A Fatal Co-infections of Aspergillus latus and Pneumocystis jirovecii in COVID-19 Pneumonia Patient: Case Report

Introduction: For coronavirus disease 2019 (COVID-19) positive patients, co-infection with fungi has previously been reported. Owing to non-specific clinical manifestations and radiographic evidence, it is difficult to distinguish fungal infection from COVID-19 alone, resulting in delayed diagnosis and lack of appropriate treatment. Aspergillus latus infection, a newly rare species with life-threatening characteristics, requires rapid detection with accurate diagnosis to reduce mortality. However, there is little literature that provides a reference for a better understanding of this rare pathogen and guides medical practitioners in choosing the right diagnostics and therapies. Case Presentation: We reported a 67-year-old female complaining of fever, cough, and chest tightness, who had previously been hospitalized for a week due to initial COVID-19 pneumonia. On admission, clinical manifestations and radiological evidence were consistent with COVID-19 pneumonia, and there was no obvious improvement after anti-infective therapy. In terms of etiology for the patient, galactomannan test was positive for Aspergillus genus, and Metagenomic next-generation sequencing further determined co-infections of A. latus and Pneumocystis jirovecii. Subsequently, isolation of A. latus was obtained through microbial culture. Despite targeted antifungal therapy, no clinical improvement was observed, possibly due to delayed diagnosis and treatment. Finally, the patient died of respiratory failure. Conclusions: This case report demonstrated that metagenomic next-generation sequencing is a fast, unbiased, culture-free approach that can increase the pathogen detection rat helping clinicians improve the accuracy of clinical diagnosis and take therapeutic action as quickly as possible. Clinicians should be aware of the risk of COVID-19-associated pulmonary aspergillosis in COVID-19 patients, and we hope to optimize diagnosis and improve outcomes of COVID-19-associated pulmonary aspergillosis.