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PMC:7326463 JSONTXT 17 Projects

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Id Subject Object Predicate Lexical cue
T1 0-95 Sentence denotes Invasive pulmonary fusariosis in an immunocompetent critically ill patient with severe COVID-19
T2 97-111 Sentence denotes To the Editor,
T3 112-276 Sentence denotes Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may develop severe coronavirus disease (COVID-19) and acute respiratory failure.
T4 277-358 Sentence denotes As the lung parenchyma is seriously damaged, opportunistic infections are feared.
T5 359-665 Sentence denotes While invasive pulmonary mould superinfections are usually diagnosed primarily in highly immunocompromised patients, invasive aspergillosis has also been described in immunocompetent patients infected with influenza or SARS-CoV (responsible for the severe acute respiratory syndrome outbreak in 2002–2003).
T6 666-800 Sentence denotes Moreover, we recently reported a case of invasive aspergillosis in an immunocompetent critically ill patient with severe COVID-19 [1].
T7 801-903 Sentence denotes Another study also suggested an increased risk of Aspergillus superinfection in COVID-19 patients [2].
T8 904-1054 Sentence denotes To know whether or not COVID-19 is a factor promoting invasive pulmonary mould infections in immunocompetent individuals is of great medical interest.
T9 1055-1236 Sentence denotes We report here the case of an immunocompetent diabetic patient with severe COVID-19 who developed a pulmonary fusariosis due to the common environmental mould Fusarium proliferatum.
T10 1237-1342 Sentence denotes A 57-year-old man was sent to our hospital after 7 days of fever and cough worsening over the last 24 hr.
T11 1343-1567 Sentence denotes On admission the patient presented signs of acute respiratory failure and was rapidly transferred to our intensive care unit (ICU) on March 26 (day 1) where he was intubated and placed under mechanical ventilation (Fig. 1 ).
T12 1568-1679 Sentence denotes The patient had no history of any acquired or inherited immunodeficiency and no underlying respiratory disease.
T13 1680-1862 Sentence denotes He was overweight (body mass index 30.6 kg/m2) with type 2 diabetes (blood glucose 11.6 mmol/L and glycosuria 1.4 mmol/L on admission), hypertension and a substituted hypothyroidism.
T14 1863-1935 Sentence denotes SARS-CoV-2 viral RNA was detected in a tracheal aspiration on admission.
T15 1936-2021 Sentence denotes The patient's condition worsened with a PaO2/FiO2 ratio <90 mmHg with a FiO2 of 100%.
T16 2022-2092 Sentence denotes A protected specimen brush sample performed on day 2 remained sterile.
T17 2093-2200 Sentence denotes While the patient's condition showed no improvement, a bronchoalveolar lavage (BAL) was performed on day 7.
T18 2201-2310 Sentence denotes On day 9 this sample grew with 7 × 102/mL colony-forming unit (CFU) of mould while no bacteria were detected.
T19 2311-2472 Sentence denotes The same day, a second BAL was performed: atypical fungal hyphae were detected on microscopic examination, testing for galactomannan antigen was positive (index:
T20 2473-2523 Sentence denotes 1.7) and the sample grew with 103/mL CFU of mould.
T21 2524-2758 Sentence denotes The different cultures were identified as Fusarium proliferatum using mass spectrometry (Bruker Microflex with MSI database) and a liposomal amphotericin B-based therapy was started on day 12 (5 mg/kg/day for 2 days then 7 mg/kg/day).
T22 2759-2964 Sentence denotes Antifungal susceptibility testing determined using the gradient concentration strips method showed high minimal inhibitory concentrations (MICs) (>32 mg/L) for voriconazole, posaconazole and isavuconazole.
T23 2965-3009 Sentence denotes The MIC value for amphotericin B was 2 mg/L.
T24 3010-3124 Sentence denotes Fig. 1 Timeline for an immunocompetent patient who developed invasive pulmonary fusariosis during severe COVID-19.
T25 3125-3194 Sentence denotes Day 1 is the day the patient was admitted to the intensive care unit.
T26 3195-3295 Sentence denotes D, days; BAL, bronchoalveolar lavage; GM, galactomannan index determination; BDG, β-D-glucan dosage.
T27 3296-3557 Sentence denotes Considering the very serious condition of the patient, and despite the fact that voriconazole is suggested as first-line treatment (alone or in combination) [3], caspofungin was added, assuming a potential synergistic effect with liposomal amphotericin B [4,5].
T28 3558-3681 Sentence denotes To test this hypothesis in vitro, we used the checkerboard method to assess combinations of amphotericin B and caspofungin.
T29 3682-3838 Sentence denotes The MIC of each drug alone and the combinations of the two were determined concomitantly on the same plate using a method adapted from the EUCAST procedure.
T30 3839-4071 Sentence denotes Interaction was determined by calculating the fractional inhibitory concentration index (FICI) as follows: FICI = (MIC amphotericin B in combination/MIC amphotericin B alone) + (MEC caspofungin in combination/MEC caspofungin alone).
T31 4072-4162 Sentence denotes Results showed no activity for caspofungin either alone or in combination (MEC > 32 mg/L).
T32 4163-4238 Sentence denotes The MIC value for amphotericin B was 1 mg/L either alone or in combination.
T33 4239-4306 Sentence denotes The FICI value was equal to 2, which is indicative of indifference.
T34 4307-4404 Sentence denotes Moreover, as the patient's condition was beginning to improve, caspofungin was stopped on day 29.
T35 4405-4499 Sentence denotes Three other BALs performed on day 15, day 22 and day 27 still grew with Fusarium proliferatum.
T36 4500-4628 Sentence denotes Importantly, we noticed a gradual increase in the delay of culture positivity and a decrease in the number of colonies obtained.
T37 4629-4722 Sentence denotes Galactomannan testing became negative, all of which indicated a reduction of the fungal load.
T38 4723-4855 Sentence denotes The BALs performed on day 15 and day 27 also grew with a significant amount of bacteria, which led to specific antibiotic treatment.
T39 4856-4904 Sentence denotes The patient's general condition slowly improved.
T40 4905-4967 Sentence denotes He was extubated on day 30 then discharged to a post-ICU area.
T41 4968-5030 Sentence denotes Liposomal amphotericin B administration was stopped on day 35.
T42 5031-5198 Sentence denotes Invasive aspergillosis is a well-recognized complication of severe influenza pneumonia and has been reported in patients with SARS-CoV and SARS-CoV-2 infections [1,2].
T43 5199-5381 Sentence denotes As fusariosis shares many common characteristics with aspergillosis [6], occurrence of fusariosis in immunocompetent critically ill patients with severe pulmonary damage is possible.
T44 5382-5619 Sentence denotes If we draw a parallel between fusariosis and aspergillosis, the case we describe is a putative invasive fusariosis according to the classification by Blot et al. for the diagnosis of invasive aspergillosis in critically ill patients [7].
T45 5620-5684 Sentence denotes Serum β-glucan and galactomannan testing in serum were negative.
T46 5685-5893 Sentence denotes Here again a resemblance can be seen with what is observed during invasive aspergillosis in immunocompetent patients where blood tests are often negative while respiratory samples establish the diagnosis [7].
T47 5894-6020 Sentence denotes In conclusion, we have reported a case of pulmonary fusariosis in an immunocompetent patient with severe SARS-CoV-2 pneumonia.
T48 6021-6166 Sentence denotes As the outbreak continues to spread worldwide, other reports are needed to assess the frequency of fungal superinfections during severe COVID-19.
T49 6168-6192 Sentence denotes Transparency declaration
T50 6193-6201 Sentence denotes Funding:
T51 6202-6207 Sentence denotes None.
T52 6208-6251 Sentence denotes The authors declare no competing interests.
T53 6253-6273 Sentence denotes Author contributions
T54 6274-6425 Sentence denotes C.P. and M.B. collected mycological data, performed antifungal susceptibility testing and the EUCAST checkboard method and participated in the writing.
T55 6426-6529 Sentence denotes C.V. participated in the therapeutic decision, collected clinical data and participated in the writing.
T56 6530-6595 Sentence denotes A.L. participated in the therapeutic decision and in the writing.
T57 6596-6699 Sentence denotes A.M. participated in the therapeutic decision, collected clinical data and participated in the writing.
T58 6700-6782 Sentence denotes A.F. participated in the therapeutic decision, collected data and wrote the paper.