Background

Patients with severe viral pneumonia are likely to receive high-dose immunomodulatory drugs to prevent clinical worsening. Aspergillus species have been described as frequent secondary pneumonia agents in severely ill influenza patients receiving steroids. COVID-19 patients admitted to Intensive Care Unit (ICU) are receiving steroids as part of their treatment and they share clinical characteristics with other patients with severe viral pneumonias. COVID-19 patients receiving steroids should be considered a putative risk group of invasive aspergillosis.

Case report

We are reporting a SARS-CoV-2/Aspergillus section Fumigati coinfection in an elderly intubated patient with a history of pulmonary embolism treated with corticosteroids. The diagnosis was made following the ad hoc definitions described for patients admitted to ICU with severe influenza, including clinical criteria (fever for 3 days refractory to the appropriate antibiotic therapy, dyspnea, pleural friction rub, worsening of respiratory status despite antibiotic therapy and need of ventilator support), a radiological criterion (pulmonary infiltrate) and a mycological criterion (several positive galactomannan tests on serum with ratio ≥0.5). In addition, Aspergillus section Fumigati DNA was found in serum and blood samples. These tests were positive 4 weeks after the patient was admitted to the ICU. The patient received voriconazole and after two month in ICU his respiratory status improved; he was discharged after 6 weeks of antifungal treatment.

Conclusions

Severely ill COVID-19 patients would be considered a new aspergillosis risk group. Galactomannan and Aspergillus DNA detection would be useful methods for Aspergillus infection diagnosis as they allow avoiding the biosafety issues related to these patients.

中文翻译：

---

用皮质类固醇治疗的免疫功能正常患者的 SARS-CoV-2 和曲霉菌切片 Fumigati 合并感染

背景

重症病毒性肺炎患者可能会接受大剂量免疫调节药物以防止临床恶化。曲霉属已被描述为在接受类固醇的重症流感患者中常见的继发性肺炎药物。入住重症监护病房 (ICU) 的 COVID-19 患者正在接受类固醇作为治疗的一部分，他们与其他患有严重病毒性肺炎的患者具有共同的临床特征。接受类固醇的 COVID-19 患者应被视为侵袭性曲霉病的推定风险组。

案例报告

我们正在报告一名有肺栓塞病史且接受皮质类固醇治疗的老年插管患者的 SARS-CoV-2/曲霉菌部分Fumigati合并感染。诊断是根据对入住 ICU 的重症流感患者描述的特别定义做出的，包括临床标准（发热 3 天，对适当的抗生素治疗无效、呼吸困难、胸膜摩擦音、尽管接受了抗生素治疗但呼吸状态恶化以及需要呼吸机支持）、放射学标准（肺浸润）和真菌学标准（血清半乳甘露聚糖检测呈阳性，比率≥0.5）。此外，曲霉科熏蒸在血清和血液样本中发现了 DNA。这些测试在患者入住 ICU 4 周后呈阳性。患者接受了伏立康唑治疗，在 ICU 住了两个月后，他的呼吸状况有所改善；经过6周的抗真菌治疗后，他出院了。

结论

重症 COVID-19 患者将被视为新的曲霉菌病风险组。半乳甘露聚糖和曲霉菌DNA 检测将是曲霉菌感染诊断的有用方法，因为它们可以避免与这些患者相关的生物安全问题。