Article ; Online: SARS-CoV-2 and Aspergillus section Fumigati coinfection in an immunocompetent patient treated with corticosteroids.
Revista iberoamericana de micologia
2020 Volume 38, Issue 1, Page(s) 16–18
Abstract: ... section Fumigati coinfection in an elderly intubated patient with a history of pulmonary embolism treated ... risk group of invasive aspergillosis.: Case report: We are reporting a SARS-CoV-2/Aspergillus ... patients would be considered a new aspergillosis risk group. Galactomannan and Aspergillus DNA detection ...
| Abstract | Background: Patients with severe viral pneumonia are likely to receive high-dose immunomodulatory drugs to prevent clinical worsening. Aspergillus species have been described as frequent secondary pneumonia agents in severely ill influenza patients receiving steroids. COVID-19 patients admitted to Intensive Care Unit (ICU) are receiving steroids as part of their treatment and they share clinical characteristics with other patients with severe viral pneumonias. COVID-19 patients receiving steroids should be considered a putative risk group of invasive aspergillosis. Case report: We are reporting a SARS-CoV-2/Aspergillus section Fumigati coinfection in an elderly intubated patient with a history of pulmonary embolism treated with corticosteroids. The diagnosis was made following the ad hoc definitions described for patients admitted to ICU with severe influenza, including clinical criteria (fever for 3 days refractory to the appropriate antibiotic therapy, dyspnea, pleural friction rub, worsening of respiratory status despite antibiotic therapy and need of ventilator support), a radiological criterion (pulmonary infiltrate) and a mycological criterion (several positive galactomannan tests on serum with ratio ≥0.5). In addition, Aspergillus section Fumigati DNA was found in serum and blood samples. These tests were positive 4 weeks after the patient was admitted to the ICU. The patient received voriconazole and after two month in ICU his respiratory status improved; he was discharged after 6 weeks of antifungal treatment. Conclusions: Severely ill COVID-19 patients would be considered a new aspergillosis risk group. Galactomannan and Aspergillus DNA detection would be useful methods for Aspergillus infection diagnosis as they allow avoiding the biosafety issues related to these patients. |
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| MeSH term(s) | Acetaminophen/therapeutic use ; Aged ; Anti-Infective Agents/therapeutic use ; Aspergillus fumigatus/isolation & purification ; Bronchoalveolar Lavage Fluid/microbiology ; COVID-19/complications ; COVID-19/diagnosis ; COVID-19/drug therapy ; COVID-19/therapy ; COVID-19/virology ; COVID-19 Nucleic Acid Testing ; Coinfection/diagnosis ; Coinfection/microbiology ; Coinfection/therapy ; Coinfection/virology ; Combined Modality Therapy ; Diagnosis, Differential ; Drug Therapy, Combination ; Enoxaparin/therapeutic use ; Galactose/analogs & derivatives ; Humans ; Hydroxychloroquine/therapeutic use ; Immunocompetence ; Immunosuppressive Agents/adverse effects ; Immunosuppressive Agents/therapeutic use ; Intubation, Intratracheal ; Invasive Pulmonary Aspergillosis/complications ; Invasive Pulmonary Aspergillosis/diagnosis ; Invasive Pulmonary Aspergillosis/microbiology ; Invasive Pulmonary Aspergillosis/therapy ; Male ; Mannans/blood ; Methylprednisolone/adverse effects ; Methylprednisolone/therapeutic use ; Nasopharynx/virology ; Pneumonia, Mycoplasma/diagnosis ; Pseudomonas aeruginosa/isolation & purification ; Real-Time Polymerase Chain Reaction ; Respiration, Artificial ; SARS-CoV-2/isolation & purification ; Staphylococcus aureus/isolation & purification ; Trachea/microbiology |
| Chemical Substances | Anti-Infective Agents ; Enoxaparin ; Immunosuppressive Agents ; Mannans ; galactomannan (11078-30-1) ; Acetaminophen (362O9ITL9D) ; Hydroxychloroquine (4QWG6N8QKH) ; Galactose (X2RN3Q8DNE) ; Methylprednisolone (X4W7ZR7023) |
| Language | English |
| Publishing date | 2020-11-28 |
| Publishing country | Spain |
| Document type | Case Reports |
| ISSN | 2173-9188 |
| ISSN (online) | 2173-9188 |
| DOI | 10.1016/j.riam.2020.11.001 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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