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Chronic Pulmonary Aspergillosis Secondary Infection: A Case Report of Achromobacter spp. Lung Infection
Marius Paulin Ngouanom Kuate1, Felix Bongomin2,3, David W Denning3,4
1Department of Microbiology and Parasitology, Faculty of Science University of Buea Buea Cameroon.
Abstract:
Both pulmonary tuberculosis (PTB) and coronavirus disease-2019 (COVID-19) are risk factors for chronic pulmonary aspergillosis (CPA) and other pulmonary infectious diseases because of residual lung damage. We report a case of Achromobacter spp. infection following CPA in an immunocompetent woman with a history of PTB and COVID-19. A 63-year-old Cameroonian woman presented in November 2021 with a history of cough with productive muco-purulent sputum, asthenia, headaches, and chest pain for 8 weeks. There was no history of hemoptysis or difficulty in breathing. She was treated for PTB in 2002 and COVID-19 in 2020 and had no other underlying co-morbidities. Chest X-ray showed bronchiectasis in the right lung and features of healed PTB. SARS-CoV-2 antigen, antibody, and real-time polymerase chain reaction tests were negative. Microscopy and GeneXpert MTB/RIF on the sputum sample were both negative. Sputum samples grew Aspergillus flavus complex and Aspergillus niger complex, and serum Aspergillus-specific IgG-IgM antibody was positive, suggestive of CPA. She showed significant clinical improvement on itraconazole tablets 200 mg (every 12 h) after 4 months of therapy. She presented 1 month later with severe symptomatic relapse and elevated white blood cells (27,000 cells/μL). Antibiotic therapy with amoxicillin + clavulanic acid and subsequently with ceftriaxone was unsuccessful. Chest CT scan showed a middle right mediastinal tissue mass with crenulated edges. Bronchoalveolar lavage (BAL) and lung biopsy testing yielded a negative result for PTB, invasive aspergillosis, and lung cancer. However, the BAL sample grew Achromobacter spp. She was initiated on imipenem 1 g (3 g/day × 10 days) with resolution of symptoms. This case suggests that because of the high burden of TB and COVID-19 in Cameroon, pulmonary bacterial and fungal superinfections are underreported. CPA is presently undiagnosed and underreported in Cameroon. Further investigations should be performed in patients not responding to usual antibiotics.
Insights
Pulmonary tuberculosis (PTB) and COVID-19 increase risks for chronic pulmonary aspergillosis (CPA). A case highlights Achromobacter infection following CPA in an immunocompetent woman, suggesting underreported superinfections in Cameroon.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pulmonology
Background:
- Pulmonary tuberculosis (PTB) and coronavirus disease-2019 (COVID-19) are significant risk factors for developing chronic pulmonary aspergillosis (CPA) due to residual lung damage.
- Cameroon faces a high burden of both PTB and COVID-19, potentially leading to an underestimation of associated pulmonary complications.
Purpose of the Study:
- To report a rare case of Achromobacter spp. infection occurring subsequent to chronic pulmonary aspergillosis (CPA) in an immunocompetent patient.
- To emphasize the potential for underdiagnosis and underreporting of pulmonary bacterial and fungal superinfections in regions with high TB and COVID-19 prevalence.
Main Methods:
- A case study of a 63-year-old Cameroonian woman with a history of PTB and COVID-19 presenting with respiratory symptoms.
- Diagnostic procedures included sputum microscopy, GeneXpert MTB/RIF, fungal cultures, Aspergillus-specific antibody testing, chest X-ray, CT scan, bronchoalveolar lavage (BAL), and lung biopsy.
- Treatment involved itraconazole for CPA and imipenem for Achromobacter spp. infection.
Main Results:
- The patient initially presented with symptoms suggestive of CPA, confirmed by positive Aspergillus IgG-IgM antibodies and fungal growth in sputum. Initial treatment with itraconazole led to improvement.
- A relapse occurred with elevated white blood cells, and subsequent antibiotic therapies were unsuccessful. BAL culture identified Achromobacter spp.
- Treatment with imipenem resulted in complete symptom resolution, indicating successful eradication of the bacterial superinfection.
Conclusions:
- This case underscores the possibility of secondary bacterial infections, such as Achromobacter spp., following CPA in patients with a history of PTB and COVID-19.
- Pulmonary fungal and bacterial superinfections may be underdiagnosed and underreported in Cameroon due to the high prevalence of PTB and COVID-19.
- Further investigations are crucial for patients with persistent respiratory symptoms who do not respond to standard antibiotic treatments.
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