Aspergillosis Co-infection Research Articles

Recurrent pulmonary nocardiosis due to Nocardia Otitidiscaviarum in a patient with isolated CD4 lymphocytopenia: a case report

BackgroundIdiopathic CD4 lymphocytopenia (ICL) is an underdiagnosed immunodeficiency syndrome characterised by persistent low CD4 counts in the absence of HIV and other causes of lymphocytopenia. ICL patients are susceptible to opportunistic infections, with human papillomavirus, cryptococcal, and tuberculosis being the most common infections reported. Nocardiosis is rarely reported in patient with ICL.Case PresentationWe herein discuss a 46-year-old female presented with complaints of weight loss, low grade fever and cough with expectoration from last four months. The patient was diagnosed with pulmonary nocardiosis and aspergillosis co-infection four years back; in addition she also had ICL. Subsequently, the patient was lost in follow-up and readmitted four years later. Bronchoalveolar lavage sample shows the presence of acid-fast bacilli in modified gram stain, which later identified as Nocardia otitidiscaviarum by metagenomic next-generation sequencing. Her CD4 counts were still found low (298 cells/mm3). After an initial improvement with trimethoprim-sulfamethoxazole (TMP-SMX), she was commenced on indefinite secondary prophylaxis.ConclusionsNocardiosis without usual risk factors should be evaluated for ICL. This case emphasize the importance of periodic follow-up with CD4 count monitoring and secondary prophylaxis therapy to prevent recurrence or the emergence of new infections in ICL.Clinical trial numberNot applicable.

Aspergillosis coinfection in patients with proven mucormycosis.

Although research on aspergillosis and mucormycosis confection is important to optimize antifungal therapy, data on this issue is scarce. Thus, we systematically investigated aspergillosis coinfection in patients with proven mucormycosis. Medical records of adult patients with proven mucormycosis whose formalin-fixed paraffin-embedded (FFPE) tissue sections were available, in a tertiary hospital from August 2007 to July 2023 were retrospectively reviewed to assess coinfection with aspergillosis. We noted cultures of fungi from sterile and non-sterile sites and performed polymerase chain reaction (PCR) assays on FFPE tissues to detect Aspergillus- and Mucorales-specific DNA. Sixty-seven patients with proven mucormycosis, including 12 (18%) with a positive culture of the mucormycosis agent from sterile site cultures, were enrolled. Fungal cultures from sterile and non-sterile sites revealed Aspergillus spp. growth in nine (13%) of the 67 patients, including two sterile and seven non-sterile cultures. The fungal PCR analysis from the FFPE sections was positive for Aspergillus-specific PCR in five (7%) and positive for both Aspergillus- and Mucorales-specific PCR results in eight (12%). Overall, 21 (31%) of the 67 patients with proven mucormycosis had microbiologic and/or molecular evidence of aspergillosis coinfection. Positive blood or bronchoalveolar lavage fluid galactomannan results were more common in the coinfection group (67% [14/21]) than in the mucormycosis group (37% [17/46], P=.024). No significant difference in mortality between the two groups was observed. Approximately one-third of patients with proven mucormycosis exhibited molecular and/or microbiologic evidence of aspergillosis coinfection. Further research is needed to identify patients with aspergillosis and mucormycosis coinfections, for optimal antifungal therapy.

Epidemiology of fungal infection in COVID 19 in Spain during 2020 and 2021: a nationwide study

We realize a nationwide population-based retrospective study to analyze the characteristics and risk factors of fungal co-infections in COVID-19 hospitalized patients as well as describe their causative agents in the Spanish population in 2020 and 2021. Data were obtained from records in the Minimum Basic Data Set of the National Surveillance System for Hospital Data in Spain, provided by the Ministry of Health, and annually published with two years lag. The assessment of the risk associated with the development of healthcare-associated fungal co-infections was assessed using an adjusted logistic regression model. The incidence of fungal co-infection in COVID-19 hospitalized patients was 1.41%. The main risk factors associated were surgery, sepsis, age, male gender, obesity, and COPD. Co-infection was associated with worse outcomes including higher in-hospital and in ICU mortality, and higher length of stay. Candida spp. and Aspergillus spp. were the microorganisms more frequent. This is the first study analyzing fungal coinfection at a national level in hospitalized patients with COVID-19 in Spanish population and one of the few studies available that demonstrate that surgery was an independent risk factor of Aspergillosis coinfection in COVID-19 patients.

The Impact of Chronic Pulmonary Aspergillosis Co-infection on the Health-Related Quality of Life of Patients with Pulmonary Tuberculosis in Uganda.

Both pulmonary tuberculosis (PTB) and chronic pulmonary aspergillosis (CPA) significantly affect health-related quality of life (HR-QoL). We aimed to determine the impact of CPA co-infection on the HR-QoL of Ugandans with PTB. We conducted a prospective study as part of a larger study among participants with PTB with persistent pulmonary symptoms after 2months of anti-TB treatment at Mulago Hospital, Kampala, Uganda between July 2020 and June 2021. HR-QoL was assessed using St. George Respiratory Questionnaire (SGRQ) at enrollment and at the end of PTB treatment (4months apart). SGRQ scores range from 0 to 100, with higher score representing a poorer HR-QoL. Of the 162 participants enrolled in the larger study, 32 (19.8%) had PTB + CPA and 130 (80.2%) had PTB. The baseline characteristics of the two groups were comparable. Regarding overall health, a higher proportion of the PTB group rated their HR-QoL as "very good" compared to those who had PTB + CPA (68 [54.0%] versus 8 [25.8%]). At enrollment, both groups had comparable median SGRQ scores. However, at follow up, the PTB group had statistically significantly better SGRQ scores (interquartile range); symptoms (0 [0-12.4] versus 14.4 [0-42.9], p < 0.001), activity ((0 [0-17.1] versus 12.2 [0-35.5], p = .03), impact (0 [0-4.0] versus 3.1 [0-22.5], p = 0.004), and total scores ((0 [0-8.5] versus 7.6[(0-27.4], p = 0.005). CPA co-infection impairs HR-QoL of people with PTB. Active screening and management of CPA in patients with PTB is recommended to improve HR-QoL of these individuals.

THE ROLE OF CHEST CT ANGIOGRAPHY AS A DIAGNOSTIC TOOL AND ROAD MAP FOR THE MANAGEMENT OF RASMUSSEN’S ANEURYSM: A CASE REPORT

Rasmussen’s aneurysm is a pulmonary artery pseudoaneurysm, secondary to the invasion of granular tissues to the pulmonary artery wall, causing massive hemoptysis. A 39-year-old male, with a history of pulmonary TB presented with massive hemoptysis, persistent cough, and dyspnea. Chest X-ray and Chest CT depicted active pulmonary tuberculosis and a co-infection with aspergillosis in the form of aspergilloma. Chest CT angiography (CTA) showed narrow-necked Rasmussen’s aneurysm with the feeding artery coming from the pulmonary artery of the apicoposterior segment and the systemic artery from the left thyrocervical trunk branch and left bronchial artery. Fluoroscopy-guided transarterial embolization with polyvinyl alcohol (PVA) and gel foam was performed from the left bronchial artery and thyrocervical trunk branch followed by transcatheter embolization with glue insertion via the pulmonary artery in the aneurysmal site. After the procedures the embolic agent completely filled the aneurysm and there were no complaints of hemoptysis during the follow-up. Appropriate chest CT angiography procedures can help diagnose Rasmussen’s aneurysm and become a road map for embolization. Transarterial catheter embolization from bronchial or non-bronchial systemic artery and pulmonary artery can be used as the treatment modality of choice for Rasmussen’s aneurysm in pulmonary tuberculosis with aspergillosis co-infection in the form of aspergilloma.

Study of Microbial Infections and Some Immunological Parameters among Covid-19 in ICU Patients in Najaf Governorate, Iraq.

The present study aimed to investigate some microbial infections and immunological parameters associated with Covid-19 patients admitted to the intensive care unit (ICU) of Al-Amal Specialized Hospital in AL-Najaf Governorate during February and March 2021. The study included 50 patients who were assigned to two groups: 20 patients aged ≤70 years and 30 patients aged ≥70 years. The method of microbial culture was adopted to isolate bacteria and yeasts by collecting sputum specimens and oral swabs from patients and cultivating them on diagnostic media and then confirming the diagnosis by Vitek. Moreover, serum samples were collected from patients' blood to diagnose fungal infections. Thereafter, some immunological criteria were assessed, including Covid-19 diagnosis by measuring Immunoglobulin M (IgM) and IgG, as well as examining the concentration of cytokines (Interleukin 6 (IL-6) and IF ) using the enzyme-linked immunosorbent assay (ELISA) method. The results demonstrated that bacterial species Streptococcus pneumonia (n=5; 25%), Haemophilus Influenzae (n=7; 35%), and Moraxella catarrhalis (n=3; 15%) were isolated from the first group of patients (≤70 years). The recorded data pointed out that Streptococcus pneumonia (n=10; 33.3%), Streptococcus pyogenes (n=5; 16.6%), Streptococcus viridans (n=1; 3.3%), Haemophilus Influenzae (n=6; 20%), Mycobacterium tuberculosis (n=2; 6.6%), and Pseudomonas aeruginosa (n=2; 6.6%) were the isolated and identified microorganisms in the second age group (≥ 70 years). The results revealed that the isolated yeast from the first age group was Candida albicans (n=5; 25%) and Candida glabrata (n=3; 10%), while in the second age group, 1 (3.3%) Candida albicans was isolated. The results of this study proved that 30% and 10% of patients in the first and second age groups had invasive pulmonary aspergillosis co-infection by detecting Galactomannan (GM) in the blood serum (1.05±0.59, 1.25±0.38), respectively. The results indicated that IgM and IgG levels in the serum of patients in the first age group were 11.42±6.82 and 0.47±6.82, respectively. Moreover, the levels of IgM and IgG in the second age group were 14.84±9.21 and 0.12±0.11, respectively. Furthermore, IFɤ and IL6 levels were 98.37±65.70, and 146.12±46.35 in the first group, while IFɤ and IL6 were obtained at 110.69±47.60 and 133.28±116.94 in the second group, respectively. Elderly patients with severe COVID-19 are more frequently admitted to ICUs since the proportion of severe cases and comorbidities caused by a weakened immune system is higher among this age group. Secondary bacterial infections can also occur, especially Gram-negative bacteria which are among the most significant public health problems worldwide. Moroever, aspergillosis may infect patients hospitalized with COVID-19 and lead to death.

Invasive Mucormycosis and Aspergillosis Coinfection Associated with Post-COVID-19 Pneumonia in a Tertiary Care Hospital.

Acute invasive fungal rhinosinusitis is a rare infection primarily affecting patients with co-morbidities like immunosuppression and poorly controlled diabetes. Mucormycosis is increasingly being reported in patients with SARS-CoV-2 (COVID-19). However, reports of coinfection of aspergillosis and mucormycosis involving nose, paranasal sinuses, orbit, and brain are rare in literature. We aimed to evaluate the patient demographics, clinical presentation, and management of cases presenting with mixed infection. We carried out retrospective analysis of 12 patients with confirmed diagnosis of mixed invasive fungal infections post-COVID-19 disease out of 70 cases of COVID-19-associated mucormycosis (CAM) presenting to a tertiary-level hospital in North India from May to June 2021. All patients had diabetes mellitus; the mean age was 48 years. The common presenting features were headache, nasal congestion, palatal ulcer, and vision loss accompanied by facial pain and swelling. Two patients developed cerebral abscess during the course of treatment; three patients had concurrent COVID-19 pneumonia. All patients received systemic liposomal amphotericin B and serial surgical debridements. The overall mortality rate was 16.7%. Our study demonstrates that mucormycosis and aspergillosis are angioinvasive mycoses that are clinically and radiologically identical. KOH direct mount of clinical sample showing septate hyphae should be extensively searched for aseptate hyphae after digestion and clearing of the tissue. A high index of suspicion of mixed infection post-COVID-19 and early initiation of liposomal amphotericin B followed by prompt surgical intervention can reduce the overall morbidity and mortality among patients with this condition.

Chronic invasive aspergillosis with fulminant mucormycosis sparing palate in a Post-COVID-19 patient - A case report

Rationale:COVID-19 patients, especially immunocompromised or severely ill, have a higher probability of suffering from invasive fungal infections.Patient Concerns:A 41-years-old male reported with pain and heaviness in the face for the past 20 days. Patient had tested COVID-19 positive 20 days back and was recently diagnosed with diabetes mellitus. On histopathological examination numerous hyphae resembling mucor and asper fungi were evident.Diagnosis:Chronic invasive aspergillosis with fulminant mucormycosis sparing palate.Treatment:Since the lesion was spreading very rapidly the patient was referred to an isolation facility for further management.Outcomes:We have postulated few hypothesis for the coinfection of aspergillosis and mucormycosis in our patient.Take-away Lessons:It is important for the clinicians to systematically screen post COVID-19 patients for fungal infections, especially in immunocompromised and severely ill patients.

Severe Influenza With Invasive Pulmonary Aspergillosis in Immunocompetent Hosts: A Retrospective Cohort Study.

Background: Influenza was an independent risk factor for invasive pulmonary aspergillosis (IPA). In light of increasing incidence and mortality of influenza associated aspergillosis, our study summarized risk factors, clinical characteristics, and prognostic factors of developing aspergillosis in immunocompetent hosts with influenza to further screen high-risk population and improve outcome.Methods: We reviewed the patient characteristics, laboratory examinations, radiological imaging, and microbiology data of 72 influenza patients with IPA and 84 influenza patients without IPA admitted to West China Hospital.Result: Our study shown that aspergillosis co-infection increased overall mortality of severe influenza from 22.6 to 52.8%, along with higher white blood count (WBC) (10.9 ± 5.0 vs. 8.4 ± 3.3, P = 0.016), Neutrophiles (9.5 ± 5.0 vs. 7.0 ± 3.8, P = 0.023), procalcitonin (PCT) (8.6 ± 15.9 vs. 1.2 ± 2.1, P = 0.009), and a lower CD4+ T cell count (189.2 ± 135.3 vs. 367.1 ± 280.0, P = 0.022) in death group. No impact of age, gender, underlying diseases, immunosuppressive agents and steroids use, CD4+ T cell count on incidence of influenza associated aspergillosis was observed. But influenza associated aspergillosis cases mostly accompanied with more H1N1 subtype (91.7 vs. 79.8%, P = 0.037) and higher level of C-reactive protein (CRP) (117.6 ± 88.1 vs. 78.5 ± 75.2, P = 0.017) and interleukin 6 (IL-6) (133.5 ± 149.2 vs. 69.9 ± 100.0, P = 0.021) than those without aspergillosis.Conclusion: Aspergillosis co-infection in severe influenza patients can lead to a significant increased mortality, which was associated with severe respiratory failure due to mixed infection and immunosuppression. Pulmonary excessive inflammatory response was related with IPA co-infection.

Invasive Aspergillosis associated with Covid-19: A word of caution

IntroductionInvasive pulmonary aspergillosis is a well-known complication of acute respiratory distress syndrome, the most serious manifestation of COVID-19. Four recent studies have reported its incidence among ICU COVID-19 patients. However, they do not share the same case definition, and have provided conflicting results. In this paper we have aimed at reported the incidence of invasive pulmonary aspergillosis for COVID-19 patients in our ICU, and at comparing the different definitions in order to assess their respective relevance. MethodsRetrospective cohort study of critically ill patients with severe COVID-19 requiring ICU management between 1st March and 30th April 2020. ResultsOur results showed significantly lower incidence of invasive pulmonary aspergillosis (1.8%;1/53), compared to three out of four previous studies, and wide variation in the numbers of cases with regard to the different definitions. ConclusionLarge-scale studies are needed for a better definition and a more accurate estimation of invasive pulmonary aspergillosis coinfection during COVID-19.

Coinfection of mucormycosis and aspergillus in a diabetic patient: A rare entity

Mucormycosis is a life threating infection caused by mucorales occurring in immunocompromised /diabetic individuals. Aspergillosis caused by aspergillus also causes a fatal disease in these individuals. A very few cases of coinfection of aspergillosis and mucormycosis are reported in diabetic patients in the literature. Here, we report this coinfection in a 60-years old female. Keywords: Mucormycosis, Aspergillosis, Diabetes, Coinfection.

The clinical characteristics of severe influenza virus pneumonia complicated with invasive pulmonary aspergillosis: a retrospective study of 15 cases

Objective: To explore the clinical characteristics, risk factors and possible inflammatory response mechanisms in critically ill patients with influenza and invasive pulmonary aspergillosis co-infection. Methods: Sixty-four patients with severe influenza virus pneumonia were included in the RICU of the China-Japanese Friendship Hospital from November 1(st), 2017 to March 31(th), 2018. There were 33 males and 31 females, with an average age of (55±14) years. T-tests or χ(2) test were applied for comparisons between the two groups. Fifteen patients were complicated with IPA and were classified as the IPA group, while the other 49 served as the control group. The clinical characteristics, laboratory examinations, and endoscopic manifestations were compared between the two groups and the risk factors for severe influenza virus pneumonia with IPA were analyzed by multivariate logistic regression. The possible mechanisms of inflammatory response were explored by comparing the differences of plasma inflammatory factors between the two groups. Results: Seven patients (7/15, 47.7%) in the IPA group died. The percentage of wheezing in the IPA group (n=13) was significantly higher than that in the control group (n=25) (P<0.05). The values of WBC [(11.0±2.7)×10(9)/L], and the levels of blood GM [(2.46±0.80) μg/L] and BALF GM [(5.30±0.98) μg/L] in the IPA group were significantly higher than those in the control group, while PCT was lower than that in the control group[(6.1±3.3)×10(9)/L, (0.33±0.07) μg/L and (0.73±0.17) μg/L, respectively] (P<0.01). Compared with the control group, the chest CT of the IPA group showed more nodules along the bronchial bundle (n=11), massive consolidation shadow (n=9), halo sign (n=3) and cavity/air crescent sign (n=5) (control group: 8, 11, 0 and 4, respectively) (P<0.05). Airway mucosal pseudomembrane formation (n=12) and airway stenosis (n=10) were significantly higher in the IPA group than in the control group (2 and 17) (P<0.05). Multivariate logistic regression analysis suggested that the history of glucocorticoid use after ICU admission, normal PCT, multiple nodules, halo signs and pseudomembrane formation under endoscopy were risk factors for severe influenza virus pneumonia with IPA. The plasma pro-inflammatory factors IFN-γ [IPA group: 34.9 (20.6-64.0) μg/L] and IL-2 [16.2 (8.9-20.7) μg/L] were significantly lower than in patients without IPA [control group: 65.2 (43.8-124.5) μg/L and 20.4 (14.6-28.8) μg/L, respectively] (P<0.05); while the inflammatory inhibitors IL-4 [51.6 (32.7-69.7) μg/L) and IL-10 [15.7 (11.8-92.5) μg/L] were higher in IPA group [control group 8.9 (6.1-15.0) μg/L and 7.8 (3.6-21.8) μg/L] (P<0.05). SOFA scores showed a negative correlation with IFN-γ (r=-0.658, P=0.02) and IL-6 (r=-0.602, P=0.038), but a positive correlation with IL-10 (r=0.641, P=0.025) by Spearman correlation analysis. Conclusions: Some relatively specific clinical characteristics could be found in severe influenza pneumonia complicated with IPA. IPA should be highly suspected when a patient had a history of glucocorticoid use after ICU admission, high WBCs in the course of treatment without significant increase of PCT,multiple nodules along the airway distribution and the characteristic pseudomembrane formation under bronchoscopy. Influenza virus caused imbalance of immune responses, leading to a weakened pro-inflammatory response and a strengthened inflammatory suppression, which might be a possible mechanism for IPA development.

Endotracheal Tuberculosis and Aspergillosis Co-Infection Manifested as Acute Respiratory Failure: A Case Report

Background: Endotracheal and endobronchial tuberculosis are defined by microbiological and histopathological evidence of tuberculosis involving tracheobronchial tree, with or without parenchymal involvement. Tracheal tuberculosis is a rare and localized form of tuberculosis which can present itself with acute respiratory failure due to upper airway obstruction. Case presentation: We present a case of a 62 year old female with a diagnosis of pulmonary tuberculosis, who was admitted to the emergency department of our hospital with severe dyspnea, which rapidly progressed to acute respiratory failure requiring tracheal intubation and mechanical ventilation. A four-drug anti-tuberculosis (TB) regimen, consisting of isoniazid, rifampicin, pyrazinamide and ethambutol, was started one month before and identification of a sensitive Mycobacterium tuberculosis strain was made at that time. During medical investigation, tracheobronchial tuberculosis and endotracheal aspergillosis co-infection were diagnosed by bronchoscopy and histological examination. Conclusion: This uncommon case illustrates a severe clinical presentation of tracheobronchial tuberculosis with concomitant diagnosis of tracheal aspergillosis. It underlines the importance of a prompt diagnosis and treatment of tracheal tuberculosis and co-incidental infections in order to prevent serious complications, such as bronchostenosis and bronchomalacia. The bronchoscopic examination is the key for microbiological and histopathological confirmation of tracheobronchial involvement for both tuberculosis and aspergillosis. Corticosteroid therapy combined with anti-TB regimen remains controversial for endobronchial TB and its impact on patients’ outcome is not well documented.

Fatal Disseminated Histoplasmosis and Aspergillosis Coinfection During Adalimumab Therapy in a Patient From New York State

We report a fatal case of disseminated histoplasmosis and aspergillosis coinfection associated with tumor necrosis factor α inhibitor therapy in a patient from New York State with remote exposure to an area endemic for histoplasma.

The clinical characteristics of hepatic failure with aspergillosis

To study the clinical characteristics of hepatic failure with aspergillosis. The data of hepatic failure patients with fungal infection hospitalized in our hospital form January 1985 to June 2006 were collected. This research mainly focused on the clinical characteristics of the patients co-infected with aspergillosis. The occurrence of aspergillosis was 20.5% (104 cases) among 507 hepatic failure patients with fungal infection. Compared with other fungal infection in hepatic failure patients, the effective rate of antifungal therapy and the improvement rate of underlying disease were worse in patients with aspergillus infection (36.5% vs 57.8%, P = 0.000; 26.0% vs 36.7%, P = 0.049). Aspergillus fumigatus was the most common species among 108 fungal species. The species next to Aspergillus fumigatus were Aspergillus niger and Aspergillus flavus. The mainly infected organ was lung and its clinical manifestation was atypical. Liver function could be improved with effective anti-fungus therapy. Diagnosis and treatment of aspergillosis is difficult in hepatic failure patients co-infected with aspergillosis. Early and effective antifungal therapy is helpful to the recovery of liver function in the hepatic failure patients suspected with aspergillosis co-infection.

Infection pulmonaire à Cunninghamella bertholletiae chez une jeune patiente leucémique

Cunninghamella bertholletiae, a zygomycete isolated in soil and plants in temperate climates, causes an infection with a very high mortality rate(76%). The pulmonary form is rare and occurs mostly in patients treated for leukemia. Since 1959 five cases have been reported in children (< 18-years-old), 4 with leukemia, 2 with aspergillosis co-infection and 3 deaths. A 17-year-old girl was treated for relapsed acute lymphoid leukemia. Neutropenia induced by chemotherapy was complicated by fever and was treated with a large broad spectrum antibiotic. At day 13, a chest radiograph revealed a left parahilar alveolar condensation. Direct mycological examination of the bronchoalveolar lavage sample showed mycelium very suggestive of mucorales. At the same time, the galactommanan antigen titer increased to 2.95 ng/ml. Treatment with conventional amphotericin B (Fungizone ®) was started; the patient became afebrile at the 48 th hour. After the fungal culture yielded C. bertholletiae, liposomal amphotericin B (Ambisome ®) was started. Because of the closeness of the pulmonary artery and the persistence of haemoptysis, a resection of the left upper pulmonary lobe was performed. An examination of the mycological parenchyma was negative. Microscopic examination and fungal culture of the pulmonary vein fragment were positive. Histological examination revealed mycelial invasion of the vascular and bronchial lumens and walls. Ambisome ® treatment was continued until day 57, then changed to posaconazole (Noxafil ®). On November 17 the patient received an allogenic bone marrow transplant. At the time of writing, 5 months after the transplant, she is well with no evidence of disease recurrence and posaconazole therapy is being continued.