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COVID-19 患者因感染土曲霉导致免疫功能正常的致命性播散性曲霉病。

Fatal disseminated aspergillosis in an immunocompetent patient with COVID-19 due to Aspergillus ochraceus.

机构信息

Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Department of Pulmonology, Isfahan University of Medical Sciences, Isfahan, Iran.

出版信息

J Mycol Med. 2021 Jun;31(2):101124. doi: 10.1016/j.mycmed.2021.101124. Epub 2021 Feb 23.

Abstract

Aspergillus infection is a well-known complication of severe influenza and severe acute respiratory syndrome coronavirus (SARS-CoV), and these infections have been related with significant morbidity and mortality even when appropriately diagnosed and treated. Recent studies have indicated that SARS-CoV-2 might increase the risk of invasive pulmonary aspergillosis (IPA). Here, we report the first case of Aspergillus ochraceus in a SARS-CoV-2 positive immunocompetent patient, which is complicated by pulmonary and brain infections. Proven IPA is supported by the positive Galactomannan test, culture-positive, and histopathological evidence. The patient did not respond to voriconazole, and liposomal amphotericin B was added to his anti-fungal regimen. Further studies are needed to evaluate the prevalence of IPA in immunocompetent patients infected with SARS-CoV-2. Consequently, testing for the incidence of Aspergillus species in lower respiratory secretions and Galactomannan test of COVID-19 patients with appropriate therapy and targeted anti-fungal therapy based on the primary clinical suspicion of IPA are highly recommended.

摘要

曲霉属感染是严重流感和严重急性呼吸综合征冠状病毒(SARS-CoV)的已知并发症,即使得到适当诊断和治疗,这些感染仍与显著的发病率和死亡率相关。最近的研究表明,SARS-CoV-2 可能会增加侵袭性肺曲霉病(IPA)的风险。在这里,我们报告了首例 SARS-CoV-2 阳性免疫功能正常患者的土曲霉感染病例,该患者并发肺部和脑部感染。阳性半乳甘露聚糖试验、培养阳性和组织病理学证据支持确诊 IPA。该患者对伏立康唑无反应,因此在他的抗真菌治疗方案中添加了脂质体两性霉素 B。需要进一步研究来评估免疫功能正常的 SARS-CoV-2 感染患者中 IPA 的患病率。因此,强烈建议对下呼吸道分泌物中的曲霉属物种进行检测,并对 COVID-19 患者进行半乳甘露聚糖检测,对 IPA 的主要临床疑似病例进行适当的治疗和靶向抗真菌治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b82d/7901383/e6743f44499a/gr1_lrg.jpg

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