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yeah, there is a issue with people uploading pirated games

If you see a pirated game on itch, chances are about 99% that it is also malware. And if the account is older, then chances are very high, that the account was recently hacked.

But I also seen complete fake games here, with random or ai made screenshots. 

Also the criminals try every variation. Even faking comments and ratings. I kid you not.

The detectors used by itch will not catch all. They are soso. And also there is the user angle, like prompting the user to do something or simply downloading the malware from somewhere else and disguise it as an update function. Or simply point to an external hoster in the first place.

The only protection if we wanna call it that, is the fact that the criminals face the same problem all the real developers face. Attracting people to their games. Unfortunately that also means, that there are some time bombs in the itch archives. If the fake game was not attractive enough, maybe no one reported it. I seen stuff that was older than 6 months.