Possible COVID-19-Associated Pulmonary Aspergillosis Due to Aspergillus niger in Greece

Area of Science:

• Mycology
• Infectious Diseases
• Pulmonology

Background:

• Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to pulmonary epithelium damage, increasing the risk of invasive aspergillosis.
• Invasive pulmonary aspergillosis (IPA) in COVID-19 patients presents a diagnostic challenge and is associated with high mortality.

Observation:

• A rare case of possible COVID-19-associated pulmonary aspergillosis (CAPA) caused by Aspergillus niger in a Greek patient is presented.
• Diagnosis utilized European Confederation of Medical Mycology/International Society for Human and Animal Mycology (ECMM/ISHAM) criteria and the BM-AspICU algorithm.
• Aspergillus niger was identified in a non-bronchoalveolar lavage sample via morphological studies and MALDI-TOF, with positive galactomannan and PCR results.

Findings:

• The Aspergillus niger isolate exhibited high resistance to fluconazole and echinocandins, with intermediate susceptibility to voriconazole and amphotericin B.
• Initial treatment with voriconazole was followed by the addition of amphotericin B due to disease progression.
• The patient's unfavorable outcome was ultimately attributed to septic shock from a pandrug-resistant Acinetobacter baumannii infection.

Implications:

• This case highlights the importance of considering and diagnosing invasive pulmonary aspergillosis in critically ill COVID-19 patients.
• Accurate identification and antifungal susceptibility testing are crucial for managing CAPA.
• Co-infections with multidrug-resistant bacteria pose significant challenges in managing critically ill patients with COVID-19 and invasive fungal infections.