Mucorales/Fusarium Mixed Infection in Hematologic Patient with COVID-19 Complications: An Unfortunate Combination

Abstract

Hematological diseases, especially those causing severe neutropenia, represent the main factor in the development of invasive fungal infections (IFIs). Furthermore, COVID-19 has been considerably associated with IFIs due to immunological dysregulation, prolonged hospitalization in intensive care units, and immunomodulatory therapies. Opportunistic molds are correlated with elevated morbidity and mortality rates in these patients, due to immune impairment, diagnostic complexity, and therapeutic challenges. Among opportunistic fungal infections, the Mucorales and Fusarium species are considered particularly aggressive, especially during severe neutropenia. A mixed Mucorales/Fusarium infection has been rarely described in scientific literature. Herein, we report a case of Mucorales and Fusarium co-infection in a patient with acute leukemia whose clinical history was also complicated by COVID-19. Herein, we report a challenging case in order to encourage the clinical suspicion of combined fungal infections in immunosuppressed patients, performing a punctual microbiological diagnosis, and promptly administering the correct empiric and targeted antifungal therapy.

Development of a monoclonal antibody and a lateral-flow device for the rapid detection of a Mucorales-specific biomarker

“…(Arndt et al, 2009;Bergantim et al, 2013;Henn et al, 2014;Obradovic-Tomasev et al, 2014;Pandey et al, 2019;Anita et al, 2021; Bellanger Benhadid-Brahmi et al, 2022;Johnson et al, 2021;Moorthy et al, 2021;Paul et al (2022); Ramıŕez-Hinojosa et al, 2021;Singh et al, 2021;Zayet et al, 2021;Rahna et al, 2022;Suresh et al, 2022;Tabarsi et al, 2022;Teng et al, 2022;Zhan et al, 2022;Murray et al, 2023;Sardeshmukh et al, 2023), Fusarium spp. (De Almeida Junior et al, 2015;Marino et al, 2023), Candida albicans (Obradovic-Tomasev et al, 2014;Pandey et al, 2019;Jawanda et al, 2022), Cryptococcus neoformans (Henn et al, 2014;Gupta et al, 2023), Lomentospora prolificans (Erami et al, 2023), and Scedosporium apiospermum (Shand et al, 2004;Marques et al, 2011;Song et al, 2022;Kanaujia et al, 2023).…”

“…At present, there are no antigen biomarker tests which allow rapid, sensitive and specific detection of Mucorales species (Skiada et al, 2020;Lamoth, 2023), and their differentiation from other fungal pathogens such as Aspergillus, Candida, Cryptococcus, Fusarium and Scedosporium (Marques et al, 2011;Obradovic-Tomasev et al, 2014;Skiada et al, 2020;Marino et al, 2023). Despite this, we recently reported the development of a monoclonal antibody (mAb), KC9, specific to R. arrhizus, and its incorporation into a lateral-flow device (KC9-LFD) for rapid detection of an extracellular polysaccharide (EPS) biomarker of the pathogen in human serum and bronchoalveolar lavage (BAL) fluid (Davies and Thornton, 2022).…”