Glucocorticoids, COVID-19 and Cryptococcosis

Abstract

Abstract: Cryptococcus neoformans and C. gattii pneumonitis could persist asymptomatically for indefinite periods, resolve, or progress to symptomatic dissemination, mainly in immunocompromised individuals (e.g., treated with corticosteroids). The symptoms of COVID 19 may range from a self limiting illness with general symptoms, such as fever, to more severe complications, such as pneumonitis. The glucocorticoids emerged as potential for treatment of COVID 19, mainly those patients who required ventilator therapy. However, although treatment with glucocorticoids has shown benefits in patients with COVID 19, they can be dangerous due to increased risk of co infections and superinfections caused by opportunistic pathogens such as Cryptococcus ssp. Some patients with severe COVID 19 pneumonia treated with glucocorticoids developed cryptococcal infection and died. Therefore, immunomodulatory therapy could increase the susceptibility to acute infection or reactivation of Cryptococcus ssp in COVID 19 patients, and this could be complicated once pulmonary cryptococcosis has symptoms similar to COVID 19 becomes difficult to distinguish between the two disease states and treatment.