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Kapałka M, Kubik H, Krawiec M, Danel A, Krzyżak K, Śliwka J, Pawlak S. Invasive Pulmonary Aspergillosis After Sars-CoV-2 Infection as Limitation of Contemporary Transplantology: A Case Report. Transplant Proc 2023; 55:1880-1882. [PMID: 37365104 PMCID: PMC10239897 DOI: 10.1016/j.transproceed.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
Invasive fungal infections are uncommon in pediatric heart transplant recipients. Risk and mortality are highest in the first 6 months post-transplant, especially in patients with previous surgery and those requiring mechanical support. There is a possibility that prior SARS-CoV-2 infection may cause a more severe course of pulmonary aspergillosis, especially in immunosuppressed individuals. This report describes a female patient, eight years of age, who was admitted to the pediatric cardiac surgery department with symptoms of end-stage heart failure in urgent need of mechanical circulatory support (MCS). A left ventricular assist device (LVAD) was implanted as a bridge to transplantation. During over a year on the waiting list, LVAD was replaced twice due to the presence of fibrin on the inlet valve. While staying in the ward, the patient underwent SARS-CoV-2 infection. An orthotopic heart transplant was successfully performed after 372 days of MCS with LVAD. One month after transplantation, the girl developed severe pulmonary aspergillosis complicated by sudden cardiac arrest and implantation of venovenous extracorporeal membrane oxygenation (VV ECMO) used for 25 days. Unfortunately, a few days after weaning from VV ECMO, the patient died due to intracerebral bleeding.
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Affiliation(s)
- Michał Kapałka
- Student research group at Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Hanna Kubik
- Student research group at Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Michał Krawiec
- Student research group at Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Anna Danel
- Student research group at Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Katarzyna Krzyżak
- Student research group at Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland.
| | - Joanna Śliwka
- Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Szymon Pawlak
- Department of Cardiac Surgery, Transplantology, Vascular and Endovascular Surgery Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
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Du W, Xu R, He Z, Yang H, Gu Y, Liu Y. Transcriptomics-based investigation of molecular mechanisms underlying synergistic antimicrobial effects of AgNPs and Domiphen on the human fungal pathogen Aspergillus fumigatus. Front Microbiol 2023; 14:1089267. [PMID: 36819018 PMCID: PMC9928863 DOI: 10.3389/fmicb.2023.1089267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023] Open
Abstract
Critically ill patients have higher risk of serious fungal infections, such as invasive aspergillosis (IA) which is mainly caused by the human fungal pathogen Aspergillus fumigatus. Triazole drugs are the primary therapeutic agents for the first-line treatment of IA, which could easily cause drug resistance problems. Here, we assess the potential of AgNPs synthesized with Artemisia argyi leaf extract and domiphen as new antifungal agents to produce synergistic antimicrobial effects on Aspergillus fumigatus, and dissect possible molecular mechanisms of action. Plate inoculation assays combined with drug susceptibility test and cytotoxicity test showed that the combination of AgNPs and domiphen has synergistic antimicrobial effects on A. fumigatus with low cytotoxicity. Gene Ontology (GO) enrichment analysis showed that AgNPs and domiphen inhibit the growth of A. fumigatus by suppressing nitrate assimilation, and purine nucleobase metabolic process and amino acid transmembrane transport, respectively. When the two drugs are combined, AgNPs has epistatic effects on domiphen. Moreover, the combination of AgNPs and domiphen primarily influence secondary metabolites biosynthesis, steroid biosynthesis and nucleotide sugar metabolism of A. fumigatus via Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. Furthermore, protein-protein interactions (PPI) analysis combined with validation experiments showed that the combination of AgNPs and domiphen could enhance the expression of copper transporter and inhibit nitrogen source metabolism. In addition, the synergistic antimicrobial effects could be enhanced or eliminated depending on exogenous addition of copper and nitrogen source, respectively. Taken together, the results of this study provide a theoretical basis and a new strategy for the treatment of IA.
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Affiliation(s)
- Wenlong Du
- Department of Bioinformatics, School of Life Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China,Department of Biophysics, School of Life Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China,*Correspondence: Wenlong Du, ✉
| | - Ruolin Xu
- Department of Bioinformatics, School of Life Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China,Department of Biophysics, School of Life Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhiqiang He
- Department of Bioinformatics, School of Life Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China,Department of Biophysics, School of Life Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Huan Yang
- Department of Bioinformatics, School of Life Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China,Department of Biophysics, School of Life Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yufan Gu
- Department of Bioinformatics, School of Life Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China,Department of Biophysics, School of Life Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yi Liu
- Department of Bioinformatics, School of Life Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China,Department of Biophysics, School of Life Sciences, Xuzhou Medical University, Xuzhou, Jiangsu, China,Yi Liu, ✉
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Penicillium digitatum, First Clinical Report in Chile: Fungal Co-Infection in COVID-19 Patient. J Fungi (Basel) 2022; 8:jof8090961. [PMID: 36135686 PMCID: PMC9503875 DOI: 10.3390/jof8090961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 12/04/2022] Open
Abstract
Penicillium digitatum is one of the most important phytopathogens. It causes deterioration and rotting of citrus fruits, generating significant economic losses worldwide. As a human pathogen, it is extremely rare. We present a case of pulmonary co-infection in a patient diagnosed with pneumonia due to SARS-CoV-2. A 20-year-old female patient, primigravid, 36 weeks of gestation, without comorbidities, and diagnosed with severe pneumonia due to the SARS-CoV-2, showed rapid lung deterioration for which their pregnancy was interrupted by surgery. The patient was hospitalized in the Intensive Care Unit (ICU), connected to mechanical ventilation and receiving corticosteroids and antibiotics. The diagnosis of pulmonary fungal infection was made through bronchoalveolar lavage (BAL) culture, and the species identification was performed by sequencing of β-tubulin. Phylogenetic analysis with related species was performed for the confirmation of species identification. Antifungal susceptibility tests were performed for itraconazole (4 µg/mL), voriconazole (2 µg/mL), and amphotericin B (2 µg/mL). The patient was successfully treated with itraconazole. This is the second worldwide report of pulmonary infection by P. digitatum and the first in Chile. Although it is a fungus that rarely infects humans, it could represent an emerging opportunistic fungal pathogen, with associated risk factors that should be considered in the differential diagnosis of Penicillium species isolated from infections in humans.
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