Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5883_Библиотеки_им_академика_М_И_Перельмана

pathogenic fungal species including Aspergillus, Candida, and Cryptococcus [1, 2]. Research reports suggest that COVID-19 predisposes patients to fungal, and other viral coinfections, and superinfections [3]. Concurrently occurring coinfections pose a massive challenge because it complicates diagnoses and COVID-19 management [3]. COVID-19 by severe acute respiratory coronavirus 2 (SARS-CoV-2) [1–4] causes respiratory symptoms such as shortness of breath, fever, fatigue, runny nose, head­ache, chest pain, congestion, anosmia, ageusia, sore throat, confusion, and vomiting [3, 5, 6], similar to those caused by Aspergillus, Candida, and Cryptococcus species infections [3]. An estimated 15% of COVID-19 patients admitted to the hospital’s intensive care units (ICU) become coinfected by Aspergillus [7]. Aspergillus causes pulmonary aspergillosis including allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA), and invasive pulmonary aspergillosis (IPA) [8]. COVID-19-associated pulmonary aspergillosis (CAPA) is reported to have a 52% death rate [9]. Aspergillus fumigatus/A. fumigatus and A. flavus are the most com­mon Aspergillus species causing coinfection in COVID-19 patients [4]. Conducted cohort studies on COVID-19-associated pulmonary aspergillosis have described its incidence to be between 2 and 33% [2, 10]. Aspergillosis is treated by the antifungal drug class, triazoles [1, 11], voriconazole, and isavuconazole being the first-line therapies [7, 9]. However, there are challenges associated with treatment therapy including the occurrence of azole-resistant A. fumigatus [11] and drug-drug interac­tions associated with the use of voriconazole, which lead to increased cardiotoxic effects of anti-SARS-CoV-2 agents [1]. The study conducted on COVID-19 patients who were severely and critically ill has revealed that dexamethasone is associated with increased pulmonary aspergillosis risk and death [12]. COVID-19-associated candidiasis (CAC) has occurred in various hospitals across countries [3]. CAC is an opportunistic infection caused by fungal species of Candida genus [3, 13]. Studies conducted in various countries, including the UK, Italy, Egypt, China, Iran, India, Gharbia, and Cairo, have revealed that Candida species including C. albicans, C. tropicalis, C. glabrata, C. auris, and C. parapsilosis are implicated in CAC [4, 13, 14]. Treatment of Candida infections includes azoles, echinocandin, Amphotericin B, and its liposomes [15]. However, there is an emergence of multidrug-resistant Candida species, including C. glabrata, C. auris, inherently resistant C. krusei, C auris-resistant fluconazole, and Amphotericin B, and fluconazole-resistant C. parapsilosis and C. tropicalis [4, 15]. Moreover, COVID-19 patients receiving treatment therapy, includ­ing tocilizumab, interferon type 1β, and lopinavir-ritonavir, are at an elevated risk of developing coinfections with Candida spp. [16]. Chloroquine, hydroxychloroquine, azithromycin, and protease inhibitors can cause direct myocardial toxicity, arrhyth­mias, and death [1]. COVID-19 patients coinfected with human immunodeficiency virus (HIV) or those with compromised immune systems are at risk of developing cryptococcosis [15]. The literature reveals a growing number of cryptococcosis cases in COVID-19 patients who were receiving corticosteroids and immunomodulators [17–19]. Pulmonary cryptococcosis is caused by two cryptococcal pathogenic species, namely C. neoformans and C. gattii [20, 21]. The recommended treatment therapy for cryptococcosis includes initial treatment with Amphotericin B in combination with flucytosine, followed by maintenance therapy with fluconazole [15, 22]. However, fluconazole-resistant Cryptococcus has been reported, and there is also an increased risk of antifungal toxicity [19]. Phytotherapy is an important solution for treating respiratory infections and diseases in adults and children [23]. Research reports that medicinal plants contain a variety of active secondary metabolites including alkaloids, saponins, and terpenoids with antifungal activity [24]. In South Africa