Aspergillosis species of fungus causes invasive disease in the setting of immunocompromise. Of the various manifestations, invasive aspergillosis is the severest form and failure to timely identify and treat the infection will lead to mortality and morbidity. The difficult task is to isolate the pathogen and confirm the diagnosis as the criteria for the same are stringent. In the setting of severe COVID-19, this poses a risk, especially in a resource-limited setting. We report a case of Covid-associated pulmonary aspergillosis in a resource-limited setting which was confirmed by histopathologic. We would like to highlight that a high index of suspicion and evaluation in the right setting is necessary to identify the pathogen.
SchauwvliegheAFAD, RijndersBJA, PhilipsN, . Invasive aspergillosis in patients admitted to the intensive care unit with severe influenza: a retrospective cohort study. Lancet Respir Med. 2018;6(10):782–792.
2.
WangH, DingY, LiX, YangL, ZhangW, KangW. Fatal aspergillosis in a patient with SARS who was treated with corticosteroids. N Engl J Med. 2003;349(5):507–508.
3.
MohamedA, HassanT, Trzos-GrzybowskaM, . Multi-triazole-resistant Aspergillus fumigatus and SARS-CoV-2 co-infection: a lethal combination. Med Mycol Case Rep[Internet]. 2020 Jun [cited 2020 Aug 27]. https://linkinghub.elsevier.com/retrieve/pii/S2211753920300427. Accessed September 7, 2022.
4.
PrattesJ, ValentinT, HoeniglM, TalakicE, ReisingerAC, EllerP. Invasive pulmonary aspergillosis complicating COVID-19 in the ICU—A case report. Med Mycol Case Rep. 2021;31:2–5.
5.
van ArkelALE, RijpstraTA, BelderbosHNA, van WijngaardenP, VerweijPE, BentvelsenRG. COVID-19-associated pulmonary aspergillosis. Am J Respir Crit Care Med. 2020;202(1):132–135.
6.
SantanaMF, PivotoG, AlexandreMAA, . Confirmed invasive pulmonary aspergillosis and COVID-19: the value of postmortem findings to support antemortem management. Rev Soc Bras Med Trop. 2020;53:e20200401.
7.
AlanioA, DellièreS, FodilS, BretagneS, MégarbaneB. Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19. Lancet Respir Med. 2020;8(6):e48-e49.
8.
ChenX, ZhaoB, QuY, ChenY, XiongJ, FengY, . Detectable serum severe acute respiratory syndrome coronavirus 2 viral load (RNAemia) is closely correlated with drastically elevated interleukin 6 level in critically ill patients with coronavirus disease 2019. Clinical Infectious Diseases[Internet]. 2020 Apr 17 [cited 2020 Aug 27]. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa449/5821311. Accessed September 7, 2022.
9.
DuY, TuL, ZhuP, MuM, WangR, YangP, . Clinical features of 85 fatal cases of COVID-19 from Wuhan. A retrospective observational study. Am J Respir Crit Care Med. 2020;201(11):1372–1379.
10.
RussellCD, MillarJE, BaillieJK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020;395(10223):473–475.
11.
CoxMJ, LomanN, BogaertD, O’GradyJ. Co-infections: potentially lethal and unexplored in COVID-19. Lancet Microbe. 2020;1(1):e11.
12.
RutsaertL, SteinfortN, Van HunselT, . COVID-19-associated invasive pulmonary aspergillosis. Annals of Intensive Care[Internet]. 2020 Dec [cited 2020 Aug 27];10(1). https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-00686-4. Accessed September 7, 2022.
13.
WangD, HuB, HuC, . Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061.
14.
ToniatiP, PivaS, CattaliniM, . Tocilizumab for the treatment of severe COVID-19 pneumonia with hyperinflammatory syndrome and acute respiratory failure: a single center study of 100 patients in Brescia, Italy. Autoimmun Rev. 2020;19(7):102568.
15.
CenciE, MencacciA, CasagrandeA, MosciP, BistoniF, RomaniL. Impaired antifungal effector activity but not inflammatory cell recruitment in interleukin-6–deficient mice with invasive pulmonary aspergillosis. J Infect Dis. 2001;184(5):610–617.
16.
AderF, NseirS, Le BerreR, . Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease: an emerging fungal pathogen. Clin Microbiol Infect. 2005;11(6):427–429.
17.
Government of Kerala. COVID-19 treatment guidelines for Kerala state. COVID 19 Virus Outbreak Control and Prevention Cell, Health and family Welfare Department, Government of Kerala. 2020. https://dhs.kerala.gov.in/wp-content/uploads/2020/08/COVID-19-Rx-Guidelines-15th-August-2020.pdf. Accessed September 7, 2022.
18.
DonnellyJP, ChenSC, KauffmanCA, . Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium. Clinical Infectious Diseases [Internet]. 2019 Dec 5 [cited 2020 Aug 27]. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz1008/5645434. Accessed September 7, 2022.
AlanioA, DellièreS, FodilS, BretagneS, MégarbaneB. High prevalence of putative invasive pulmonary aspergillosis in critically ill COVID-19 patients. SSRN Electronic Journal[Internet]. 2020 [cited 2020 Aug 27]. https://www.ssrn.com/abstract=3575581. Accessed September 7, 2022.
21.
BlotSI, TacconeFS, Van den AbeeleAM, . A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am J Respir Crit Care Med. 2012;186(1):56–64.
22.
VerweijPE, RijndersBJA, BrüggemannRJM, . Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion. Intensive Care Med. 2020;46(8):1524–1535.
MeerssemanW, LagrouK, MaertensJ, . Galactomannan in bronchoalveolar lavage fluid: a tool for diagnosing aspergillosis in intensive care unit patients. Am J Respir Crit Care Med. 2008;177(1):27–34.
25.
NouérSA, NucciM, KumarNS, GrazziuttiM, BarlogieB, AnaissieE. Earlier response assessment in invasive aspergillosis based on the kinetics of serum aspergillus galactomannan: proposal for a new definition. Clin Infect Dis. 2011;53(7):671–676.
26.
UllmannAJ, AguadoJM, Arikan-AkdagliS, . Diagnosis and management of aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect. 2018;24Suppl 1:e1-38.
27.
WahidiMM, ShojaeeS, LambCR, . The use of bronchoscopy during the coronavirus disease 2019 pandemic. Chest[Internet]. 2020 May [cited 2020 Aug 27]. https://linkinghub.elsevier.com/retrieve/pii/S0012369220308503. Accessed September 7, 2022.
28.
PattersonTF, ThompsonGR, DenningDW, . Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;63(4):e1-60.
29.
UllmannAJ, AguadoJM, Arikan-AkdagliS, . Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect. 2018;24:e1-38.
30.
DoltonMJ, RayJE, ChenSCA, NgK, PontLG, McLachlanAJ. Multicenter study of voriconazole pharmacokinetics and therapeutic drug monitoring. Antimicrob Agents Chemother. 2012;56(9):4793–4799.
