SARS-CoV-2 and Aspergillus section Fumigati coinfection in an immunocompetent patient treated with corticosteroids

IF 1.5 4区 生物学 Q4 MYCOLOGY Revista Iberoamericana De Micologia Pub Date : 2021-01-01 DOI:10.1016/j.riam.2020.11.001
Natalia Sasoni , Milton Rodriguez Müller , Graciela Posse , Jorge González , Florencia Leonardelli , Guillermo Garcia-Effron
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引用次数: 9

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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经皮质类固醇治疗的免疫功能正常患者的SARS-CoV-2和烟熏曲霉共感染
背景:严重病毒性肺炎患者可能会接受大剂量免疫调节药物,以防止临床恶化。曲霉属已被描述为在接受类固醇治疗的严重流感患者中常见的继发性肺炎病原体。入住重症监护病房(ICU)的COVID-19患者正在接受类固醇治疗,他们与其他严重病毒性肺炎患者具有相同的临床特征。接受类固醇治疗的COVID-19患者应被视为侵袭性曲霉病的推定危险群体。病例报告:我们报告一例接受过皮质类固醇治疗的肺栓塞史的老年插管患者发生SARS-CoV-2/烟状曲霉段合并感染。根据重症流感入院患者的特殊定义进行诊断,包括临床标准(发热3天,抗生素治疗无效,呼吸困难,胸膜摩擦摩擦,抗生素治疗后呼吸状况恶化,需要呼吸机支持),放射学标准(肺浸润)和真菌学标准(血清中几项半乳甘露annan阳性,比例≥0.5)。此外,在血清和血液样本中发现了烟熏曲霉片段DNA。患者入住ICU后4周,这些检查均呈阳性。患者接受伏立康唑治疗,ICU治疗2个月后呼吸状况好转;经6周抗真菌治疗后出院。结论重症COVID-19患者可视为新的曲霉病危险人群。半乳甘露聚糖和曲霉DNA检测可以避免曲霉感染患者的生物安全问题,是诊断曲霉感染的有效方法。
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来源期刊
CiteScore
1.90
自引率
0.00%
发文量
17
审稿时长
81 days
期刊介绍: Revista Iberoamericana de Micología (Ibero-American Journal of Mycology) is the official journal of the Asociación Española de Micología, Asociación Venezolana de Micología and Asociación Argentina de Micología (The Spanish, Venezuelan, and Argentinian Mycology Associations). The Journal gives priority to publishing articles on studies associated with fungi and their pathogenic action on humans and animals, as well as any scientific studies on any aspect of mycology. The Journal also publishes, in Spanish and in English, original articles, reviews, mycology forums, editorials, special articles, notes, and letters to the editor, that have previously gone through a scientific peer review process.
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