ABSTRACT
BACKGROUND: The prevalence of pulmonary aspergillosis and the importance of its early diagnosis are recognized. However, non-pulmonary involvement, including the sinuses region, is not frequently reported, and an infection in this area can affect all paranasal sinuses (pansinusopathy), being a rare pathology that affects immunocompromised hosts. Recent studies have highlighted the occurrence of Aspergillus flavus resistant to antifungal therapy. Therefore, a nasal sinus infection by resistant Aspergillus strains in immunocompromised patients may be linked to a high risk of lethality. CASE REPORT: We are reporting a resistant A. flavus infection in an allogeneic hematopoietic stem cell transplant recipient with episodes of febrile neutropenia, and prolonged use of various antibacterial drugs and antifungal prophylaxis. The patient underwent brain magnetic resonance, which showed the presence of pansinusopathy, and presented necrosis in the left nasal region. Direct microscopic examination of a sample taken from the nasal mucosa revealed the presence of septate hyphae and conidiophores resembling those of A. flavus, that species being the identification achieved with MALDI-TOF MS. Antifungigram was performed by microdilution in broth (EUCAST-E.DEF. 9.3.2) and E-test, and resistance to amphotericin B was shown in both tests. The patient died after septic shock and hemorrhage. CONCLUSIONS: Invasive fungal infections due to amphotericin-B resistant A. flavus may lead to the death of the patient due to an ineffective therapeutic management. Therefore, antifungal susceptibility testing are of utmost importance for administering the proper treatment.
Subject(s)
Amphotericin B , Aspergillosis , Amphotericin B/pharmacology , Amphotericin B/therapeutic use , Antifungal Agents/pharmacology , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillosis/microbiology , Aspergillus flavus , Humans , Microbial Sensitivity TestsABSTRACT
Os esforços envidados para o controle e extinção da pandemia do novo Coronavírus-2019 (COVID-19) não estão obtendo êxito, e já atingiram critérios epidemiológicos alarmantes, tendo infectado mais de dez milhões de pessoas no Brasil e mais de 100 milhões no mundo. A infecção por este vírus pode causar a síndrome respiratória aguda grave, com danos diretos ao epitélio das vias aéreas, permitindo a instalação de patógenos secundários de origem bacteriana e fúngica, como exemplo os fungos do gênero Aspergillus, que podem causar complicações nas manifestações clínicas e aumentar a taxa de mortalidade. Porém, mesmo com a alta probabilidade de infecção por estes fungos, verifica-se que são poucos os estudos direcionados a este assunto, como também, em alguns países, não há critério para identificar os fungos patógenos em geral, sendo possível que o verdadeiro número de coinfecções e a necessidade de internação em UTI seja maior. Portanto, neste artigo, revisamos estudos anteriores sobre a CAPA em bancos de dados eletrônicos e discutimos a necessidade do diagnóstico da aspergilose invasiva para aumento da sobrevida dos pacientes envolvidos. Neste trabalho recomendamos o diagnóstico correto e precoce das infecções fúngicas invasivas em pacientes com COVID-19, e que novos estudos sobre o tema sejam realizados para padronizar um diagnóstico eficaz e comprovado.
The new corona virus 2019 (COVID-19) is becoming unstoppable, and has already reached alarming epidemiological criteria, having infected more than 10,000,000 in Brazil and more than 100,000,000 worldwide. Infection with this virus can cause severe acute respiratory syndrome, which causes direct damage to the airway epithelium, allowing the invasion of secondary pathogens of bacterial and fungal origin, such as fungi of the genus Aspergillus, which can cause complications in clinical manifestations. and increase the mortality rate, however, even with the high probability of infection by these fungi, it appears that there are few studies directed to this subject, and also, in some countries there is no criterion to identify pathogenic fungi in general, it is possible that the true number of co-infections and the need for ICU admission is greater. Therefore, in this article, we reviewed previous studies on CAPA in electronic databases, and discussed the need for the diagnosis of invasive aspergillosis to increase the survival of the patients involved. Therefore, in this work, we recommend the correct and early diagnosis of invasive fungal infections in patients with COVID-19, and that further studies on the subject be carried out to standardize an effective and proven diagnosis.
