Pulmonary coinfection by Pneumocystis jirovecii and Aspergillus terreus in an ITP patient after corticosteroid therapy: A case report

IF 9.7 4区 医学 Q1 MATERIALS SCIENCE, BIOMATERIALS VIEW Pub Date : 2024-06-03 DOI:10.1002/viw.20230051
Lili Wang, Fengling Wang, Enqiang Mao, Erzhen Chen, Dayu Chen, Linyu Wang, Yusi Qiu, Xiaolan Bian, Yan Li, Juan He
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Abstract

Pneumocystis jirovecii pneumonia and invasive pulmonary aspergillosis are both life-threatening opportunistic fungal infections. There are only few reports of coinfection by these two fungi in the literature, and Aspergillus fumigatus is the predominant Aspergillus species in the coinfection. We report here the first case of coinfection by Aspergillus terreus and P. jirovecii pneumonia and caspofungin can be an appropriate choice for salvage treatment of the coinfection. A 51-year-old man with a history of immune thrombocytopenia treated with prednisone over 2 months was admitted to emergency intensive care unit for acute respiratory failure and a cavity was found on chest computed tomography. Therefore, his trachea was immediately intubated. The patient was treated with a large spectrum of antibiotic regimen, consisting initially of imipenem/cilastatin, moxifloxacin and fluconazole followed by fluconazole, imipenem/cilastatin, vancomycin, trimethoprim–sulphamethoxazole (TMP-SMZ) and azithromycin. When the polymerase chain reaction analysis of the bronchoalveolar lavage sample revealed P. jirovecii and A. terreus, all the antibiotics were stopped except TMP-SMZ, and voriconazole was added. Two weeks later, the patient showed clinical improvement but radiological deterioration. Consequently, caspofungin was started for salvage therapy, then the patient showed gradual clinical improvement. He was discharged with oral voriconazole and TMP-SMZ. The antifungal treatment was continued for 6 months until complete radiological absorption. In conclusion, early bronchoscopy with bronchoalveolar lavage fluid should be considered in order to diagnose and treat promptly in those treated with corticosteroids combined with immunocompromised and caspofungin could be an appropriate choice for salvage treatment of coinfection by P. jirovecii and A. terreus.

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一名接受皮质类固醇治疗的 ITP 患者合并感染肺孢子虫和土曲霉:病例报告
肺孢子菌肺炎和侵袭性肺曲霉菌病都是威胁生命的机会性真菌感染。文献中关于这两种真菌合并感染的报道很少,而在合并感染中最主要的曲霉菌是烟曲霉。我们在此报告了首例由赤曲霉和姬酵母菌肺炎同时感染的病例,卡泊芬净可作为合并感染的挽救性治疗的适当选择。一名 51 岁的男子因急性呼吸衰竭被送入急诊重症监护室,他有免疫性血小板减少症病史,使用泼尼松治疗 2 个月,胸部计算机断层扫描发现有空腔。因此,他的气管被立即插管。患者接受了广谱抗生素治疗,最初使用亚胺培南/西司他丁、莫西沙星和氟康唑,随后使用氟康唑、亚胺培南/西司他丁、万古霉素、三甲氧苄氨嘧啶-磺胺甲噁唑(TMP-SMZ)和阿奇霉素。当对支气管肺泡灌洗液样本进行聚合酶链反应分析后发现有嗜血杆菌和赤霉菌时,除 TMP-SMZ 外,停止使用其他所有抗生素,并添加了伏立康唑。两周后,患者的临床症状有所改善,但放射学指标恶化。因此,开始使用卡泊芬净进行挽救治疗,随后患者的临床症状逐渐好转。他在口服伏立康唑和 TMP-SMZ 后出院。抗真菌治疗持续了 6 个月,直到放射学检查完全吸收。总之,对于接受皮质类固醇激素治疗的患者和免疫力低下者,应考虑尽早进行支气管镜检查和支气管肺泡灌洗液检查,以便及时诊断和治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
VIEW
VIEW Multiple-
CiteScore
12.60
自引率
2.30%
发文量
0
审稿时长
10 weeks
期刊介绍: View publishes scientific articles studying novel crucial contributions in the areas of Biomaterials and General Chemistry. View features original academic papers which go through peer review by experts in the given subject area.View encourages submissions from the research community where the priority will be on the originality and the practical impact of the reported research.
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