tetano
Editor, Senior Moderator
Antibiotics (Basel)
. 2022 Feb 23;11(3):300.
doi: 10.3390/antibiotics11030300.
Possible COVID-19-Associated Pulmonary Aspergillosis Due to Aspergillus niger in Greece
Maria Katsiari[SUP] 1 [/SUP], Angeliki Mavroidi[SUP] 2 [/SUP], Eleftheria Palla[SUP] 2 [/SUP], Konstantina Zourla[SUP] 2 [/SUP], Theodoros Alonistiotis[SUP] 1 [/SUP], Kyriakos Ntorlis[SUP] 1 [/SUP], Charikleia Nikolaou[SUP] 1 [/SUP], Georgia Vrioni[SUP] 3 [/SUP], Athanasios Tsakris[SUP] 3 [/SUP]
Affiliations
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes direct damage to the pulmonary epithelium, enabling Aspergillus invasion. Rapid progression and high mortality of invasive aspergillosis have been reported. In the present study, we report a rare case of possible COVID-19-associated pulmonary aspergillosis (CAPA) caused by A. niger in a Greek patient. Diagnosis was based on ECMM/ISHAM specific criteria and the new algorithm "BM-AspICU" for the invasive pulmonary aspergillosis diagnostic strategy. The fungal isolate was recovered in a non-bronchoalveolar lavage (non-BAL) sample and its identification was performed by standard macroscopic and microscopic morphological studies. MALDI-TOF analysis confirmed the identification of A. niger. In addition, galactomannan antigen and Aspergillus real-time PCR testing were positive in the non-BAL sample, while in serum they proved negative. The A. niger isolate showed an MIC for fluconazole ≥128 μg/mL, for itraconazole and posaconazole 0.25 μg/mL, for voriconazole 0.5 μg/mL, for flucytosine 4 μg/mL, for amphotericin B 1 μg/mL, and for all echinocandins (caspofungin, anidulafungin, micafungin) >8 μg/mL. The patient was initially treated with voriconazole; amphotericin B was subsequently added, when a significant progression of cavitation was demonstrated on chest computed tomography. A. niger was not isolated in subsequent samples and the patient's unfavorable outcome was attributed to septic shock caused by a pandrug-resistant Acinetobacter baumannii strain.
Keywords: Aspergillus niger; COVID-19-associated pulmonary aspergillosis; ICU; amphotericin B; voriconazole.
. 2022 Feb 23;11(3):300.
doi: 10.3390/antibiotics11030300.
Possible COVID-19-Associated Pulmonary Aspergillosis Due to Aspergillus niger in Greece
Maria Katsiari[SUP] 1 [/SUP], Angeliki Mavroidi[SUP] 2 [/SUP], Eleftheria Palla[SUP] 2 [/SUP], Konstantina Zourla[SUP] 2 [/SUP], Theodoros Alonistiotis[SUP] 1 [/SUP], Kyriakos Ntorlis[SUP] 1 [/SUP], Charikleia Nikolaou[SUP] 1 [/SUP], Georgia Vrioni[SUP] 3 [/SUP], Athanasios Tsakris[SUP] 3 [/SUP]
Affiliations
- PMID: 35326764
- DOI: 10.3390/antibiotics11030300
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes direct damage to the pulmonary epithelium, enabling Aspergillus invasion. Rapid progression and high mortality of invasive aspergillosis have been reported. In the present study, we report a rare case of possible COVID-19-associated pulmonary aspergillosis (CAPA) caused by A. niger in a Greek patient. Diagnosis was based on ECMM/ISHAM specific criteria and the new algorithm "BM-AspICU" for the invasive pulmonary aspergillosis diagnostic strategy. The fungal isolate was recovered in a non-bronchoalveolar lavage (non-BAL) sample and its identification was performed by standard macroscopic and microscopic morphological studies. MALDI-TOF analysis confirmed the identification of A. niger. In addition, galactomannan antigen and Aspergillus real-time PCR testing were positive in the non-BAL sample, while in serum they proved negative. The A. niger isolate showed an MIC for fluconazole ≥128 μg/mL, for itraconazole and posaconazole 0.25 μg/mL, for voriconazole 0.5 μg/mL, for flucytosine 4 μg/mL, for amphotericin B 1 μg/mL, and for all echinocandins (caspofungin, anidulafungin, micafungin) >8 μg/mL. The patient was initially treated with voriconazole; amphotericin B was subsequently added, when a significant progression of cavitation was demonstrated on chest computed tomography. A. niger was not isolated in subsequent samples and the patient's unfavorable outcome was attributed to septic shock caused by a pandrug-resistant Acinetobacter baumannii strain.
Keywords: Aspergillus niger; COVID-19-associated pulmonary aspergillosis; ICU; amphotericin B; voriconazole.