Prevalence Of Pulmonary Fungal Co-Infection Associated With Covid-19; A Retrospective Meta-Analysis Report

Abstract

Background: Secondary infection is death dealing due to weakened immune system. Pulmonary fungal infection may occur either by the inhalation of fungal spores present in air or by the increased number of fungus present in normal flora. Studies of co-infections revealed the major fungal pathogens target in COVID-19 patients are Aspergillus fumigatus, Candida albicans, Candida glabrata and Mucormycosis. A. fumigatus has gliotoxin that induces an apoptosis. An increased number of Candida albicans protein Pra1 disrupts the innate immunity of host. The spore coat protein homologs (CotH) of Mucorales act as ligand for GRP78 that damaging the endothelial cells. C. glabrata secretes adhesins (Epa1p) that helps to attach to the host epithelial cells. These four have same symptoms but different mechanism of action with COVID-19 that release Pro-inflammatory cytokines (especially IL-6 and IL-10) leads to tissue necrosis. Methods: Systematic meta-analysis was performed by an extensive literature, including different studies from the year 2020 to 2022 of pulmonary fungal infection associated with COVID-19 and sought them according to the published country and to the most causing fungi. Relevant data was extracted and then arranging in the form of a paper. After that, statistical analysis was performed by using Metaprop Stata version 14.1. Results: A total of 106 studies were identified from different webpages and only 50 studies met our inclusion criteria. Overall, the pooled proportion of the worldwide was 0.47 (95% CI: 0.39-0.62). The overall heterogeneity was significant was found (=99.96, p=0.004). Conclusion: Overall, these findings provide an information about the prevalence of fungal coinfections with COVID-19. This analysis will expand our knowledge of COVID-19- associated with pulmonary fungal pathogens and gives an understanding to treat coinfected COVID-19 patients