекомендации. Версия 15 (22.02.2022). Москва: Минздрав РФ, 2022. 245 с.

[61] Klimko NN, editor. Diagnosis and treatment of mycoses in intensive care units and intensive care: Russian recommendations. 2nd ed. Moscow: Farmtek; 2015. 96 p. (In Russ).

[62] Диагностика и лечение микозов в отделениях реанимации и интенсивной терапии: российские рекомендации / отв. ред. Н.Н. Климко. 2-е изд. Москва: Фармтек, 2015. 96 с.

[63] Bagirova NS. Invasive fungal infections: redefinition, new in diagnosis according to EORTC/MSGERC. Malignant Tumors. 2020;10(3 suppl. 1):39–48. (In Russ). doi: 10.18027/2224-5057-2019-10-3s1-39-48

[64] Багирова Н.С. Инвазивные грибковые инфекции: пересмотр определений, новое в диагностике по данным EORTC / MSGERC // Злокачественные опухоли. 2020. Т. 10, № 3 (приложение 1). С. 39–48. doi: 10.18027/2224-5057-2019-10-3s1-39-48

[65] Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the. Infectious Diseases Society of America. Clin Infect Dis. 2016;62(4): e1–50. doi: 10.1093/cid/civ933

[66] Pappas P.G., Kauffman C.A., Andes D.R., et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the. Infectious Diseases Society of America // Clin Infect Dis. 2016. Vol. 62, N 4. P. e1–50. doi: 10.1093/cid/civ9335

[67] Koehler P, Bassetti M, Chakrabarti A, et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis. 2021;21(6):e149–e162. doi: 10.1016/S1473-3099(20)30847-1

[68] Koehler P., Bassetti M., Chakrabarti A., et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance // Lancet Infect Dis. 2021. Vol. 21, N 6. P. e149–e162. doi: 10.1016/S1473-3099(20)30847-1

[69] Solopova GG, Maschan AA, Novichkova GA. Updated 2020 guidelines for diagnosis and treatment of invasive aspergillosis in children with hematologic malignancy. Pediatric Hematology/Oncology and Immunopathology. 2020;19(1):158–166. (In Russ). doi: 10.24287/1726-1708-2020-19-1-158-166

[70] Солопова Г.Г., Масчан А.А., Новичкова Г.А. Рекомендации 2020 года по диагностике и терапии инвазивного аспергиллёза у детей с онкогематологическими заболеваниями // Вопросы гематологии/онкологии и иммунопатологии в педиатрии. 2020. Т. 19, № 1. С. 158–166. doi: 10.24287/1726-1708-2020-19-1-158-166

[71] Avdeeva MG, Shubina GV, Ganzha AA, Zhuravleva EV. Community-acquired pneumonia in infectious hospital patients: the development of resistance to antimicrobials. Epidemiology and Infectious Diseases. 2018;23(3):108–113. (In Russ). doi: 10.18821/1560-9529-2018-23-3-108-113

[72] Авдеева М.Г., Шубина Г.В., Ганжа А.А., Журавлёва Е.В. Внебольничная пневмония у пациентов инфекционного стационара: проблемы развития резистентности к антимикробным препаратам // Эпидемиология и инфекционные болезни. 2018. Т. 23, № 3. С. 108–113. doi: 10.18821/1560-9529-2018-23-3-108-113

[73] Avdeeva MG, Kulbuzheva MI, Zotov SV, et al. Microbial landscape in hospital patients with new coronavirus disease (COVID-19), antibiotic resistance comparison vs. Pre-covid stage: a prospective study. Kuban Scientific Medical Bulletin. 2021;28(5):14–28. (In Russ). doi: 10.25207/1608-6228-2021-28-5-14-28

[74] Авдеева М.Г., Кулбужева М.И., Зотов С.В., и др. Микробный пейзаж у госпитальных больных с новой коронавирусной инфекцией COVID-19, сравнительная антибиотикорезистентность с «доковидным» периодом: проспективное исследование // Кубанский научный медицинский вестник. 2021. Т. 28, № 5. С. 14–28. doi: 10.25207/1608-6228-2021-28-5-14-28

[75] Garg D, Muthu V, Sehgal IS, et al. Coronavirus Disease (Covid-19) Associated Mucormycosis (CAM): Case Report and Systematic Review of Literature. Mycopathologia. 2021;186(2):289–298. doi: 10.1007/s11046-021-00528-2

[76] Garg D., Muthu V., Sehgal I.S., et al. Coronavirus Disease (Covid-19) Associated Mucormycosis (CAM): Case Report and Systematic Review of Literature // Mycopathologia. 2021. Vol. 186, N 2. P. 289–298. doi: 10.1007/s11046-021-00528-2

[77] Ashour MM, Abdelaziz TT, Ashour DM, et al. Imaging spectrum of acute invasive fungal rhino-orbital-cerebral sinusitis in COVID-19 patients: A case series and a review of literature. J Neuroradiol. 2021;48(5):319–324. doi: 10.1016/j.neurad.2021.05.007

[78] Ashour M.M., Abdelaziz T.T., Ashour D.M., et al. Imaging spectrum of acute invasive fungal rhino-orbital-cerebral sinusitis in COVID-19 patients: A case series and a review of literature // J Neuroradiol. 2021. Vol. 48, N 5. P. 319–324. doi: 10.1016/j.neurad.2021.05.007

[79] Brackin AP, Hemmings SJ, Fisher MC, Rhodes J. Fungal Genomics in Respiratory Medicine: What, How and When? Mycopathologia. 2021;186(5):589–608. doi: 10.1007/s11046-021-00573-x

[80] Brackin A.P., Hemmings S.J., Fisher M.C., Rhodes J. Fungal Genomics in Respiratory Medicine: What, How and When? // Mycopathologia. 2021. Vol. 186, N 5. P. 589–608. doi: 10.1007/s11046-021-00573-x

[81] Cadena J, Thompson GR 3rd, Patterson TF. Aspergillosis: Epidemiology, Diagnosis, and Treatment. Infect Dis Clin North Am. 2021;35(2):415–434. doi: 10.1016/j.idc.2021.03.008

[82] Cadena J., Thompson G.R. 3rd, Patterson T.F. Aspergillosis: Epidemiology, Diagnosis, and Treatment // Infect Dis Clin North Am. 2021. Vol. 35, N 2. P. 415–434. doi: 10.1016/j.idc.2021.03.008

[83] Van de Veerdonk FL, Brüggemann RJM, Vos S, et al. COVID-19- associated Aspergillus tracheobronchitis: the interplay between viral tropism, host defence, and fungal invasion. Lancet Respir Med. 2021;9(7):795–802. doi: 10.1016/S2213-2600(21)00138-7

[84] Van de Veerdonk F.L., Brüggemann R.J.M., Vos S., et al. COVID-19-associated Aspergillus tracheobronchitis: the interplay between viral tropism, host defence, and fungal invasion // Lancet Respir Med. 2021. Vol. 9, N 7. P. 795–802. doi: 10.1016/S2213-2600(21)00138-7

[85] Wiederhold NP. Emerging Fungal Infections: New Species, New Names, and Antifungal Resistance. Clin Chem. 2021;68(1):83–90. doi: 10.1093/clinchem/hvab217

[86] Wiederhold N.P. Emerging Fungal Infections: New Species, New Names, and Antifungal Resistance // Clin Chem. 2021. Vol. 68, N 1. P. 83–90. doi: 10.1093/clinchem/hvab217

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Avdeeva M.G., Zotov S.V., Kulbuzheva M.I., Moshkova D.Y., Zhuravleva Y.V.