COVID-19-ASSOCIATED PULMONARY FUSARIUM INFECTION IN A NON-CRITICALLY ILL IMMUNOCOMPETANT PATIENT

Abstract

TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Fusarium is a common pathogen that infects the immunocompromised patient and rarely infects healthy individuals. It mostly infects people with lung transplants leading to fusariosis. We present a case of Fusariosis in a healthy non-critically ill patient recovering from SARS-COV2. CASE PRESENTATION: A 57 y/o male w/ history of TB treated w/ RIPE therapy 30 yrs ago presented with dyspnea on exertion. He was recently diagnosed with SARS-COV2 at which point he had myalgias, headaches and dyspnea on exertion that lasted 4 weeks and now he only has residual dyspnea on exertion. He was never critically ill. He denied any fevers, night sweats, weight loss and cough. He denied any tobacco smoking, vaping, any recreational drugs. He has no pets at home. He is a painter by profession. He had been in good health until his COVID infection. Patient did receive an extensive course of steroids over the course of 4 weeks. He was never dependent on supplemental oxygen.CT of his chest revealed new cavitary lesions in the left lower lobe. He underwent a bronch where the cell count was neutrophilic predominant and had a negative MTB-PCR on bronchial wash. He was negative for Blastomyces, Coccidiodes and Histoplasma antigens. He was negative for galactomannan Antigen as well. However, he was positive for Beta-(1,3)-D-Glucan of greater than 500 pg/dl. Patient's sputum culture grew Fusarium species. Due to his ongoing symptoms, he was started on Voriconazole for 3 months. On follow-up 6 weeks later, patient had resolution of his symptoms and the cavitary lesions had significantly improved on the repeat CT of chest. DISCUSSION: Fusariosis is associated with 70% mortality in the immunocompromised. Since patients with SARS-COV2 receive steroids and have deteriorated lung parenchyma, they are prone to be immunocompromised. This becomes important as there are many patients that have recovered from COVID-19 infection and continue to have dyspnea symptoms. If these patients were to have fungal infection on top of their recovered COVID-19 infection, then it may allow a simple curable treatment for their persistent symptom of dyspnea post COVID infection. Our case highlights Fusarium Spp. as the pathogen that can infect non-critically ill patients recovered from COVID infection due to their acquired immunocompromise. Fusarium organism can be detected on fungal culture and have a positive Beta-(1,3)-D-Glucan assay. Therefore these tests should be ordered when entertaining fungal infection from Fusarium Spp. CONCLUSIONS: Non-critically ill patients who have recovered from SRAS-COV2 infection and have persistence of symptoms of dyspnea, should be evaluated for Fusariosis. Fusarium species should be evaluated by Beta-(1,3)-D-Glucan and a simple fungal culture. Fusariosis should be treated as these recovered patients behave like immunocompromised patients given their lung damage and exposure to steroids. REFERENCE #1: Poignon C, Blaize M, Vezinet C, Lampros A, Monsel A, Fekkar A. Invasive pulmonary fusariosis in an immunocompetent critically ill patient with severe COVID-19. Clin Microbiol Infect. 2020;26(11):1582-1584. doi:10.1016/j.cmi.2020.06.026 REFERENCE #2: Carneiro HA, Coleman JJ, Restrepo A, Mylonakis E. Fusarium infection in lung transplant patients: report of 6 cases and review of the literature. Medicine (Baltimore). 2011;90(1):69-80. doi:10.1097/MD.0b013e318207612d REFERENCE #3: Muhammed M, Anagnostou T, Desalermos A, et al. Fusarium infection: report of 26 cases and review of 97 cases from the literature. Medicine (Baltimore). 2013;92(6):305-316. doi:10.1097/MD.0000000000000008 DISCLOSURES: No relevant relationships by Jalal Damani, source=Web Response