A Peculiar Case of Pneumonia due to Mycoplasma pneumoniae in a Child with Cystic Fibrosis and Sensibilization to Aspergillus fumigatus

Abstract

Aspergillus fumigatus plays a major role in pulmonary exacerbations in patients with cystic fibrosis. The most common A. fumigatus diseases are those based on immune-mediated response to A. fumigatus antigens; including allergic bronchopulmonary aspergillosis (ABPA). In this condition; the presence of A. fumigatus in the lower respiratory tract triggers an IgE-mediated hypersensitivity response that causes airway inflammation; bronchospasms; and bronchiectasis. This case report describes a ten-year-old male patient suffering from cystic fibrosis (CF) in whom the diagnosis of ABPA occurred in association with pneumonia due to Mycoplasma pneumoniae more than two weeks after hospitalization. This case is a good example of how difficult the identification of ABPA in CF patients can be and highlights that ABPA can occur in association with co-infections due to other pathogens. In order to avoid the risk of a late ABPA diagnosis, it is imperative that the diagnostic criteria guidelines are reviewed and standardized. Author Contributions: L.P. and S.P. co-wrote the first draft of the manuscript; V.M. and N.P. (Nicola Palladino) were in charge of patient's management; M.S. performed the literature review; N.P. (Nicola Principi) gave a substantial scientific contribution; G.P. supervised patient's management; S.E. supervised the project and made substantial scientific contributions. All authors have read and agreed to the published version of the manuscript. Funding: This research received no external funding. Conflicts of Interest:The authors declare no conflict of interest.

Aspergillus fumigatus escape mechanisms from its harsh survival environments

“…Indeed, P. aeruginosa was shown to generate siderophore pyoverdine to induce iron starvation and inhibit A. fumigatus biofilm metabolism; however, A. fumigatus may be self-protected by siderophore production (Sass et al 2019). In CF, invasive aspergillosis, or chronic obstructive pulmonary disease patients, A. fumigatus co-localization with other pathogens (Streptococcus pneumonia, Staphylococcus aureus, Klebsiella pneumonia, Mycobacterium tuberculosis, and Mycoplasma pneumoniae) has been reported (Iwahashi et al 2020;Moodley et al 2014;Nogueira et al 2019;Peccini et al 2019;Ramírez Granillo et al 2015). Most of these pathogens also produce biofilms, and inhibitory interactions have been reported depending on the residing microenvironment.…”

Allergic Bronchopulmonary Aspergillosis in Children with Cystic Fibrosis: An Update on the Newest Diagnostic Tools and Therapeutic Approaches

“…Many examples of delayed diagnosis due to co-infections can be found in the literature. A recent case report by an Italian group described a case of delayed diagnosis in a 10-year-old child co-infected with Aspergillus and Mycoplasma pneumoniae [ 51 ]. Since clinical manifestations might be misleading, there is great need for novel diagnostic tools.…”