Onddoen infekzioak COVID-19 pazienteengan

Abstract

[EUS] COVID-19a 2019ko amaieran agertutako SARS-CoV-2ak eragindako gaixotasuna da eta horretan beste patogenoek eragindako bigarren mailako infekzioak behatu dira. Hauen artean, onddoek eragindakoak gorakada deigarria izan arren, ez zaie merezitako arreta eskaini. Denboran zehar, patogeno horiek heriotza-arrisku nabarmeneko infekzioak eragiten dituztela ikusi da. Horri, aurretiko gripe kasuetan agente etiologiko anitzek eragindako koinfekzioek erakusten duten hilkortasunaren gorakada gehitzen bazaio, COVID-19an agertu daitezkeen onddoen infekzioak aintzat hartzearen premia existitzen da. Hori dela eta, lan honetan, COVID-19 pazienteengan onddo-infekzioen prebalentzia eta eragina jaso da, eta baita hauek garatzea errazten duten arrisku-faktore nagusienak ere. Honekin batera, agente etiologiko hauen detekzioaren garrantzia eta identifikaziorako froga nagusienak aztertu dira. Honetarako berrikuspen bibliografiko bat egin da erakunde internazionalen argitalpenak kontuan hartuz (World Health Organization, Centers for Disease Control and Prevention…) datu base desberdinetako (PubMed) ikerketekin batera. Ikerketa bibliografiko honetan ikus daiteke, COVID-19 gaixoen % 33raino Aspergillusen koinfekzioa pairatu dezakeela, Candidarena % 23,5eraino eta Indian, Mucorales ordenak eragindako gaixoak 2020an bikoiztu direla, heriotza-tasak % 50era, % 90era eta % 31ra heldu direlarik, hurrenez hurren. COVID-19 pazienteengan onddoek eragindako koinfekzioak pairatzeko arrisku-faktore nagusien artean ospitale tratamenduak, diabetes mellitusa eta COVID-19 gaixoaren ezaugarri diren hipoxia, immunosupresioa, hipergluzemia eta burdinaren desregulazioa daude. Diagnostiko-teknikei dagokionez, gaur egun aspergilosia eta mukormikosia detektatzeko espezifikotasun eta sentikortasun baxua duten hazkuntza eta behaketa mikroskopikoa konbinatu behar dira. Horietaz gain, PCR edo antigenoen detekzioa bezalako beste hainbat teknika garatuta dauden arren, batzuk onddoen detekziorako oraindik estandarizazio bidean daude. Ondorioz, eragile hauek garaiz detektatzeko tekniken ikerketa gehiagoren beharra existitzen da.

[EN] COVID-19 is a disease caused by SARS-CoV-2 that appeared in late 2019 and has been linked to secondary infections by other pathogens. In this environment, those produced by fungi have increased dramatically and it is sometimes considered that they have not been given enough importance. Over time, these pathogens have been shown to cause infections with a significant risk of death. Taking into account the increase in mortality from co infections caused by multiple etiological agents in previous influenza cases, there is a need to pay attention to fungal infections that may occur in COVID-19. In this paper we have analyzed the prevalence and incidence of fungal infections in COVID 19 patients, with special emphasis on the importance of detecting these etiological agents and the tests for their identification. In order to analyze the later, the various challenges encountered in fungal detection have also been mentioned. For this purpose, a bibliographic review has been carried out using information from different databases, taking into account the publications of international organizations (World Health Organization, Centers for Disease Control and Prevention etc.) together with research from different databases (PubMed). In this literature review, it can be seen that up to 33% of patients with COVID-19 can suffer from Aspergillus infection, Candida infection up to 23.5% and in India, Mucorales patients have doubled in 2020, with mortality rates reaching 50%, 90% and 31%, respectively. Among the major risk factors for fungal coinfection in COVID-19 patients are hospital treatments, diabetes mellitus, and COVID-19 patient characteristics such as hypoxia, immunosuppression, hyperglycemia, and iron dysregulation. In terms of diagnostic techniques, it is currently necessary to combine growth and microscopic observation to detect aspergillosis and mucormicosis, which have low specificity and sensitivity. In addition to these, although there are other techniques developed such as PCR or antigen detection, some are still in the process of being standardized for fungal detection. Consequently, there is a need for further research into the early detection techniques of these agents.