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.

• Klíčová slova
• COVID-19, Inhalation injury, Isavuconazole, Mycobiome,
• MeSH
• antifungální látky * terapeutické užití   MeSH
• COVID-19 * imunologie   komplikace   MeSH
• dospělí MeSH
• fatální výsledek MeSH
• koinfekce mikrobiologie   farmakoterapie   imunologie   MeSH
• lidé MeSH
• mykózy farmakoterapie   mikrobiologie   imunologie   diagnóza   MeSH
• nitrily terapeutické užití   MeSH
• popálení komplikace   mikrobiologie   MeSH
• pyridiny terapeutické užití   MeSH
• Saccharomycetales genetika   účinky léků   imunologie   MeSH
• sepse farmakoterapie   mikrobiologie   imunologie   MeSH
• triazoly terapeutické užití   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• antifungální látky * MeSH
• isavuconazole MeSH Prohlížeč
• nitrily MeSH
• pyridiny MeSH
• triazoly MeSH