Subacute Aspergillosis “Fungal Balls” Complicating COVID-19

Abstract

Severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV-2), commonly known as COVID-19 (coronavirus disease-2019), began in the Wuhan District of Hubei Province, China. It is regarded as one of the worst pandemics, which has consumed both human lives and the world economy. COVID-19 infection mainly affects the lungs triggering severe hypoxemic respiratory failure, also providing a nidus for superimposed bacterial and fungal infections. We report the case of a 73-year-old male who presented with progressive dyspnea; diagnosed with SARS-CoV-2–related severe acute respiratory distress syndrome and complicated with lung cavitations growing Aspergillus sp. COVID-19, to our knowledge, has rarely been associated with subacute invasive pulmonary aspergillosis with aspergillomas. Subacute invasive pulmonary aspergillosis as a superimposed infection in patients with SARS-CoV-2 is a rare entity. By reporting this case, we would like to make the readers aware of this association.

Pulmonary cavitation in patients with COVID-19

“…1A) are other important infections in this context. 3,4 Tadolini et al 4 reported the detection of cavitary lesions in23 (47%) of 49 patients with current or former tuberculosis and COVID-19.…”

Epidemiology of Systemic Mycoses in the COVID-19 Pandemic

“…A. niger , A. terreus , A. lentulus , A. nidulans , A. awamori , A. penicillioides , and A. citrinoterreus [ 23 , 56 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 ]. The most used diagnostic methods were cultivation, galactomannan and (1,3)-β-D-glucan detection, MALDI-TOF, histopathology, serological tests, PCR, and sequencing [ 23 , 56 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , …”

“…It should be noted that in some of the A. fumigatus isolates, the TR34/L98H mutation in the Cyp51A gene was detected, which is associated with environmental azole resistance to antifungal agents [ 78 , 83 ]. Caspofungin, voriconazole, amphotericin B, anidulafungin, posaconazole, itraconazole, fluconazole or isavuconazole were used in antifungal treatment [ 23 , 56 , 62 , 63 , 64 , 66 , 67 , 69 , 70 , 71 , 72 , 74 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 84 , 85 , 86 , 87 , 88 , 89 , 90 ].…”

“…The fatality rate in cases of Aspergillus co-infection with SARS-CoV-2 was between 13% and 100% [ 23 , 56 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 ]. The affected patients were mainly men between 42 and 87 years of age [ 23 , 56 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ,…”

“…The affected patients were mainly men between 42 and 87 years of age [ 23 , 56 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 ]. The reported predisposing risk factors for the mycosis progression were diverse, including treatment with corticosteroids or immunosuppressants, hospitalization in the ICU, diabetes mellitus, hypertension, obesity, invasive mechanical ventilation, neoplasms, chronic obstructive pulmonary disease (COPD), asthma, and kidney disease [ 23 , 56 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 <...>…”