Iron deficiency anemia and COVID-19

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a significant health and financial issue in the current century. Despite significant attempts to manage the illness, the transmission routes of the virus and its widespread genomic mutations have led to an increasing number of new infections and mortality rates. In the absence of specific treatment for this new virus, identifying and managing factors affecting the prognosis of the disease is one of the critical strategies to reduce disease mortality. Patients with iron deficiency anemia (IDA), who account for an estimated half a billion people globally, are more prone to infections due to immune system disorders. Since they visit hospitals more frequently for follow-up care and diagnosis, they are more susceptible to becoming infected with SARS-CoV-2. Once infected with SARS-CoV-2, low hemoglobin (Hb) levels and compromised immune systems disrupt the restriction of infection in these individuals, ultimately leading to severe complications of COVID-19.

A comprehensive overview on COVID-associated mucormycosis

In recent times, numerous reports of systemic fungal infections have been a major concern. The angioinvasive fungal infection, mucormycosis has surged in patients with COVID-19 due to various factors, mainly uncontrolled diabetes and inappropriate corticosteroid use. The prevalence of this acute and fatal fungal infection caused by Mucorales-related fungal species has been highest in the Indian population. COVID-associated mucormycosis (CAM) has a propensity for contiguous spread, and exhibits high morbidity as well as mortality. Unless promptly detected and treated, it is associated with a poor prognosis. A high index of suspicion, aggressive surgical debridement and use of systemic antifungal agents continue to be the standard of care for CAM. Moreover, there is an imperative need to address this public health issue by increasing public awareness and education. This article provides a comprehensive overview on the emergence of CAM during the pandemic, the current burden, pathophysiology, diagnostic interventions and management of CAM in Indian clinical practice.

Lung Aspergillus niger infection after SARS-CoV2

A 64-year-old never-smoker man, with professional exposure, presented to Marius Nasta Pneumophtisiology Institute for fatigability to effort, in the context of severe SARS-COV2 infection one month previously. His medical history includes pulmonary tuberculosis (55 years ago) and newly diagnosed type II diabetes (261 mg/dL glycemia). The thoracic tomography computer in the immediate post-COVID period (Fig. 1A) revealed the presence of glass ground lesions and a 3 cm nodule with cystic degeneration in the upper left lobe. A gross examination of the specimen identified a condensation area of 2.5 cm diameter, brown-grey colored, with necrosis and central ulceration. Microscopic examination showed the presence of bronchiectasis with squamous metaplasia of the epithelium, which appears ulcerated;numerous calcium oxalate crystals with adjacent foreign body granulomatous reaction;endobronchial are present fibrinous and inflammatory debris, brown-black pigment, and septate, dichotomous branching hyphae, suggestive of Aspergillus spp. A periodic acid-Schiff stain was performed, identifying the fungal hyphae. The histopathological diagnosis was bronchiectasis supra-infected and colonized with fungal filaments (Aspergillus niger).

Modern aspects of COVID-19 in HIV-positive patients (literature review)

The article is devoted to the global problems of modern medicine - HIV infection and the COVID-19 pandemic. The review of the literature highlights current ideas about the pathogenesis and course of COVID-19 in patients with HIV infection, and also touches upon the problems of concomitant pathology and mental health of patients with HIV in the setting of the COVID-19 pandemic. It has been shown that HIV-positive patients are a risk group for the severe course of COVID-19, in particular, individuals with severe immunodeficiency (CD4+ T lymphocytes 200 cells/l) due to the development of synergetic lung damage by SARS-CoV-2 and secondary infectious agents such as cytomegalovirus and Pneumocystis carinii. It has been proven that one of the targets of the SARS-CoV-2 virus is CD4+ T cells, which in COVID-19 leads to a more rapid progression of immunodeficiency in patients with HIV infection and, thus, significantly increases the risk of secondary diseases and death. Particular attention should be paid to middle-aged and elderly people living with HIV, who, compared with HIV-negative patients, are more likely to have concomitant pathology - arterial hypertension, cardiomyopathy and diabetes mellitus, which are the risk factors for severe COVID-19. The results of studies on the effect of antiretroviral drugs on the course of COVID-19 showed that HIV-infected patients receiving tenofovir + emtricitabine have a lower risk of severe COVID-19 and associated hospitalization than patients receiving other HIV treatment regimens. Clinical and preclinical data support the potential use of tenofovir in the treatment of novel coronavirus infection.

A Clinical Analysis of COVID Associated Mucormycosis in a Tertiary Care Hospital

Background: With an increase in the spread of the pandemic, ailments related to the COVID illness started to appear. Patients with COVID - 19 infection experienced a worse outcome with an increase in the prevalence of opportunistic infections in the infected person especially Mucormycosis. It was recognized that people with diabetes, cancer, patients undergoing chemotherapy and other immune-compromised conditions can develop Mucormycosis. Systemic steroids and other immune-modulating agents which are the mainstay of treatment for COVID-19 predisposes to the chance of developing invasive fungal infections. Methodology: Here we provide a retrospective analysis in which out of 212 patients who were subjected to screening 13 individuals were KOH mount positive with unique clinical characteristics as well as demographic and therapeutic profile. The information was gathered retrospectively at a single facility that serves a sizable group of patients with varying severity of the Corona virus infection. Results: Of the total in-patients taken into consideration 13 were diagnosed with mucormycosis post COVID-19 infection. The median age was greater among individuals who survived the infections (49.5 years) and those with severe COVID had high chance of dying (23.8), with an overall mortality rate of 64.3 percent. Additionally 61.5 percent of patients had diabetes mellitus and 75% of them died. 11 patients (84.6%) had previously been on steroids for COVID-19. Both the individuals who survived and succumbed to the disease had same level of hyperglycemia. Conclusion: The prevalence of mucormycosis among COVID-19 patients appears to be rising, which may be attributed to increasing usage of steroid, a potential immunocompromised state brought about by the virus per se and the co-morbid conditions. A high index of suspicion and early diagnosis is necessary to bring down the mortality rate This is in addition to the preventive measures and sensible use of immunemodulators. [ FROM AUTHOR] Copyright of Journal of Pharmaceutical Negative Results is the property of ResearchTrentz and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Effect of Coronavirus Disease 2019 Lockdowns on Identification of Advanced Human Immunodeficiency Virus Disease in Outpatient Clinics in Uganda.

Using data from 67 Ugandan human immunodeficiency virus (HIV) clinics (July 2019-January 2022), we report a 40% (1005/1662) reduction in the number of people with HIV presenting to care after August 2021 compared to prepandemic levels, with a greater proportion presenting with advanced HIV disease (20% vs 16% in the pre-coronavirus disease 2019 period).

Perspective of dental health-care professionals during the second wave of COVID-19 pandemic: a national online survey

Objectives: COVID-19 pandemic has shown a substantial impact on the entire world both physiologically and psychologically. By the hit of the second wave, which opened dangerous gates for secondary infections, apprehension was carried among health-care sectors. These secondary infections were due to decreased immunity. On the other hand, risk modifiers, such as diabetes and hypertension played a leading role in the mortality rate. A substantial number of studies have not been conducted so far regarding the impact of this second wave on dental healthcare professionals. The present study aimed to evaluate the dental healthcare professionals' perspective levels during the second wave of the COVID-19 pandemic through a web-based survey. Material and Methods: A total of 853 responses were gathered by sending 15 questions in Google forms. Data collected were gathered and subjected to statistical analysis, expressed in frequency distribution and Pearson's Chi-square test was performed. Results: Data obtained and projected that the study population expressed higher anxiety and stress levels, despite which was many of them showed an inclination to work during these tough times. The knowledge about secondary fungal infections like Mucormycosis, which was caused due to immune suppression, was abundant among the participants. A significant proportion conveyed the ill effect of COVID-19 on clinical practice and academics as well. Conclusion: Dental professionals have shown a positive perspective despite of higher stress levels and being a part of frontline workers, they are much primed to assure, educate, and treat the patients amidst the COVID-19 pandemic.

COVID-19-associated mucormycosis: a systematic review and meta-analysis of 958 cases.

BACKGROUND: Mucormycosis, a rare fungal infection, has shown an increase in the number of reported cases during the COVID-19 pandemic. OBJECTIVES: To provide a comprehensive insight into the characteristics of COVID-19-associated mucormycosis, through a systematic review and meta-analysis. METHODS OF DATA SYNTHESIS: Demographic information and clinical features were documented for each patient. Logistic regression analysis was used to predict the risk of mortality. DATA SOURCES: PubMed, Scopus, Web of Science, Cochrane, CINAHL, Ovid MEDLINE, and FungiSCOPE. STUDY ELIGIBILITY CRITERIA: Studies reporting individual-level information in patients with adult COVID-19-associated mucormycosis (CAM) between 1 January 2020 and 28 December 2022. PARTICIPANTS: Adults who developed mucormycosis during or after COVID-19. INTERVENTIONS: Patients with and without individual clinical variables were compared. ASSESSMENT OF RISK OF BIAS: Quality assessment was performed based on the National Institutes of Health quality assessment tool for case series studies. RESULTS: Nine hundred fifty-eight individual cases reported from 45 countries were eligible. 88.1% (844/958) were reported from low- or middle-income countries. Corticosteroid use for COVID-19 (78.5%, 619/789) and diabetes (77.9%, 738/948) were common. Diabetic ketoacidosis (p < 0.001), history of malignancy (p < 0.001), underlying pulmonary (p 0.017), or renal disease (p < 0.001), obesity (p < 0.001), hypertension (p 0.040), age (>65 years) (p 0.001), Aspergillus coinfection (p 0.037), and tocilizumab use during COVID-19 (p 0.018) increased the mortality. CAM occurred on an average of 22 days after COVID-19 and 8 days after hospitalization. Diagnosis of mucormycosis in patients with Aspergillus coinfection and pulmonary mucormycosis was made on average 15.4 days (range, 0-35 days) and 14.0 days (range, 0-53 days) after hospitalization, respectively. Cutaneous mucormycosis accounted for <1% of the cases. The overall mortality rate was 38.9% (303/780). CONCLUSION: Mortality of CAM was high, and most reports were from low- or middle-income countries. We detected novel risk factors for CAM, such as older age, specific comorbidities, Aspergillus coinfection, and tocilizumab use, in addition to the previously identified factors.

Nocardia pseudobrasiliensis Co-infection in SARS-CoV-2 Patients.

During the SARS-CoV-2 pandemic, few cases of Nocar-dia spp. co-infection have been reported during or after a COVID-19 infection. Nocardia spp. are gram-positive aerobic actinomycetes that stain partially acid-fast, can infect immunocompromised patients, and may cause dis-seminated disease. We report the case of a 52-year-old immunocompromised man who had Nocardia pseudobrasiliensis pneumonia develop after a SARS-CoV-2 in-fection. We also summarize the literature for no-cardiosis and SARS-CoV-2 co-infections. Nocardia spp. infection should remain a part of the differential diagnosis for pneumonia in immunocompromised hosts, regardless of other co-infections. Sulfonamide/carbapenem combina-tions are used as empiric therapy for nocardiosis; species identification and susceptibility testing are required to se-lect the optimal treatment for each patient.

Comparison of mucormycosis infection between patients with and without a history of COVID-19 infection: a retrospective cohort study.

BACKGROUND: Mucormycosis infection is a complication seen in some coronavirus disease 2019 (COVID-19) patients. This study compares the characteristics of mucormycosis infection between COVID-19 and non-COVID-19 patients. METHODS: This retrospective cohort comprised 87 patients with mucormycosis divided into two groups. The first included 44 patients who had COVID-19 recently before hospitalization due to mucormycosis at Namazi Hospital, Shiraz, Iran, between February 2019 and August 2021. The second group included all 43 patients hospitalized at the same hospital due to mucormycosis between 2010 and 2019 (pre-pandemic). RESULTS: Mucormycosis patients with a history of recent COVID-19 infection had a higher rate of diabetes mellitus, fewer malignancies and higher blood glucose, erythrocyte sedimentation rate and C-reactive protein levels (p<0.05). Glucocorticoid use was common (77%) in the COVID-19 group. CONCLUSIONS: In the pre-COVID-19 era, mucormycosis mainly affected immunodeficient patients like those receiving chemotherapy due to malignancy but now seems to affect COVID-19 patients with uncontrolled blood glucose and glucocorticoids use. Special care must be taken in prescribing glucocorticoids and controlling the blood glucose levels of COVID-19 patients.

Another Addition To The Covid-19 Associated Complications-Mucormycosis.

New manifestations of coronavirus disease are appearing over time. The association between coronavirus and mucormycosis must be given serious consideration. Without early diagnosis and treatment, there may be rapid progression of the disease, with high mortality from complications. We present a case of a 40-year-old male who presented with rhino-orbital-cerebral mucormycosis and COVID-19 infection. With this case, we highlight the importance of considering mycotic coinfection in COVID-19 patients with diabetes and the significance of its early diagnosis and treatment.

Profile of Newly Diagnosed Patients with HIV Infection in North-Eastern Romania.

Background and Objectives: Human immunodeficiency virus infection and the acquired immunodeficiency syndrome (HIV/AIDS) pandemic are unquestionably the most serious public crisis of our time. Identifying, preventing, and treating HIV-associated comorbidities remains a challenge that must be addressed even in the era of antiretroviral therapy. Materials and Methods: In this study, we aimed to characterize the aspects of newly diagnosed patients with HIV/AIDS, during 2021-2022 in Northeastern Romania. We reviewed the frequency and associated comorbidities of these patients in correspondence with national and global results. Results: Our study found that of all newly diagnosed HIV cases (167 cases-74 cases in 2021 and 98 cases in 2022), 49.70% were diagnosed with HIV infection and 50.30% had AIDS. Based on sex correlated with the CD4+ T-lymphocyte level, the most affected were males, with a lower CD4+ T-lymphocyte level overall. The average HIV viral load was 944,689.55 copies/mL. Half of males had an abnormal ALT or AST (39.53% and 49.61%); as for the females, less than a quarter had an increased value of ALT or AST, respectively (18% and 26%). The most frequent co-infections were as follows: oral candidiasis (34.73% of patients), hepatitis B (17.37% of patients), and SARS-CoV-2 infection (8.38%), followed by hepatitis C (6.39%), tuberculosis (TB), syphilis, toxoplasmosis, Cryptococcus, Cytomegalovirus infections. Males were more affected than females, with a higher percentage of co-infections. The prescribed antiretroviral treatment focused on a single-pill regimen (79.04%) to ensure adherence, effectiveness, and safety. Therefore, 20.96% had been prescribed a regimen according to their comorbidities. Conclusions: Our study found a concerning rise in the incidence of HIV in 2022 compared to that in 2021 in Northeastern Romania, because of the rise in post-SARS-CoV-2 pandemic addressability. Advanced immunodeficiency and the burden of opportunistic infections characterize newly diagnosed HIV patients. The physicians should keep in mind that these patients may have more than one clinical condition at presentation.

Clinico-pathological study of mucormycosis in post-COVID patients at government general hospital, Nizamabad

Background: Mucormycosis is a rare, opportunistic fungal infection with high morbidity and mortality. Coronavirus disease 2019 (COVID-19) associated mucormycosis has been increasing in frequency since early 2021, particularly among patients with uncontrolled diabetes and systemic corticosteroid treatment. Aims and Objectives: The aim of the study was to study mucormycosis occurrence in COVID-19 patients at Government General Hospital, Nizamabad - A tertiary care center and to correlate mucormycosis with comorbidities and previous treatment modalities among admitted post COVID-19 patients. Materials and Methods: Cross-sectional retrospective study was done for 3 months, from June 2021 to August 2021. Fifty suspected cases of mucormycosis specimens sent to the Department of Pathology, Government General Hospital, Nizamabad for histopathological diagnosis were considered. Clinical history and treatment details were noted. Tissues obtained were fixed in 10% formalin, routine hematoxylin and eosin (H&E) stains were done. Gomori's methenamine silver stains were done. Results: Mucormycosis was most common in males 37 (74%) and common in the age group of 41-50 years (26%). Diabetes mellitus is the most common comorbidity (60%). The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 6-40 days. Out of 50 cases, 46 patients received steroid therapy and 39 cases were given oxygen support. Conclusion: Mucormycosis is a rapidly progressive life-threatening opportunistic infection. Post COVID-19 patients with uncontrolled diabetes are more prone to it and an important predisposing factor. Treatment with steroid therapy and oxygen support must be carefully monitored and used in a vigilant manner. Histopathological examination and clinical correlation are essential for early diagnosis and treatment. [ FROM AUTHOR]

Risk of severe and opportunistic infections and the impact of SARS-COV-2 on this risk in a nationwide cohort of patients with inflammatory bowel disease.

BACKGROUND: The Inflammatory Bowel Disease (IBD) patients have adopted lifestyle modifications to prevent infection via SARS COV-2. AIMS: This study aims to examine rate of serious infections and opportunistic infections in the pre-pandemic and pandemic period, and to analyse if the risk associated with medications used to treat IBD were potentially modified by associated change in lifestyle. METHODS: We conducted a retrospective cohort study of patients from the US national Veteran Affairs Healthcare System (VAHS). Patients were stratified into two groups: pre-pandemic (prior to SARS COV-2 pandemic) and pandemic (during SARS COV-2 pandemic) and outcomes were measured in these groups. Primary outcome was occurrence of any serious infection. Secondary outcome was occurrence of any opportunistic infection. RESULTS: There were 17,202 IBD patients in the pre-pandemic era and 15,903 patients in the pandemic era. The pre-pandemic era had a significantly higher proportion of serious infections relative to the pandemic era (5.1% vs. 4.4%, p = 0.002). The proportion of opportunistic infections were similar between pre-pandemic and pandemic eras (0.3% vs. 0.3%, p = 0.82). Relative to 5-ASA, patients taking anti-TNF (HR = 1.50 (1.31-1.72)), anti-TNF+TP (HR = 1.56 (1.24-1.95)) or vedolizumab (HR = 1.81 (1.49-2.20)) had an increased hazard of serious infection (p > 0.001). CONCLUSION: In a nationwide cohort of IBD patients, we found that risk of serious infections could possibly be affected by behavioural modifications due to SARS-COV-2 pandemic.

Diagnosis and management of mucormycosis in the dental clinic: A guide for oral health professionals in India.

With the current pandemic raging over the world, science and medicine is faced with hereto with unfought enemies or less fought opponent in the form of viruses and consequently, other biotic entities. While researchers are striving to identify and conquer the variants of COVID-19, other innocuous organisms are raising their ugly heads in the form of opportunistic fungal infections. Mucormycosis/Black Fungus is an invasive opportunistic fungal infection caused by mucorale species. It spreads through blood vessels causing thrombosis, ischemia, and necrosis. Population with pre-existing immunocompromised conditions such as Diabetes Mellitus, Malignancy, Long-term immunosuppressant therapy are more susceptible. Mucormycosis associated with Corona Virus Disease-2019 (COVID-19) proved to be catastrophic due to its high mortality rates. Rhino orbital Mucormycosis is the most common form. The primary care physician, being the first and often, (more so in developing countries) and being the only point of contact with a healthcare professional, plays a pivotal role in the diagnosis and management of this condition. The keystone to decreasing mortality is early detection and diagnosis followed by preventive measures to control progression to the brain. A multidisciplinary approach by various specialties is a prerequisite for effective diagnosis and management. Antifungal therapy, surgical debridement, and resection of the affected areas are protocols to be followed. Post-operative defects cause impairment of function, phonetics, and esthetics. Prosthetic rehabilitation of these defects has shown favorable results, especially in the aged and immunocompromised individuals.

Pathogenesis of opportunistic infections

Opportunistic infections (OIs) are caused by a non-pathogenic microorganism in an immunocompromised individual. OIs causing organisms are bacteria, viruses, fungi, and parasites which are commonly present in the environment and also in immunocompetent individuals. These organisms become pathogenic and infectious when there is an imbalance between host immunity and virulence of the pathogen. Typically, the balance is maintained by our immune system which can be natural or acquired immunity. In human, natural immunity is inborn and pre-programmed at the time of birth, whereas the adaptive is stimulated naturally or by artificial means to build immunity and do the defense mechanism. The immunity is lost or reduced under certain circumstances includes genetic mutations, chromosomal abnormality, autoimmune destruction of immune cells, environmental predisposition damage to immune cells, specific infections which have tropism for the immune cells and destroy them, major trauma and injuries, nutritional deficiency and therapy for cancers with immunosuppressants. There are a few well-known conditions like Diabetes Mellitus, HIV, organ or bone marrow transplantation, covid-19 are at most risk for this OIs. Notably, patients who need to be started on prophylactic drugs to prevent OIs as the defense mechanism in the immune system is reduced and cause the non-pathogenic organism to grow in large number. Immunity in a host can be maintained by means of good control of infection with appropriate therapy for the above diseases. The conclusion is that immunity is the main weapon for an individual to protect against OIs as well the other infections which would help to lead a healthy normal life. © 2022 Nova Science Publishers, Inc.

Plant as an Alternative Source of Antifungals against Aspergillus Infections: A Review.

Aspergillus species consists of a group of opportunistic fungi that is virulent when the immunity of the host is compromised. Among the various species, Aspergillus fumigatus is the most prevalent species. However, the prevalence of fungal infections caused by non-fumigatus Aspergillus has been increasing. Polyenes, echinocandins and azoles are the three main classes of antifungal agents being used for the treatment of aspergillosis. Nevertheless, the incidence of resistance towards these three classes has been rising over the years among several Aspergillus spp. The side effects associated with these conventional antifungal agents have also limited their usage. This urges the need for the discovery of a safe and effective antifungal agent, which presents a major challenge in medicine today. Plants present a rich source of bioactive molecules which have been proven effective against a wide range of infections and conditions. Therefore, this present review intends to examine the current literature available regarding the efficacy and mechanism of action of plant extracts and their compounds against Aspergillus spp. In addition, novel drug delivery systems of plant extracts against Aspergillus spp. were also included in this review.

A Case Series of Spinal Infections Following COVID-19: A Delayed Complication.

Spinal infection in the form of tuberculous vertebral osteomyelitis or pyogenic spondylodiscitis is a commonly associated state of an immunodeficient host from various pathologies. For example, secondary infections can be seen following coronavirus disease 2019 (COVID-19). We report three cases of different forms of spinal infections that occurred as delayed complications to recent COVID-19 infection. The first case is a 60-year-old female who was diagnosed with an epidural abscess presenting with severe back pain and bilateral lower limb weakness. The second case is an elderly male who was diagnosed with L3/L4 spondylodiscitis and presented with predominantly back pain and minimal leg symptom. The final case is a young female who was diagnosed with severe T5 tuberculous spondylitis and presented with a complete sensory and motor deficit from T5 below. All patients showed good improvement after surgery and antibiotic therapy. Patients treated for COVID-19 are at risk of spinal infection development due to multiple pathophysiologies. Treatment of these various forms of spinal infection remains difficult, and we encourage physicians to be vigilant for the development of these complications post COVID-19 infection.

Detection of SARS-CoV-2 and HHV-8 from a large pericardial effusion in an HIV-positive patient with COVID-19 and clinically diagnosed Kaposi sarcoma: a case report.

BACKGROUND: Pericardial effusion is a late manifestation of HIV more commonly observed in individuals with depressed CD4 counts. Although Mycobacterium tuberculosis remains to be one of the most frequently identified pathogens in the pericardial fluid among people living with HIV, less commonly described etiologies include SARS-CoV-2 that causes coronavirus disease and human herpesvirus-8 which is associated with Kaposi sarcoma. Isolation of more than one pathogen in normally sterile sites remains challenging and rare. We report the first documentation of both SARS-CoV-2 and HHV-8 in the pericardial fluid. CASE PRESENTATION: We present the case of a young man in his 20s with a recent history of clinically diagnosed pulmonary tuberculosis who was admitted for progressive dyspnea and cough. He had multiple violaceous cutaneous lesions on the face, neck, and trunk and diffused lymphadenopathies. He tested positive for SARS-CoV-2 on admission. The patient was clinically diagnosed with pneumonia, Kaposi sarcoma, and HIV/AIDS. Empiric broad spectrum antimicrobial regimen was subsequently initiated. HIV with low CD4 count was confirmed during hospitalization. Echocardiography revealed a large pericardial effusion, in impending cardiac tamponade. Frond-like fibrin strands, extending to the parietal pericardium, were also observed. Pericardiostomy yielded hemorrhagic, exudative effusion with lymphocytic predominance. SARS-CoV-2 and HHV-8 were detected in the pericardial fluid, and bacterial, fungal, and tuberculous studies were negative. The patient had clinical improvement after pericardial drainage. However, despite our best clinical care, he developed a nosocomial infection leading to clinical deterioration and death. CONCLUSION: Detection of SARS-CoV-2 and HHV-8 in the pericardial fluid is rare, and interpretation of their significance in clinical care is challenging. However, coronavirus disease and Kaposi sarcoma must be considered and adequately addressed in immunocompromised adults presenting with large pericardial effusion.