Central Nervous System Aspergillus Quadrilineatus Infection in a Covid-19 Patient, a Case Report and Literature Review Publisher Pubmed



Amirizad K¹ ; Ghazanfari M^{2, 3} ; Javidnia J^{2, 3} ; Abastabar M^{2, 3} ; Haghiashtiani MT⁴ ; Sotoudehanvari M⁵ ; Fathi M⁷ ; Espahbodi A⁸ ; Badali H⁹ ; Hedayati MT^{2, 3} ; Haghani I^{2, 3} ; Seyedmousavi S¹⁰
Source: Journal of Clinical Laboratory Analysis Published:2023

Abstract

Background: Viral pneumonia such as COVID-19-associated aspergillosis could increase susceptibility to fungal super-infections in critically ill patients. Methods: Here we report a pediatric case of Aspergillus quadrilineatus cerebral infection in a recently diagnosed COVID-19-positive patient underlying acute lymphocytic leukemia. Morphological, molecular methods, and sequencing were used to identify this emerging species. Results: Histopathological examination showed a granulomatous necrotic area containing dichotomously branching septate hyphae indicating a presumptive Aspergillus structure. The species-level identity of isolate growing on brain biopsy culture was confirmed by PCR sequencing of the β-tubulin gene as A. quadrilineatus. Using the CLSI M38-A3 broth microdilution methodology, the in vitro antifungal susceptibility testing demonstrated 0.032 μg/mL MIC for posaconazole, caspofungin, and anidulafungin and 8 μg/mL against amphotericin B. A combination of intravenous liposomal amphotericin B and caspofungin therapy for 8 days did not improve the patient's condition. The patient gradually continued to deteriorate and expired. Conclusions: This is the first COVID-19-associated cerebral aspergillosis due to A. quadrilineatus in a pediatric patient with acute lymphocytic leukemia. However, comprehensive screening studies are highly recommended to evaluate its frequency and antifungal susceptibility profiles. Before being recommended as first-line therapy in high-risk patients, more antifungal susceptibility data are needed. © 2023 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals LLC.