Mixed Etiology COVID-19 Associated Pulmonary Aspergillosis (CAPA)—A Case Report and Brief Review of the Literature

Abstract

The SARS-CoV-2 pandemic has proved to be a significant risk addition for invasive infections with Aspergillus. Even though there are plenty of data about the COVID-19-associated pulmonary aspergillosis (CAPA), especially involving Aspergillus fumigatus, recent studies are presenting cases of CAPA involving more than one species of Aspergillus. We report the first case of a SARS-CoV-2 patient associating co-infection with, most likely, Aspergillus section Fumigati and Aspergillus section Flavi from Romania, and we review the existing medical literature in order to shed light upon mixed etiology cases of CAPA. Since mortality remains high in these cases, there is an acute need for more information about the interaction between SARS-CoV-2 and Aspergillus spp., and the therapies for CAPA. The emerging number of cases and the high mortality rate must be considered an incentive for future research.

Filamentous Fungi Infections: Yet Another Victim of COVID-19?

“…Multiple articles regarding the association between invasive mold infections (especially aspergillosis) and severe or critical forms of COVID-19 were published [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Similarly to our cases, when COVID-19 was associated with aspergillosis, the mortality rate was very high [ 18 ].…”

Co‐infection of Klebsiella pneumonia, Cytomegalovirus, Aspergillus and Zygomycete in a patient with SARS‐CoV‐2

“…Few recent research have shown instances of COVID‐19 infection involving more than one aspergillus species or two separate fungal infections at the same time. Toc et al reported a case of COVID‐19‐associated pulmonary aspergillosis with Aspergillus fumigatus and Aspergillus flavus with favorable outcome 2 . Johnson et al 3 reported a case of combined probable pulmonary aspergillosis and possible mucormycosis in a diabetic male with COVID‐19 in the ICU who was treated with liposomal amphotericin B.…”

“…Secondary infections or co‐infections are commonly identified in the severe influenza and other severe respiratory viral infections with high mortality and morbidity rates 1 . Co‐infection between severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and other pathogens has become another serious threat to treat the patients, which should not be neglected 2 . These co‐pathogens include bacteria such as Streptococcus pneumoniae and Staphylococcus aureus, fungal pathogens including Aspergillus or Mucorales species, and the viruses such as influenza, and rhinovirus/enterovirus 3 .…”

“…1 Coinfection between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other pathogens has become another serious threat to treat the patients, which should not be neglected. 2 These co-pathogens include bacteria such as Streptococcus pneumoniae and Staphylococcus aureus, fungal pathogens including Aspergillus or Mucorales species, and the viruses such as influenza, and rhinovirus/enterovirus. 3 Hence, we report the first case of concomitant aspergillosis, mucormycosis, cytomegalovirus (CMV) pneumonia, and klebsiella pneumoniae empyema as the complication of COVID-19 infection who had a favorable clinical outcome.…”

First Reported Case of a Clinically Nonresponsive-to-Itraconazole Alternaria alternata Isolated from a Skin Infection of a Nonimmunocompromised Patient from Romania

“…From highly resistant strains of Candida auris to COVID-19-associated pulmonary aspergillosis (CAPA) or mixed etiology CAPA, there is little doubt that we are facing an overwhelming pressure on many clinical settings caused by various fungal infections. Mycoses gradually become more difficult to treat and, similar to bacteria, some of the circulating fungal strains are on the verge of panresistance [ 1 , 2 , 3 ].…”