Phaeohyphomycosis caused by Neoscytalidiumdimidiatum in a COVID-19 patient.

BACKGROUND: Neoscytalidiumdimidiatum is an opportunistic dematiaceous fungus belonging to the class Dothideomycetes. CASE REPORT: We report a case of N. dimidiatum cerebral phaeohyphomycosis post COVID-19 infection in a 32-year-old male from Iran. The causative agent was identified by cytopathology, routine mycological methods, and DNA sequencing of the internal transcribed spacer (ITS) region of rDNA. Apart from COVID-19 complications and the corticosteroid therapy, no underlying condition was diagnosed. The symptoms suggesting the fungal infection were shown two weeks after being discharged from COVID-19 hospital stay. Magnetic resonance of the brain showed a multi-focal central nervous system infection. The delayed identification of the fungus and, thus, a late starting of the antifungal treatment with amphotericin B, might have affected the patient outcome as he finally died. CONCLUSIONS: Considering the rare incidence of N. dimidiatum infections, this case should aware us about them, leading to a timely antifungal management.

Phaeohyphomycosis caused by Neoscytalidiumdimidiatum in a COVID-19 patient / Feohifomicosis producida por Neoscytalidium dimidiatum en un paciente con COVID-19

Background: Neoscytalidiumdimidiatum is an opportunistic dematiaceous fungus belonging to the class Dothideomycetes.Case reportWe report a case of N. dimidiatum cerebral phaeohyphomycosis post COVID-19 infection in a 32-year-old male from Iran. The causative agent was identified by cytopathology, routine mycological methods, and DNA sequencing of the internal transcribed spacer (ITS) region of rDNA. Apart from COVID-19 complications and the corticosteroid therapy, no underlying condition was diagnosed. The symptoms suggesting the fungal infection were shown two weeks after being discharged from COVID-19 hospital stay. Magnetic resonance of the brain showed a multi-focal central nervous system infection. The delayed identification of the fungus and, thus, a late starting of the antifungal treatment with amphotericin B, might have affected the patient outcome as he finally died.ConclusionsConsidering the rare incidence of N. dimidiatum infections, this case should aware us about them, leading to a timely antifungal management. (AU)

Antecedentes: Neoscytalidiumdimidiatum es un hongo dematiáceo oportunista perteneciente a la clase Dothideomycetes.Caso clínicoPresentamos un caso de feohifomicosis cerebral por N. dimidiatum posterior a infección por COVID-19 en un paciente iraní de 32 años de edad. El microorganismo responsable fue identificado por citopatología, métodos rutinarios de laboratorio y secuenciación del ADN del espaciador transcrito interno (ITS) del ADNr. Aparte de las complicaciones asociadas a la COVID-19 y al uso de corticoides, el enfermo no presentaba enfermedades subyacentes. Los síntomas indicativos de infección fúngica fueron observados dos semanas después de que el paciente recibiera el alta hospitalaria por la COVID-19. La resonancia magnética cerebral mostró una infección multifocal en el sistema nervioso central. El retraso en la identificación del hongo responsable y, consecuentemente, en la instauración del tratamiento antifúngico con anfotericina B, pudo afectar a la evolución del paciente, ya que este finalmente falleció.ConclusionesA pesar de la escasa incidencia de las infecciones por N. dimidiatum, este caso debe alertarnos sobre su existencia para instaurar así el tratamiento antifúngico conveniente a la mayor brevedad. (AU)

The effectiveness of gabapentin and gabapentin/montelukast combination compared with dextromethorphan in the improvement of COVID-19- related cough: A randomized, controlled clinical trial.

INTRODUCTION: Cough is one of the most common presenting symptoms of COVID-19, which can persist for weeks or months. OBJECTIVE: The goal of this study was to evaluate the effectiveness of gabapentin (GBT) alone and in combination with montelukast (MTL) for improving cough. METHODS: In this open-label randomized controlled clinical trial, eligible cases were patients hospitalized with moderate to severe COVID-19 who had cough with a Breathlessness, Cough, and Sputum Scale (BCSS) score of at least 2 based on its cough subscale. The participants were randomly assigned to three groups including two experimental groups and one control group. The first and second experimental groups received GBT and GBT/MTL, respectively, whereas the control group received dextromethorphan (DXM). Treatment duration was 5 days in all groups. Before and after the interventions, the severity of cough was evaluated using BCSS scale and Visual Analog Scale (VAS). RESULTS: A total of 180 patients were included; GPT, GPT/MTL, and DXM consisted of 76, 51, and 53 patients, respectively. There was no significant difference between the three groups in terms of age, gender, and comorbidities (P > 0.05). Regarding BCSS and VAS scores, there was significant reduction from the baseline values in all groups (P < 0.0001), with the change rate being significantly higher in DXM group. The amount of reduction of BCSS in the GPT/MTL group was significantly more than the GPT group, whereas there was no significant difference between the two groups regarding VAS score. Although the duration of hospitalization differed between the groups with the GPT/MTL group having the shortest duration, the difference was statistically significant only between the GPT and GPT/MTL groups (P < 0.0001). CONCLUSION: GPT, both alone and in combination with MTL, improves cough frequency and severity in hospitalized patients with COVID-19, with the combination being more efficacious. This regimen may be useful in patients who cannot tolerate opioids.