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Rare multi-fungal sepsis: a case of triple-impact immunoparalysis

B. Lipovy, M. Hladik, K. Vyklicka, I. Kocmanova, M. Lengerova, L. Kren, M. Srnik, J. Bohm, P. Andrla, P. Borilova Linhartova

. 2024 ; 69 (4) : 903-911. [pub] 20240422

Jazyk angličtina Země Spojené státy americké

Typ dokumentu kazuistiky, časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc24015644

Grantová podpora
65269705 Ministerstvo Zdravotnictví Ceské Republiky
LM2023069 Ministerstvo Školství, Mládeže a Tělovýchovy
CZ.02.1.01/0.0/0.0/17_043/0009632 Ministerstvo Školství, Mládeže a Tělovýchovy
LM2018132 Ministerstvo Školství, Mládeže a Tělovýchovy
857560 Horizon 2020

Patients with burn injury and inhalation injury are highly susceptible to infectious complications, including opportunistic pathogens, due to the loss of skin cover and mucosal damage of respiratory tract as well as the disruption of homeostasis. This case report, a 34-year-old man suffered critical burns, provides the first literature description of triple-impact immunoparalysis (critical burns, inhalation injury, and SARS-CoV-2 infection), leading to a lethal multifocal infection caused by several fungi including very rare environmental representatives Metschnikowia pulcherrima and Wickerhamomyces anomalus. The co-infection by these common environmental yeasts in a human is unique and has not yet been described in the literature. Importantly, our patient developed refractory septic shock and died despite targeted antifungal therapy including the most potent current antifungal agent-isavuconazole. It can be assumed that besides immunoparalysis, effectiveness of therapy by isavuconazole was impaired by the large distribution volume in this case. As this is a common situation in intensive care patients, routine monitoring of plasmatic concentration of isavuconazole can be helpful in personalization of the treatment and dose optimization. Whatmore, many fungal species often remain underdiagnosed during infectious complications, which could be prevented by implementation of new methods, such as next-generation sequencing, into clinical practice.

Citace poskytuje Crossref.org

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