Fungal Infections in Transplant Recipients Pre- and Post-coronavirus Disease 2019: Results from a Single-Center Retrospective Cohort Study.

Abstract

Objectives: To investigate the incidence, subtypes, and pathogens of fungal infections in transplant recipients pre- and post-coronavirus disease 2019 (COVID-19) and their prognosis.

Methods: Data from transplant recipients with fungal infections treated at our hospital between January 2005 and April 2024 were collected. Pre- and post-COVID-19 data were compared.

Results: Among 3,505 transplant recipients, 203 had fungal infections, mostly in hematopoietic stem cell recipients (178 cases, 8.4%). The pre-COVID-19 incidence of fungal infections was 5.0%, with a median time from transplantation to infection of 96.5 days. The post-COVID-19 incidence was 6.3%, with a median time of 92.5 days. Before the COVID-19 outbreak, invasive fungal infections were predominant, with Candida as the outbreak, Candida, Aspergillus, Pneumocystis jirovecii, and mixed infections became more common. In addition to the oral cavity and lungs, infection sites following the COVID-19 outbreak also included the skin, blood, and intestinal tract. Twenty-six patients were treated with monotherapy, 14 of whom were treated with voriconazole. Voriconazole, sulfamethoxazole, and caspofungin are typically used in combination or sequentially for treatment. At 180 days, 1.4% of transplant recipients were aggravated before the outbreak of COVID-19, with a mortality rate of 8.2%. The proportion of exacerbations after the outbreak was 3.1%, with a mortality rate of 6.9%.

Conclusions: Post-COVID-19, transplant recipients exhibited increased fungal infection incidence, broader pathogen diversity, and more frequent exacerbations. However, this was not accompanied by an increase in mortality, likely reflect both enhanced clinical surveillance and SARS-CoV-2-specific biological effects, such as immune dysregulation, endothelial damage and microbiome alterations.