Recovery of a triazole-resistant Aspergillus fumigatus in respiratory specimen of COVID-19 patient in ICU - A case report

doi:10.1016/j.mmcr.2020.06.006

Case Reports

. 2021 Mar:31:15-18.

doi: 10.1016/j.mmcr.2020.06.006. Epub 2020 Jul 2.

Recovery of a triazole-resistant Aspergillus fumigatus in respiratory specimen of COVID-19 patient in ICU - A case report

Affiliations

¹ Laboratoire de Parasitologie - Mycologie, Hôpital Saint-Louis (AP-HP), Université de Paris, France.
² Médecine Intensive et Réanimation, Hôpital Saint-Louis (AP-HP), Université de Paris, France.
³ Unité de Mycologie Moléculaire, Institut Pasteur, CNRS URA 3012, Centre National de Référence des Mycoses Invasives et des Antifongiques, URA, 3012, Paris, France.

PMID: 32837880
PMCID: PMC7331532
DOI: 10.1016/j.mmcr.2020.06.006

Case Reports

Recovery of a triazole-resistant Aspergillus fumigatus in respiratory specimen of COVID-19 patient in ICU - A case report

Théo Ghelfenstein-Ferreira et al. Med Mycol Case Rep. 2021 Mar.

. 2021 Mar:31:15-18.

doi: 10.1016/j.mmcr.2020.06.006. Epub 2020 Jul 2.

Authors

Affiliations

¹ Laboratoire de Parasitologie - Mycologie, Hôpital Saint-Louis (AP-HP), Université de Paris, France.
² Médecine Intensive et Réanimation, Hôpital Saint-Louis (AP-HP), Université de Paris, France.
³ Unité de Mycologie Moléculaire, Institut Pasteur, CNRS URA 3012, Centre National de Référence des Mycoses Invasives et des Antifongiques, URA, 3012, Paris, France.

PMID: 32837880
PMCID: PMC7331532
DOI: 10.1016/j.mmcr.2020.06.006

Abstract

Although invasive pulmonary aspergillosis (IPA) is typically described in immunocompromised host, patient with severe influenzae can develop IPA. Similarly, patients with severe COVID-19 complicated with IPA are increasingly reported. Here, we describe a case of invasive aspergillosis with triazole-resistant A. fumigatus (TR34/L98H mutation) in a 56-year-old patient with COVID-19 in intensive care unit. This report highlights the need to define the available tools for diagnosis of invasive aspergillosis in severe COVID-19 patients.

Keywords: Aspergillosis; COVID-19; Coronavirus; ICU; SARS-CoV2; Triazole-resistance.

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Conflict of interest statement

There was no funding for this manuscript. All authors declare that they have no conflicts of interest regarding this manuscript.

Figures

**Fig. 1**
Time course of the patient with COVID-19-associated pulmonary aspergillosis. First day of hospitalization is considered day 0. CTX, cefotaxime; SPM, spiramycin; DXM, dexamethasone; TZP, piperacillin-tazobactam; GM, serum galactomannan; BDG, serum β-D-Glucan.

**Fig. 2**
(A) Chest CT on day 14 of symptom onset, which demonstrates bilateral ground glass opacities with a 7mm nodule in the right upper lobe. (B) Direct examination of the sample with calcofluor white, original magnification x200. (C) Strain culture of *Aspergillus fumigatus* isolates from tracheal aspirate.

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References

1. Blot S.I., Taccone F.S., Van Den Abeele A.M., Bulpa P., Meersseman W., Brusselaers N. A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am. J. Respir. Crit. Care Med. 2012;186(1):56–64. - PubMed
1. Donnelly J.P., Chen S.C., Kauffman C.A., Steinbach W.J., Baddley J.W., Verweij P.E. 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. Clin. Infect. Dis. 2019;46 1813–10. - PMC - PubMed
1. van Arkel A.L.E., Rijpstra T.A., Belderbos H.N.A., van Wijngaarden P., Verweij P.E., Bentvelsen R.G. COVID-19 associated pulmonary aspergillosis. Am. J. Respir. Crit. Care Med. 2020;202(1):132–135. - PMC - PubMed
1. Garnacho-Montero J., Amaya-Villar R., Ortiz-Leyba C., León C., Alvarez-Lerma F., Nolla-Salas J. Isolation of Aspergillus spp. from the respiratory tract in critically ill patients: risk factors, clinical presentation and outcome. Crit. Care. 2005;9(3):R191. - PMC - PubMed
1. Schauwvlieghe A.F.A.D., Rijnders B.J.A., Philips N., Verwijs R., Vanderbeke L., Van Tienen C. 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. - PubMed

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[1] Blot S.I., Taccone F.S., Van Den Abeele A.M., Bulpa P., Meersseman W., Brusselaers N. A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am. J. Respir. Crit. Care Med. 2012;186(1):56–64. - PubMed

[2] Blot S.I., Taccone F.S., Van Den Abeele A.M., Bulpa P., Meersseman W., Brusselaers N. A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am. J. Respir. Crit. Care Med. 2012;186(1):56–64. - PubMed

[3] Donnelly J.P., Chen S.C., Kauffman C.A., Steinbach W.J., Baddley J.W., Verweij P.E. 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. Clin. Infect. Dis. 2019;46 1813–10. - PMC - PubMed

[4] Donnelly J.P., Chen S.C., Kauffman C.A., Steinbach W.J., Baddley J.W., Verweij P.E. 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. Clin. Infect. Dis. 2019;46 1813–10. - PMC - PubMed

[5] van Arkel A.L.E., Rijpstra T.A., Belderbos H.N.A., van Wijngaarden P., Verweij P.E., Bentvelsen R.G. COVID-19 associated pulmonary aspergillosis. Am. J. Respir. Crit. Care Med. 2020;202(1):132–135. - PMC - PubMed

[6] van Arkel A.L.E., Rijpstra T.A., Belderbos H.N.A., van Wijngaarden P., Verweij P.E., Bentvelsen R.G. COVID-19 associated pulmonary aspergillosis. Am. J. Respir. Crit. Care Med. 2020;202(1):132–135. - PMC - PubMed

[7] Garnacho-Montero J., Amaya-Villar R., Ortiz-Leyba C., León C., Alvarez-Lerma F., Nolla-Salas J. Isolation of Aspergillus spp. from the respiratory tract in critically ill patients: risk factors, clinical presentation and outcome. Crit. Care. 2005;9(3):R191. - PMC - PubMed

[8] Garnacho-Montero J., Amaya-Villar R., Ortiz-Leyba C., León C., Alvarez-Lerma F., Nolla-Salas J. Isolation of Aspergillus spp. from the respiratory tract in critically ill patients: risk factors, clinical presentation and outcome. Crit. Care. 2005;9(3):R191. - PMC - PubMed

[9] Schauwvlieghe A.F.A.D., Rijnders B.J.A., Philips N., Verwijs R., Vanderbeke L., Van Tienen C. 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. - PubMed

[10] Schauwvlieghe A.F.A.D., Rijnders B.J.A., Philips N., Verwijs R., Vanderbeke L., Van Tienen C. 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. - PubMed

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Recovery of a triazole-resistant Aspergillus fumigatus in respiratory specimen of COVID-19 patient in ICU - A case report

Affiliations

Recovery of a triazole-resistant Aspergillus fumigatus in respiratory specimen of COVID-19 patient in ICU - A case report

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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References

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