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



Amirizad K1 ; Ghazanfari M2, 3 ; Javidnia J2, 3 ; Abastabar M2, 3 ; Haghiashtiani MT4 ; Sotoudehanvari M5 ; Fathi M7 ; Espahbodi A8 ; Badali H9 ; Hedayati MT2, 3 ; Haghani I2, 3 ; Seyedmousavi S10
Authors
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Authors Affiliations
  1. 1. Department of Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
  2. 2. Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Sari, Iran
  3. 3. Invasive Fungi Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
  4. 4. Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Surgical and Clinical Pathology, Cardiac Research, Tehran Heart Center, Tehran University of Medical Sciences
  6. 6. Tehran, Iran
  7. 7. Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
  8. 8. Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Sari, Iran
  9. 9. Department of Molecular Microbiology & Immunology, South Texas Center for Emerging Infectious Diseases, The University of Texas at San Antonio, San Antonio, TX, United States
  10. 10. Department of Laboratory Medicine, Microbiology Service, Clinical Center, National Institutes of Health, Bethesda, MD, United States

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.
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