@article{2999597,
    title = "Possible COVID-19-Associated Pulmonary Aspergillosis due to Aspergillus niger in Greece",
    author = "Katsiari, M. and Mavroidi, A. and Palla, E. and Zourla, K. and Alonistiotis, T. and Ntorlis, K. and Nikolaou, C. and Vrioni, G. and Tsakris, A.",
    journal = "Journal of Antibiotics",
    year = "2022",
    volume = "11",
    number = "3",
    publisher = "MDPI",
    issn = "0021-8820, 1881-1469",
    doi = "10.3390/antibiotics11030300",
    abstract = "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes direct damage to the pulmonary epithelium, enabling Aspergillus invasion. Rapid progression and high mortality of invasive aspergillosis have been reported. In the present study, we report a rare case of possible COVID-19-associated pulmonary aspergillosis (CAPA) caused by A. niger in a Greek patient. Diagnosis was based on ECMM/ISHAM specific criteria and the new algorithm “BM-AspICU” for the invasive pulmonary aspergillosis diagnostic strategy. The fungal isolate was recovered in a non-bronchoalveolar lavage (non-BAL) sample and its identification was performed by standard macroscopic and microscopic morphological studies. MALDI-TOF analysis confirmed the identification of A. niger. In addition, galactomannan antigen and Aspergillus real-time PCR testing were positive in the non-BAL sample, while in serum they proved negative. The A. niger isolate showed an MIC for fluconazole ≥128 µg/mL, for itraconazole and posaconazole 0.25 µg/mL, for voricona-zole 0.5 µg/mL, for flucytosine 4 µg/mL, for amphotericin B 1 µg/mL, and for all echinocandins (caspofungin, anidulafungin, micafungin) >8 µg/mL. The patient was initially treated with voricona-zole; amphotericin B was subsequently added, when a significant progression of cavitation was demonstrated on chest computed tomography. A. niger was not isolated in subsequent samples and the patient’s unfavorable outcome was attributed to septic shock caused by a pandrug-resistant Acinetobacter baumannii strain. © 2022 by the authors. Licensee MDPI, Basel, Switzerland."
}