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COVID-19 and candiduria: an investigation of the risk factors and immunological aspects

  • Clinical Microbiology - Research Paper
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Abstract

Secondary fungal infections are frequently observed in COVID-19 patients. However, the occurrence of candiduria in these patients and its risk factors are underexplored. We evaluated the risk factors of candiduria in COVID-19 patients, including inflammatory mediators that could be used as prognostic markers. Clinical information, laboratory test results, and outcomes were collected from severely ill COVID-19 patients with and without candiduria. Candida species identification, antifungal susceptibility, and plasma inflammatory mediators’ measurements were performed. Regression logistic and Cox regression model were used to evaluate the risk factors. A higher risk of longer hospitalization and mortality were observed in patients with candiduria compared to those with COVID-19 only. Candiduria was caused by Candida albicans, C. glabrata, and C. tropicalis. Isolates with intermediate susceptibility to voriconazole and resistant to caspofungin were identified. Classic factors such as the use of corticosteroids and antibacterials, the worsening of renal function, and hematological parameters (hemoglobin and platelets) were found to predispose to candiduria. The mediators IL-1β, IL-1ra, IL-2, CXCL-8, IL-17, IFN-γ, basic FGF, and MIP-1β were significantly increased in patients with COVID-19 and candiduria. Furthermore, IFN-γ, IL-1ra, and CXCL-8 were associated with the occurrence of candiduria in COVID-19 patients, whereas basic FGF, IL-1β, and CXCL-8 were associated with the risk of death in these patients. Classical and immunological factors were associated with worse prognosis among patients with COVID-19 and candiduria. Some mediators, especially CXCL-8, can be a reliable biomarker of fungal coinfection and may guide the diagnostic and the treatment of these patients.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available to protect our participants’ sensitive data but are available from the corresponding author on reasonable request.

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Funding

This work was supported by Fundação de Amparo à Pesquisa do Estado de Minas Gerais — FAPEMIG (Grant number APQ-00267–20); and Brazilian Ministry of Health and Conselho Nacional de Desenvolvimento Científico e Tecnológico — CNPq (440010/2018–7; 402200/2021–7). D. A. S. (303762/2020–9) and J. L. S. (163516/2020–0) are research fellows of the CNPq.

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Authors and Affiliations

  1. Department of Microbiology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Av. Antonio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, Brazil

    Junya L. Singulani, Danielle L. Silva, Caroline M. Lima, Vanessa C. R. Magalhães, Ludmila M. Baltazar, Ana Raquel O. Santos, Susana Johann, Nalu T. A. Peres, Jordana G. A. Coelho dos Reis & Daniel A. Santos

  2. Hospital Eduardo de Menezes, Fundação Hospitalar Do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, Brazil

    Vanessa C. R. Magalhães, Alexandre S. Moura, Tatiani Fereguetti, Juliana C. Martins, Lívia F. Rabelo & Ana C. Lyon

  3. Center of Post-Graduation and Research - IEP, Faculdade Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil

    Alexandre S. Moura

  4. Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, FIOCRUZ-Minas, Belo Horizonte, Minas Gerais, Brazil

    Olindo A. Martins-Filho

Authors
  1. Junya L. Singulani
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  2. Danielle L. Silva
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  3. Caroline M. Lima
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Contributions

All authors contributed to the study conception and design. Vanessa C.R. Magalhães, Rachel B. Caligiorne, Alexandre S. Moura, Ana Raquel O. Santos, Tatiani Fereguetti, Juliana C. Martins, Lívia F. Rabelo, and Ana C. Lyon contributed to the patient enrollment, sample and data collection. Junya L. Singulani, Danielle L. Silva, Caroline M. Lima, and Vanessa C.R. Magalhães were responsible for the microbiological identification and antimicrobial susceptibility tests. Junya L. Singulani, Olindo A. Martins-Filho, and Jordana G. A. Coelho dos Reis were responsible for the analysis of inflammatory mediators. Daniel A. Santos performed conceptualization, funding acquisition, project administration, resources and supervision. The first draft of the manuscript was written by Junya L. Singulani, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Daniel A. Santos.

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Ethics approval

This study was approved by the National Ethics Committee (Comissão Nacional de Ética em Pesquisa- CONEP) and the hospital’s Ethics Committee (CAAE: 30627320.6.0000.0008).

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Each participant signed written informed participatory consent.

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The authors declare no competing interests.

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Singulani, J.L., Silva, D.L., Lima, C.M. et al. COVID-19 and candiduria: an investigation of the risk factors and immunological aspects. Braz J Microbiol 54, 1783–1793 (2023). https://doi.org/10.1007/s42770-023-01042-x

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