A case of invasive pulmonary aspergillosis in a patient diagnosed with Crimean-Congo Hemorrhagic Fever
Abstract
Crimean-Congo hemorrhagic fever (CCHF) is endemic around Kelkit valley in our country. It is a zoonotic disease characterized by fever, headache, abdominal pain, nausea-vomiting, myalgia, and bleeding. Invasive pulmonary aspergillosis (IPA) is frequently seen in the presence of risk factors such as prolonged neutropenia, transplantation, hematological-solid malignancies, immunosuppressive treatments, and has a high mortality rate. The case presented in this report is a patient with a definitive diagnosis of CCHF who received dexamethasone treatment due to a severe disease course with profound cytopenias. After short-term corticosteroid treatment, IPA developed in the early period, and the patient died. Our case is remarkable in terms of IPA development in the course of CCHF, and to our knowledge, it is the first case report of this association in the literature. Aspergillus infections can be seen without classical immunosuppressive risk factors. Effective use of microbiological, serological and imaging methods are important in terms of early diagnosis of cases and early initiation of antifungal treatment. Aspergillus infections should always be kept in mind in critically ill patients followed in the intensive care unit.
Project Number
-
References
- Yılmaz GR, Buzgan T, Irmak H, et al. The epidemiology of Crimean-Congo hemorrhagic fever in Turkey, 2002-2007. Int J Infect Dis. 2009;13(3):380-6.
- Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: a clinical review. Eur Respir Rev. 2011;20(121):156-74.
- Ledoux MP, Guffroy B, Nivoix Y, Simand C, Herbrecht R. Invasive pulmonary aspergillosis. Semin Respir Crit Care Med. 2020;41(1):80-98.
- Marr KA, Carter RA, Crippa F, Wald A, Corey L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34(7):909-17.
- Zmeili OS, Soubani AO. Pulmonary aspergillosis: a clinical update. QJM. 2007;100(6):317-34.
- Kanj A, Abdallah N, Soubani AO. The spectrum of pulmonary aspergillosis. Respir Med. 2018;141:121-31.
- Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis. 1989;11(6):954-63.
- Gu Y, Ye X, Liu Y, et al. A risk-predictive model for invasive pulmonary aspergillosis in patients with acute exacerbation of chronic obstructive pulmonary disease. Respir Res. 2021;22(1):176.
- Karti SS, Odabasi Z, Korten V, et al. Crimean-Congo hemorrhagic fever in Turkey. Emerg Infect Dis. 2004;10(8):1379-84.
- Ergonul O, Tuncbilek S, Baykam N, Celikbas A, Dokuzoguz B. Evaluation of serum levels of interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha in patients with Crimean-Congo hemorrhagic fever. J Infect Dis. 2006;193(7):941-4.
- Dokuzoguz B, Celikbas AK, Gök ŞE, Baykam N, Eroglu MN, Ergönül Ö. Severity scoring index for Crimean-Congo hemorrhagic fever and the impact of ribavirin and corticosteroids on fatality. Clin Infect Dis. 2013;57(9):1270-4.
- Sharifi-Mood B, Alavi-Naini R, Metanat M, Mohammadi M, Shakeri A, Amjadi A. Efficacy of high-dose methylprednisolone in patients with Crimean-Congo haemorrhagic fever and severe thrombocytopenia. Trop Doct. 2013;43(2):49-53.
- Çayıröz P, Çayıröz MU, Iltar U, Kurtoğlu E. Kırım-Kongo kanamalı ateşi ile eş zamanlı akut lenfoblastik lösemi tanısı alan olgu. Mikrobiyol Bul. 2020;54(2):326-33.
- Blot SI, Taccone FS, Van den Abeele AM, et al. A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am J Respir Crit Care Med. 2012;186(1):56-64.
- Patterson TF, Thompson GR III, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the infectious diseases society of America. Clin Infect Dis. 2016;63(4):1-60.
Abstract
Kırım-Kongo kanamalı ateşi (KKKA), ülkemizde Kelkit vadisi ve çevresinde endemiktir. Ateş yüksekliği, baş ağrısı, karın ağrısı, bulantı-kusma, miyalji ve kanamalarla seyreden bir zoonotik hastalıktır. İnvaziv pulmoner aspergilloz (IPA), sıklıkla uzamış nötropeni, transplantasyon, hematolojik-solid malignite, immunosupresif tedaviler gibi risk faktörleri varlığında görülür ve yüksek mortaliteyle seyretmektedir. Bu bildiride sunulan olgu KKKA kesin tanısı alan ve derin sitopenilerle şiddetli hastalık seyri göstermesi üzerine deksametazon tedavisi almıştır. Kısa süreli kortikosteroid tedavisi sonrası erken dönemde IPA gelişmiş ve hasta kaybedilmiştir. Olgumuz KKKA seyrinde IPA gelişmesi açısından dikkat çekicidir ve bildiğimiz kadarıyla literatürde bu birlikteliğe ait ilk vaka bildirimidir. Aspergillus enfeksiyonları klasik immunosupresif risk faktörleri dışında da görülebilmektedir. Olguların erken tanı alması ve antifungal tedaviye erken başlanması açısından mikrobiyolojik, serolojik ve görüntüleme yöntemlerinin etkin kullanılması önemlidir. Kritik hastalığı olup yoğun bakım ünitesinde takip edilen olgularda Aspergillus enfeksiyonları her zaman akılda tutulmalıdır.
Supporting Institution
-
Project Number
-
Thanks
-
References
- Yılmaz GR, Buzgan T, Irmak H, et al. The epidemiology of Crimean-Congo hemorrhagic fever in Turkey, 2002-2007. Int J Infect Dis. 2009;13(3):380-6.
- Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: a clinical review. Eur Respir Rev. 2011;20(121):156-74.
- Ledoux MP, Guffroy B, Nivoix Y, Simand C, Herbrecht R. Invasive pulmonary aspergillosis. Semin Respir Crit Care Med. 2020;41(1):80-98.
- Marr KA, Carter RA, Crippa F, Wald A, Corey L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34(7):909-17.
- Zmeili OS, Soubani AO. Pulmonary aspergillosis: a clinical update. QJM. 2007;100(6):317-34.
- Kanj A, Abdallah N, Soubani AO. The spectrum of pulmonary aspergillosis. Respir Med. 2018;141:121-31.
- Stuck AE, Minder CE, Frey FJ. Risk of infectious complications in patients taking glucocorticosteroids. Rev Infect Dis. 1989;11(6):954-63.
- Gu Y, Ye X, Liu Y, et al. A risk-predictive model for invasive pulmonary aspergillosis in patients with acute exacerbation of chronic obstructive pulmonary disease. Respir Res. 2021;22(1):176.
- Karti SS, Odabasi Z, Korten V, et al. Crimean-Congo hemorrhagic fever in Turkey. Emerg Infect Dis. 2004;10(8):1379-84.
- Ergonul O, Tuncbilek S, Baykam N, Celikbas A, Dokuzoguz B. Evaluation of serum levels of interleukin (IL)-6, IL-10, and tumor necrosis factor-alpha in patients with Crimean-Congo hemorrhagic fever. J Infect Dis. 2006;193(7):941-4.
- Dokuzoguz B, Celikbas AK, Gök ŞE, Baykam N, Eroglu MN, Ergönül Ö. Severity scoring index for Crimean-Congo hemorrhagic fever and the impact of ribavirin and corticosteroids on fatality. Clin Infect Dis. 2013;57(9):1270-4.
- Sharifi-Mood B, Alavi-Naini R, Metanat M, Mohammadi M, Shakeri A, Amjadi A. Efficacy of high-dose methylprednisolone in patients with Crimean-Congo haemorrhagic fever and severe thrombocytopenia. Trop Doct. 2013;43(2):49-53.
- Çayıröz P, Çayıröz MU, Iltar U, Kurtoğlu E. Kırım-Kongo kanamalı ateşi ile eş zamanlı akut lenfoblastik lösemi tanısı alan olgu. Mikrobiyol Bul. 2020;54(2):326-33.
- Blot SI, Taccone FS, Van den Abeele AM, et al. A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am J Respir Crit Care Med. 2012;186(1):56-64.
- Patterson TF, Thompson GR III, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the infectious diseases society of America. Clin Infect Dis. 2016;63(4):1-60.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Infectious Diseases |
| Journal Section | CASE REPORT |
| Authors | |
| Project Number | - |
| Publication Date | January 27, 2024 |
| Acceptance Date | September 25, 2023 |
| Published in Issue | Year 2024 Volume: 29 Issue: 1 |
This Journal licensed under a CC BY-NC (Creative Commons Attribution-NonCommercial 4.0) International License.