Invasive pulmonary fungal disease during the COVID-19 pandemic: evolution and challenges

doi:10.3877/cma.j.issn.2096-1537.2025.03.003

Abstract

Abstract:

The epidemiology of invasive pulmonary fungal disease (IPFD) has evolved during the coronavirus disease 2019 (COVID-19) pandemic, characterized by the expanded susceptible population and significant increase in incidence and mortality. COVID-19 is a key driver of this epidemiological shift, as the SARS-CoV-2 virus and its associated treatments can compromise normal immune defenses, thereby elevating the risk of pulmonary fungal infection. Early recognition of risk factors for IPFD and standardization of clinical practices are crucial for improving the timeliness of diagnosis and intervention. This article presents a systematic review of the research on IPFD during the COVID-19 pandemic, aiming to elucidate the evolving epidemiology and discuss the challenges in clinical diagnosis and treatment.

Key words: Coronavirus disease 2019, Invasive pulmonary fungal disease, Epidemiology, Immunity

Zijing Zhou, Jianfeng Xie, Ming Xue. Invasive pulmonary fungal disease during the COVID-19 pandemic: evolution and challenges[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2025, 11(03): 226-232.

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References 59

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年份	来源	共识名称	定义	宿主因素
2018年	荷兰/比利时MSG	改良AspICU诊断标准^[51]	IPA	无宿主因素
2019年	EORTC-IDG及MSGERC	2019年EORTC/MSGERC侵袭性真菌病共识定义^[54]	IPA	近期中性粒细胞减少（中性粒细胞<0.5×10⁹/L[中性粒细胞<500个/mm³]，持续10 d以上），与侵袭性真菌病发病时间有相关性；血液系统恶性疾病；接受同种异体造血干细胞移植；接受实体器官移植；在过去60 d内，以≥0.3 mg/kg治疗剂量长时间使用糖皮质激素类药物≥3周（不包括过敏性支气管肺曲霉菌病患者）；在过去90 d内使用其他公认的T细胞免疫抑制剂，如钙调磷酸酶抑制剂、肿瘤坏死因子α阻滞剂、淋巴细胞特异性单克隆抗体、免疫抑制核苷类似物进行治疗；使用公认的B细胞免疫抑制剂治疗，例如布鲁顿氏酪氨酸激酶抑制剂，如伊布替尼；遗传性严重免疫缺陷病（例如慢性肉芽肿病，STAT3缺陷，或严重的联合免疫缺陷）；累及肠道、肺部或肝脏的Ⅲ级或Ⅳ级急性移植物抗宿主病，对糖皮质激素类一线药物治疗无效
2020年	ECMM及ISHAM	2020 ECMM/ISHAM研究和临床指南共识标准^[52]	CAPA	在入院至入住ICU期间2周内任意时间进行新型冠状病毒RT-PCR阳性；入住ICU后72~96 h内新型冠状病毒RT-PCR阳性
2021年	EORTC-IDG及真MSGERC的ICU工作组	EORTC/MSGERC指南侵袭性真菌病定义：ICU工作组工作总结^[13]	IPA	使用糖皮质激素治疗，剂量相当于泼尼松20 mg/d或更多；定性或定量的中性粒细胞异常（遗传性中性粒细胞缺乏，中性粒细胞计数<500个/mm³）；慢性呼吸道异常（慢性阻塞性肺疾病、支气管扩张）；肝硬化失代偿期；在过去90 d内使用公认的免疫抑制剂（如钙调磷酸酶或哺乳动物西罗莫司靶蛋白抑制剂、肿瘤坏死因子阻断剂和类似的抗真菌免疫途径、阿仑单抗、伊布替尼、核苷类似物）治疗；血液恶性肿瘤/造血；干细胞移植；实体器官移植；人类免疫缺陷病毒感染；严重流感（或其他严重的病毒性肺炎，如COVID-19）
2024年	FUNDICU协作组	ICU成年患者侵袭性真菌病（FUNDICU）共识定义*^[53]	IPA	流感；COVID-19；中度/重度慢性阻塞性肺病；失代偿期肝硬化；不受控制的人类免疫缺陷病毒感染，CD4细胞计数<200/mm³；实体瘤

年份	来源	共识名称	定义	宿主因素
2018年	荷兰/比利时MSG	改良AspICU诊断标准^[51]	IPA	无宿主因素
2019年	EORTC-IDG及MSGERC	2019年EORTC/MSGERC侵袭性真菌病共识定义^[54]	IPA	近期中性粒细胞减少（中性粒细胞<0.5×10⁹/L[中性粒细胞<500个/mm³]，持续10 d以上），与侵袭性真菌病发病时间有相关性；血液系统恶性疾病；接受同种异体造血干细胞移植；接受实体器官移植；在过去60 d内，以≥0.3 mg/kg治疗剂量长时间使用糖皮质激素类药物≥3周（不包括过敏性支气管肺曲霉菌病患者）；在过去90 d内使用其他公认的T细胞免疫抑制剂，如钙调磷酸酶抑制剂、肿瘤坏死因子α阻滞剂、淋巴细胞特异性单克隆抗体、免疫抑制核苷类似物进行治疗；使用公认的B细胞免疫抑制剂治疗，例如布鲁顿氏酪氨酸激酶抑制剂，如伊布替尼；遗传性严重免疫缺陷病（例如慢性肉芽肿病，STAT3缺陷，或严重的联合免疫缺陷）；累及肠道、肺部或肝脏的Ⅲ级或Ⅳ级急性移植物抗宿主病，对糖皮质激素类一线药物治疗无效
2020年	ECMM及ISHAM	2020 ECMM/ISHAM研究和临床指南共识标准^[52]	CAPA	在入院至入住ICU期间2周内任意时间进行新型冠状病毒RT-PCR阳性；入住ICU后72~96 h内新型冠状病毒RT-PCR阳性
2021年	EORTC-IDG及真MSGERC的ICU工作组	EORTC/MSGERC指南侵袭性真菌病定义：ICU工作组工作总结^[13]	IPA	使用糖皮质激素治疗，剂量相当于泼尼松20 mg/d或更多；定性或定量的中性粒细胞异常（遗传性中性粒细胞缺乏，中性粒细胞计数<500个/mm³）；慢性呼吸道异常（慢性阻塞性肺疾病、支气管扩张）；肝硬化失代偿期；在过去90 d内使用公认的免疫抑制剂（如钙调磷酸酶或哺乳动物西罗莫司靶蛋白抑制剂、肿瘤坏死因子阻断剂和类似的抗真菌免疫途径、阿仑单抗、伊布替尼、核苷类似物）治疗；血液恶性肿瘤/造血；干细胞移植；实体器官移植；人类免疫缺陷病毒感染；严重流感（或其他严重的病毒性肺炎，如COVID-19）
2024年	FUNDICU协作组	ICU成年患者侵袭性真菌病（FUNDICU）共识定义*^[53]	IPA	流感；COVID-19；中度/重度慢性阻塞性肺病；失代偿期肝硬化；不受控制的人类免疫缺陷病毒感染，CD4细胞计数<200/mm³；实体瘤

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