Invasive Aspergillus fumigatus infection after Plasmodium falciparum malaria in an immuno-competent host: case report and review of literature

Abstract

Invasive fungal infection is rarely reported in association with malaria, even though malaria-associated inhibition of phagocyte function is a well-known condition. Invasive aspergillosis is frequently found in severely immuno-compromised patients but not in healthy individuals. Here, a case of pulmonary invasive aspergillosis in a previously healthy patient with severe P. falciparum malaria is presented, who was successfully treated with voriconazol and caspofungin. This is the first survival of malaria-associated invasive aspergillosis.

Figure 1

A: Thoracic CT scan. Multiple confluent ground glass-infiltrates in both lungs due to Aspergillus fumigatus. B and C: Bronchoscopic findings. B: Sharply circumscribed lesion of the carina tracheae of the upper left lobe, extending into the upper lobe bronchus. C: Extensive necrosis of the bronchial wall extending into the periphery up to segment 2 of the upper right lobe. D-G: Histological findings of the transbronchial biopsy. D: Overview of the biopsy specimen, HE stain, primary magnification × 5. The black box indicates the area shown in E, primary magnification × 20: PAS staining showing extensive invasive growth of hyphae into the bronchial wall (black arrows). F: Mycelia of Aspergillus fumigatus with dichotomy branching (black arrows) with inflammatory infiltrates and necrosis (white arrows), PAS stain, primary magnification × 10. G: Extensive fungal growth with partially septated hyphae (black arrows), PAS stain, primary magnification × 20.