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Case Reports
. 2023 Feb 12;12(2):304.
doi: 10.3390/pathogens12020304.

Mucorales/ Fusarium Mixed Infection in Hematologic Patient with COVID-19 Complications: An Unfortunate Combination

Andrea Marino  1   2 , Maddalena Calvo  3 , Laura Trovato  1   3 , Guido Scalia  1   3 , Maria Gussio  2 , Ugo Consoli  4 , Manuela Ceccarelli  2 , Giuseppe Nunnari  5 , Bruno Cacopardo  2
Affiliations
Case Reports

Mucorales/ Fusarium Mixed Infection in Hematologic Patient with COVID-19 Complications: An Unfortunate Combination

Andrea Marino et al. Pathogens. .

Abstract

Hematological diseases, especially those causing severe neutropenia, represent the main factor in the development of invasive fungal infections (IFIs). Furthermore, COVID-19 has been considerably associated with IFIs due to immunological dysregulation, prolonged hospitalization in intensive care units, and immunomodulatory therapies. Opportunistic molds are correlated with elevated morbidity and mortality rates in these patients, due to immune impairment, diagnostic complexity, and therapeutic challenges. Among opportunistic fungal infections, the Mucorales and Fusarium species are considered particularly aggressive, especially during severe neutropenia. A mixed Mucorales/Fusarium infection has been rarely described in scientific literature. Herein, we report a case of Mucorales and Fusarium co-infection in a patient with acute leukemia whose clinical history was also complicated by COVID-19. Herein, we report a challenging case in order to encourage the clinical suspicion of combined fungal infections in immunosuppressed patients, performing a punctual microbiological diagnosis, and promptly administering the correct empiric and targeted antifungal therapy.

Keywords: Fusarium infections; Fusarium/Mucorales infections; antifungal stewardship; invasive fungal infections.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Echtyma-like necrotic-ulcerative lesions.
Figure 2
Figure 2
Thorax CT scan showing right medio basal consolidation, pleural effusion, and ascending aorta aneurysm.
Figure 3
Figure 3
Septate hyphae from microscopic investigation on biopsy samples (40× magnification).
Figure 4
Figure 4
Non-septate hyphae from microscopic investigations on biopsy samples (40× magnification).
Figure 5
Figure 5
Fusarium solanii colonies on Sabouraud culture examination on biopsy samples.
See this image and copyright information in PMC

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