Proven pulmonary aspergillosis in a COVID-19 patient: A case report

Document Type : Case report

Authors

1 Department of Infectious Diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

4 Department of Pathology, Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran

5 Central Laboratory, Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran

6 Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran

7 Department of Microbiology, Shahr-e-Qods Branch, Islamic Azad University, Tehran, Iran

8 Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Department of Medical Microbiology and Parasitology, College of Health Sciences, Faculty of Clinical Sciences,

10.18502/CMM.7.2.7031

Abstract

Background and Purpose: Coronavirus disease 2019 (COVID-19) has become a significant clinical challenge in healthcare settings all over the world. Critically ill COVID-19 patients with acute respiratory distress syndrome may be at increased risk of co-infection with pulmonary aspergillosis. This study aimed to describe a clinical case of proven pulmonary aspergillosis caused by Aspergillus tubingensis in a 59-year-old man with a history of hospitalization due to COVID-19 infection.
Case report: The Covid-19 infection was confirmed by positive nasopharyngeal polymerase chain reaction. He had a cavitary lesion measured 20 mm in diameter with intracavitary soft tissue density in the left lung in the first chest computerized tomography scan. After 25 days, he showed two cavitary lesions in both lungs which raised suspicion of fungal infection; hence, the patient underwent a trans-thoracic biopsy of the cavitary lesion. The direct examination and culture of the biopsy material revealed Aspergillus species. To confirm the Aspergillus species identification, the beta-tubulin region was sequenced. The patient was treated with oral voriconazole.
Conclusion: This report underlined the importance of early diagnosis and management of invasive fungal infections in severe COVID-19 patients
 

Keywords

References

1. Benedetti MF, Alava KH, Sagardia J, Cadena RC, Laplume D,
Capece P, et al. COVID-19 associated pulmonary aspergillosis
in ICU patients: Report of five cases from Argentina. Medical
Mycology Case Reports. 2020.
2. Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, et al.
Clinical characteristics of coronavirus disease 2019 in China.
New England journal of medicine. 2020;382(18):1708-20.
3. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y., et al.,
Epidemiological and clinical characteristics of 99 cases of 2019
novel coronavirus pneumonia in Wuhan, China: a descriptive
study. The lancet, 2020. 395(10223): 507-513.
4. Verweij P, Gangneux J, Bassetti M, Brüggemann R, Cornely O,
Koehler P, et al. Diagnosing COVID-19-associated pulmonary
aspergillosis. Lancet Microbe 1: 53–55. 2020.
5. Salehi M, Ahmadikia K, Mahmoudi S, Kalantari S,
Jamalimoghadamsiahkali S, Izadi A., et al., Oropharyngeal
candidiasis in hospitalised COVID‐19 patients from Iran:
Species identification and antifungal susceptibility pattern.
Mycoses, 2020. 63(8): 771-778.
6. Prattes J, Valentin T, Hoenigl M, Talakic E, Reisinger AC, Eller
P. Invasive pulmonary aspergillosis complicating COVID-19 in
the ICU-A case report. Medical Mycology Case Reports. 2020.
7. Schauwvlieghe AFAD, Rijnders BJA, Philips N, Verwijs R,
Vanderbeke L, Van Tienen C., et al., Invasive aspergillosis in
patients admitted to the intensive care unit with severe influenza:
a retrospective cohort study. The Lancet Respiratory Medicine,
2018. 6(10): 782-792.
8. Hedayati MT, Khodavaisy S, Alialy M, Omran SM, Habibi MR.
Invasive aspergillosis in intensive care unit patients in Iran. Acta
Medica, 2015; 56(2): 52-56
9. Schnettler WT, Al Ahwel Y, Suhag A. Severe acute respiratory
distress syndrome in coronavirus disease 2019–infected
pregnancy: obstetric and intensive care considerations.
American Journal of Obstetrics & Gynecology MFM. 2020;
2(3):100120.
10. Salehi M, Ahmadikia K, Badali H, Khodavaisy S. Opportunistic
fungal infections in the epidemic area of COVID-19: a clinical
and diagnostic perspective from Iran. Mycopathologia.
2020;185(4):607-11.
11. Schwartz IS, Friedman DZ, Zapernick L, Dingle TC, Lee N,
Sligl W, et al. High rates of influenza-associated invasive
pulmonary aspergillosis may not be universal: a retrospective
cohort study from Alberta, Canada. Clinical Infectious Diseases.
2020;71(7):1760-3.
12. Schauwvlieghe AF, Rijnders BJ, Philips N, Verwijs R,
Vanderbeke L, Van Tienen C, et al. Invasive aspergillosis in
patients admitted to the intensive care unit with severe influenza:
a retrospective cohort study. The Lancet Respiratory Medicine.
2018;6(10):782-92.
13. Sharma A, Hofmeyr A, Bansal A, Thakkar D, Lam L,
Harrington Z, et al. COVID-19 associated pulmonary
aspergillosis (CAPA): An Australian case report. Medical
Mycology Case Reports. 2020.
14. Zhu X, Ge Y, Wu T, Zhao K, Chen Y, Wu B, et al. Co-infection
with respiratory pathogens among COVID-2019 cases. Virus
research. 2020;285:198005.
15. Santana MF, Pivoto G, Alexandre MAA, Baía-da-Silva DC,
Borba MGdS, Val FA, et al. Confirmed Invasive Pulmonary
Aspergillosis and COVID-19: the value of postmortem findings
to support antemortem management. Revista da Sociedade
Brasileira de Medicina Tropical. 2020;53.
16. Haglund A, Christensen S, Kristensen L, Gertsen JB, Buus L,
Lausch KR. Invasive pulmonary aspergillosis and hyperthermia
in an immunocompetent patient with COVID-19. Medical
Mycology Case Reports. 2020. 
Current Medical Mycology
Volume 7, Issue 2
June 2021
Pages 39-42

Files

History

  • Receive Date: 24 February 2021
  • Revise Date: 03 July 2021
  • Accept Date: 04 July 2021
  • First Publish Date: 04 July 2021

Share

How to cite

Statistics