SARS-CoV-2 and Aspergillus section Fumigati coinfection in an immunocompetent patient treated with corticosteroids

Area of Science:

• Infectious Diseases
• Mycology
• Critical Care Medicine

Background:

• Patients with severe viral pneumonia, including COVID-19, often receive high-dose immunomodulatory drugs like steroids.
• Aspergillus species are known opportunistic pathogens, frequently causing secondary pneumonia in immunocompromised individuals, particularly those on steroids.
• COVID-19 patients in the Intensive Care Unit (ICU) share clinical similarities with other severe viral pneumonia patients receiving steroids, suggesting a potential risk for invasive aspergillosis.

Observation:

• This case report details a SARS-CoV-2/Aspergillus fumigati coinfection in an elderly, intubated patient with a history of pulmonary embolism on corticosteroids.
• Diagnosis followed established criteria for severe influenza patients in the ICU, including clinical signs, radiological evidence of pulmonary infiltrate, and mycological confirmation via positive serum galactomannan tests (ratio ≥0.5).
• Aspergillus fumigati DNA was detected in serum and blood samples four weeks post-ICU admission. The patient improved with voriconazole treatment and was discharged after six weeks of antifungal therapy.

Findings:

• Severely ill COVID-19 patients receiving corticosteroids represent a newly identified risk group for invasive aspergillosis.
• Diagnostic methods such as galactomannan testing and Aspergillus DNA detection in serum and blood are valuable for identifying invasive aspergillosis in these patients.
• These diagnostic approaches offer an advantage by mitigating biosafety concerns associated with sample handling from patients with severe respiratory infections.

Implications:

• COVID-19 patients on steroids should be actively monitored for invasive aspergillosis.
• Early and accurate diagnosis of invasive aspergillosis in COVID-19 patients can lead to timely and appropriate antifungal treatment, improving patient outcomes.
• The use of non-invasive diagnostic markers like galactomannan and Aspergillus DNA can enhance diagnostic capabilities while ensuring laboratory safety.