Publication details

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

Authors

LIPOVÝ Břetislav HLADÍK Martin VYKLICKÁ Kateřina KOCMANOVÁ Iva LENGEROVÁ Martina KŘEN Leoš SRNÍK Michal BÖHM Jan ANDRLA Petr BOŘILOVÁ LINHARTOVÁ Petra

Year of publication 2024
Type Article in Periodical
Magazine / Source Folia microbiologica
MU Faculty or unit

Faculty of Medicine

Citation
Web https://link.springer.com/article/10.1007/s12223-024-01165-0
Doi http://dx.doi.org/10.1007/s12223-024-01165-0
Keywords Mycobiome; COVID-19; Isavuconazole; Inhalation injury
Description 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.
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