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腹水检测出严重急性呼吸综合征冠状病毒2型后继发隐球菌血症:一例报告

Detected SARS-CoV-2 in Ascitic Fluid Followed by Cryptococcemia: a Case Report.

作者信息

Passarelli Victor C, Perosa Ana H, de Souza Luna Luciano Kleber, Conte Danielle D, Nascimento Oliver A, Ota-Arakaki Jaquelina, Bellei Nancy

机构信息

Infectious Diseases Division, Department of Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil.

Pulmonology Division, Department of Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brazil.

出版信息

SN Compr Clin Med. 2020;2(11):2414-2418. doi: 10.1007/s42399-020-00574-9. Epub 2020 Oct 8.

Abstract

SARS coronavirus-2 (SARS-CoV-2) detection in different clinical specimens has raised important insights about its pathogenesis, but some details remain to be understood. In that respect, disrupt viral control seen in solid organ transplant patients on chronic immunosuppression can help unveil pathogenic mechanisms and characterize new coronavirus disease-19 (COVID-19) immunological and clinical aspects, as well as secondary complications. We herein report a case of SARS-CoV-2 detection in ascitic fluid from a kidney transplant patient with decompensated cirrhosis and COVID-19 and then discuss about immune, cellular, and virological aspects of such clinical presentation of the disease, which also included a disseminated infection, demonstrated by viral detection in his blood sample. We subsequently discuss about the fatal outcome caused by a secondary bloodstream infection by Cryptococcus neoformans. This unprecedented case report presents ascitic fluid as a novel specimen in which SARS-CoV-2 can be detected. Immune dysregulation and cumulative risk factors may lead to secondary infections by opportunistic agents, including Cryptococcus neoformans.

摘要

在不同临床标本中检测严重急性呼吸综合征冠状病毒2(SARS-CoV-2)为其发病机制提供了重要见解,但仍有一些细节有待了解。在这方面,慢性免疫抑制的实体器官移植患者中出现的病毒控制失调有助于揭示发病机制,并明确新型冠状病毒肺炎(COVID-19)的免疫学和临床特征以及继发并发症。我们在此报告一例肾移植患者合并失代偿性肝硬化及COVID-19,在其腹水中检测到SARS-CoV-2的病例,随后讨论该疾病此种临床表现的免疫、细胞及病毒学方面,该患者还存在播散性感染,其血样病毒检测证实了这一点。我们随后讨论了由新型隐球菌继发血流感染导致的致命结局。这份前所未有的病例报告显示腹水是一种可检测到SARS-CoV-2的新标本。免疫失调和累积风险因素可能导致包括新型隐球菌在内的机会性病原体继发感染。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/26de/7541755/53b8dacf2349/42399_2020_574_Fig1_HTML.jpg

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