Mixed Etiology COVID-19 Associated Pulmonary Aspergillosis (CAPA)—A Case Report and Brief Review of the Literature

Dan Alexandru Toc,Carmen Costache,Sandor Botond Buksa,Roxana Mihaela Chiorescu,Ioana Alina Colosi,Razvan Marian Mihaila,Alexandru Botan

doi:10.3390/jof7100877

Abstract

The SARS-CoV-2 pandemic has proved to be a significant risk addition for invasive infections with Aspergillus. Even though there are plenty of data about the COVID-19-associated pulmonary aspergillosis (CAPA), especially involving Aspergillus fumigatus, recent studies are presenting cases of CAPA involving more than one species of Aspergillus. We report the first case of a SARS-CoV-2 patient associating co-infection with, most likely, Aspergillus section Fumigati and Aspergillus section Flavi from Romania, and we review the existing medical literature in order to shed light upon mixed etiology cases of CAPA. Since mortality remains high in these cases, there is an acute need for more information about the interaction between SARS-CoV-2 and Aspergillus spp., and the therapies for CAPA. The emerging number of cases and the high mortality rate must be considered an incentive for future research.

Highlights

The high mortality rate of the disease generated major interest in the association between the pathophysiological processes produced by fungal–virus interaction [3]
To the best of our knowledge, this paper presents the first case of COVID-19 associated pulmonary aspergillosis (CAPA) with mixed fungal etiology from Romania and one of the few cases reported worldwide
Before we again started the intravenous phialides arising from the upper two-thirds of the vesicles only with no metu treatment with voriconazole, we collected blood to determine the level of galactomannan, 5)

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The severe acute respiratory syndrome caused by the coronavirus 2 virus (SARS-CoV2) is associated with severe lung injury and complex inflammatory responses [1]. Most therapies for this disease use corticosteroids and immunomodulatory agents, causing a decrease of the immune response and, the possibility of other pathogens to colonize and produce a wide variety of infections, influencing the outcome of the disease [2]. To the best of our knowledge, this paper presents the first case of CAPA with mixed fungal etiology from Romania and one of the few cases reported worldwide This aims to contribute to the literature regarding the diagnosis, management of these cases, and the geographical distribution of the disease. CAPA remains a poorly defined entity and, with the new variants of SARS-CoV-2 emerging worldwide, we are facing a race against the clock to improve the management of this disease

Case Presentation

Findings

Discussion