Cryptococcal Pneumonia: An Unusual Complication in a COVID-19 Patient
Status PubMed-not-MEDLINE Jazyk angličtina Země Švýcarsko Médium electronic
Typ dokumentu časopisecké články
Grantová podpora
CZ.02.1.01/0.0/0.0/16_013/0001826
Ministry of Education Youth and Sports
LM2018128
Ministry of Education Youth and Sports
65269705
Ministry of Health
PubMed
36010294
PubMed Central
PMC9406651
DOI
10.3390/diagnostics12081944
PII: diagnostics12081944
Knihovny.cz E-zdroje
- Klíčová slova
- COVID-19, Cryptococcus, SARS-CoV-2, fungal superinfection,
- Publikační typ
- časopisecké články MeSH
Cryptococcal superinfection is a rare but potentially fatal complication, especially if its detection and subsequent treatment are delayed. Histopathological findings of pulmonary parenchyma from a deceased patient with these complications were acquired. Quite interestingly, only a minimal inflammatory reaction could be seen in an individual with no previously known immune suppression, indicating a disturbance of the immune system. This finding was well in concordance with the described changes in cellular immunity in COVID-19. We report the case of a 60 year old male with critical coronavirus disease 2019 (COVID-19) complicated by cryptococcal pneumonia and multiorgan failure. Both X-ray and CT scans revealed lung infiltrates corresponding with COVID-19 infection early after the onset of symptoms. Despite receiving standard treatment, the patient progressed into multiple organ failure, requiring mechanical ventilation, circulatory support, and haemodialysis. Cryptococcus neoformans was detected by subsequent BAL, and specific antifungal treatment was instituted. His clinical status deteriorated despite all treatment, and he died of refractory circulatory failure after 21 days from hospital admission. Histopathological findings confirmed severe diffuse alveolar damage (DAD) caused by COVID-19 and cryptococcal pneumonia. Timely diagnosis of cryptococcal superinfection may be challenging; therefore, PCR panels detecting even uncommon pathogens should be implemented while taking care of critical COVID-19 patients.
Department of Pathological Anatomy University Hospital Brno 625 00 Brno Czech Republic
Department of Simulation Medicine Faculty of Medicine Masaryk University 625 00 Brno Czech Republic
Faculty of Medicine Masaryk University 625 00 Brno Czech Republic
Zobrazit více v PubMed
Pappas P.G. Cryptococcal infections in non-HIV-infected patients. Trans. Am. Clin. Climatol. Assoc. 2013;124:61–79. PubMed PMC
Tian W., Zhang N., Jin R., Feng Y., Wang S., Gao S., Gao R., Wu G., Tian D., Tan W., et al. Immune suppression in the early stage of COVID-19 disease. Nat. Commun. 2020;11:5859. doi: 10.1038/s41467-020-19706-9. PubMed DOI PMC
Fajgenbaum D.C., June C.H. Cytokine Storm. N. Engl. J. Med. 2020;383:2255–2273. doi: 10.1056/NEJMra2026131. PubMed DOI PMC
Diao B., Wang C., Tan Y., Chen X., Liu Y., Ning L., Chen L., Li M., Liu Y., Wang G., et al. Reduction and Functional Exhaustion of T Cells in Patients with Coronavirus Disease 2019 (COVID-19) Front. Immunol. 2020;11:827. doi: 10.3389/fimmu.2020.00827. PubMed DOI PMC
Gordon A.C., Mouncey P.R., Al-Beidh F., Rowan K.M., Nichol A.D., Arabi Y.M., Annane D., Beane A., Van Bentum-Puijk W., Berry L.R., et al. Interleukin-6 Receptor Antagonists in Critically Ill Patients with COVID-19. N. Engl. J. Med. 2021;384:1491–1502. doi: 10.1056/NEJMoa2100433. PubMed DOI PMC
Abani O., Abbas A., Abbas F., Abbas M., Abbasi S., Abbass H., Abbott A., Abdallah N., Abdelaziz A., Abdelfattah M., et al. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): A randomised, controlled, open-label, platform trial. Lancet. 2021;397:1637–1645. doi: 10.1016/S0140-6736(21)00676-0. PubMed DOI PMC
RECOVERY Collaborative Group. Horby P., Lim W.S., Emberson J.R., Mafham M., Bell J.R., Linsell L., Staplin N., Christopher Brightling C., Ustianowski A., et al. Dexamethasone in Hospitalized Patients with COVID-19. N. Engl. J. Med. 2021;384:693–704. doi: 10.1056/NEJMoa2021436. PubMed DOI PMC
Villar J., Ferrando C., Martínez D., Ambrós A., Muñoz T., Soler J.A., Aguilar G., Alba F., González-Higueras E., Conesa L.A., et al. Dexamethasone in ARDS network. Dexamethasone treatment for the acute respiratory distress syndrome: A multicentre, randomised controlled trial. Lancet. Respir. Med. 2020;8:267–276. doi: 10.1016/S2213-2600(19)30417-5. PubMed DOI
Perfect J.R., Dismukes W.E., Dromer F., Goldman D.L., Graybill J.R., Hamill R.J., Harrison T.S., Larsen R.A., Lortholary O., Nguyen M.-H., et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin. Infect. Dis. 2010;50:291–322. doi: 10.1086/649858. PubMed DOI PMC
Spadari C.D.C., Wirth F., Lopes L.B., Ishida K. New Approaches for Cryptococcosis Treatment. Microorganisms. 2020;8:613. doi: 10.3390/microorganisms8040613. PubMed DOI PMC