{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T13:55:40Z","timestamp":1764251740991,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,2,23]],"date-time":"2022-02-23T00:00:00Z","timestamp":1645574400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes direct damage to the pulmonary epithelium, enabling Aspergillus invasion. Rapid progression and high mortality of invasive aspergillosis have been reported. In the present study, we report a rare case of possible COVID-19-associated pulmonary aspergillosis (CAPA) caused by A. niger in a Greek patient. Diagnosis was based on ECMM\/ISHAM specific criteria and the new algorithm \u201cBM-AspICU\u201d for the invasive pulmonary aspergillosis diagnostic strategy. The fungal isolate was recovered in a non-bronchoalveolar lavage (non-BAL) sample and its identification was performed by standard macroscopic and microscopic morphological studies. MALDI-TOF analysis confirmed the identification of A. niger. In addition, galactomannan antigen and Aspergillus real-time PCR testing were positive in the non-BAL sample, while in serum they proved negative. The A. niger isolate showed an MIC for fluconazole \u2265128 \u03bcg\/mL, for itraconazole and posaconazole 0.25 \u03bcg\/mL, for voriconazole 0.5 \u03bcg\/mL, for flucytosine 4 \u03bcg\/mL, for amphotericin B 1 \u03bcg\/mL, and for all echinocandins (caspofungin, anidulafungin, micafungin) &gt;8 \u03bcg\/mL. The patient was initially treated with voriconazole; amphotericin B was subsequently added, when a significant progression of cavitation was demonstrated on chest computed tomography. A. niger was not isolated in subsequent samples and the patient\u2019s unfavorable outcome was attributed to septic shock caused by a pandrug-resistant Acinetobacter baumannii strain.<\/jats:p>","DOI":"10.3390\/antibiotics11030300","type":"journal-article","created":{"date-parts":[[2022,2,23]],"date-time":"2022-02-23T22:54:02Z","timestamp":1645656842000},"page":"300","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Possible COVID-19-Associated Pulmonary Aspergillosis Due to Aspergillus niger in Greece"],"prefix":"10.3390","volume":"11","author":[{"given":"Maria","family":"Katsiari","sequence":"first","affiliation":[{"name":"Intensive Care Medicine, General Hospital of N. Ionia Konstantopouleio-Patission, 14233 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2522-1673","authenticated-orcid":false,"given":"Angeliki","family":"Mavroidi","sequence":"additional","affiliation":[{"name":"Department of Microbiology, General Hospital of N. Ionia Konstantopouleio-Patission, 14233 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleftheria","family":"Palla","sequence":"additional","affiliation":[{"name":"Department of Microbiology, General Hospital of N. Ionia Konstantopouleio-Patission, 14233 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantina","family":"Zourla","sequence":"additional","affiliation":[{"name":"Department of Microbiology, General Hospital of N. Ionia Konstantopouleio-Patission, 14233 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theodoros","family":"Alonistiotis","sequence":"additional","affiliation":[{"name":"Intensive Care Medicine, General Hospital of N. Ionia Konstantopouleio-Patission, 14233 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyriakos","family":"Ntorlis","sequence":"additional","affiliation":[{"name":"Intensive Care Medicine, General Hospital of N. Ionia Konstantopouleio-Patission, 14233 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charikleia","family":"Nikolaou","sequence":"additional","affiliation":[{"name":"Intensive Care Medicine, General Hospital of N. Ionia Konstantopouleio-Patission, 14233 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4766-8238","authenticated-orcid":false,"given":"Georgia","family":"Vrioni","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0656-4715","authenticated-orcid":false,"given":"Athanasios","family":"Tsakris","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1496","DOI":"10.1056\/NEJMra2027424","article-title":"Aspergillus infections","volume":"385","author":"Thompson","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1093\/cid\/ciaa248","article-title":"Dysregulation of immune response in patients with Coronavirus 2019 (COVID-19) in Wuhan, China","volume":"71","author":"Qin","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Arastehfar, A., Carvalho, A., Van De Veerdonk, F.L., Jenks, J.D., Koehler, P., Krause, R., Cornely, O.A., Perlin, D.S., Lass-Fl\u00f6rl, C., and Hoenigl, M. (2020). COVID-19 associated pulmonary aspergillosis (CAPA)\u2014From immunology to treatment. J. Fungi, 6.","DOI":"10.3390\/jof6020091"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e445","DOI":"10.1093\/cid\/ciaa954","article-title":"Tocilizumab for treatment of mechanically ventilated patients with COVID-19","volume":"73","author":"Somers","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"The RECOVERY Collaborative Group (2021). Dexamethasone in hospitalized patients with Covid-19. N. Engl. J. Med., 384, 693\u2013704.","DOI":"10.1056\/NEJMoa2021436"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.3201\/eid2704.204895","article-title":"COVID-19-associated pulmonary aspergillosis, March\u2013August 2020","volume":"27","author":"Sprute","year":"2021","journal-title":"Emerg. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.1097\/LBR.0000000000000681","article-title":"American Association for Bronchology and Interventional Pulmonology (AABIP) Statement on the Use of Bronchoscopy and Respiratory Specimen Collection in Patients with Suspected or Confirmed COVID-19 Infection","volume":"27","author":"Wahidi","year":"2020","journal-title":"J. Bronc. Interv. Pulmonol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Mohamed, A., Rogers, T.R., and Talento, A.F. (2020). COVID-19 associated invasive pulmonary aspergillosis: Diagnostic and therapeutic challenges. J. Fungi, 6.","DOI":"10.3390\/jof6030115"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e149","DOI":"10.1016\/S1473-3099(20)30847-1","article-title":"Defining and managing COVID-19-associated pulmonary aspergillosis: The 2020 ECMM\/ISHAM consensus criteria for research and clinical guidance","volume":"21","author":"Koehler","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13613-021-00827-3","article-title":"New clinical algorithm including fungal biomarkers to better diagnose probable invasive pulmonary aspergillosis in ICU","volume":"11","author":"Hamam","year":"2021","journal-title":"Ann. Intensiv. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and Update of the Consensus Definitions of Invasive Fungal Disease from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Gangneux, J.-P., Reizine, F., Guegan, H., Pinceaux, K., Le Balch, P., Prat, E., Pelletier, R., Belaz, S., Le Souhaitier, M., and Le Tulzo, Y. (2020). Is the COVID-19 Pandemic a Good Time to Include Aspergillus Molecular Detection to Categorize Aspergillosis in ICU Patients? A Monocentric Experience. J. Fungi, 6.","DOI":"10.3390\/jof6030105"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Apostolopoulou, A., Garrigos, Z.E., Vijayvargiya, P., Lerner, A.H., and Farmakiotis, D. (2020). Invasive Pulmonary Aspergillosis in Patients with SARS-CoV-2 Infection: A Systematic Review of the Literature. Diagnostics, 10.","DOI":"10.3390\/diagnostics10100807"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/myc.13213","article-title":"Invasive pulmonary aspergillosis in the COVID-19 era: An expected new entity","volume":"64","author":"Machado","year":"2021","journal-title":"Mycoses"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1007\/s40121-021-00486-8","article-title":"Epidemiology and Incidence of COVID-19-Associated Pulmonary Aspergillosis (CAPA) in a Greek Tertiary Care Academic Reference Hospital","volume":"10","author":"Paramythiotou","year":"2021","journal-title":"Infect. Dis. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1164\/rccm.202004-1038LE","article-title":"COVID-19-associated Pulmonary Aspergillosis","volume":"202","author":"Rijpstra","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1111\/myc.13096","article-title":"COVID-19 associated pulmonary aspergillosis","volume":"63","author":"Koehler","year":"2020","journal-title":"Mycoses"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1016\/j.cmi.2020.05.032","article-title":"Invasive pulmonary aspergillosis in severe coronavirus disease 2019 pneumonia","volume":"26","author":"Lahmer","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/s13613-020-00686-4","article-title":"COVID-19-associated invasive pulmonary aspergillosis","volume":"10","author":"Rutsaert","year":"2020","journal-title":"Ann. Intensive Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e3606","DOI":"10.1093\/cid\/ciaa1065","article-title":"Epidemiology of Invasive Pulmonary Aspergillosis Among Intubated Patients With COVID-19: A Prospective Study","volume":"73","author":"Bartoletti","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e53","DOI":"10.1016\/S2666-5247(20)30027-6","article-title":"Diagnosing COVID-19-associated pulmonary aspergillosis","volume":"1","author":"Verweij","year":"2020","journal-title":"Lancet Microbe"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"435","DOI":"10.2217\/17460913.1.4.435","article-title":"Phenotypic and genotypic identification of human pathogenic aspergilli","volume":"1","author":"Balajee","year":"2006","journal-title":"Futur. Microbiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1464","DOI":"10.1016\/j.cmi.2020.06.007","article-title":"How to interpret MICs of antifungal compounds according to the revised clinical breakpoints v. 10.0 European committee on antimicrobial susceptibility testing (EUCAST)","volume":"26","author":"Arendrup","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1111\/myc.13135","article-title":"COVID-19-associated pulmonary aspergillosis (CAPA) in patients admitted with severe COVID-19 pneumonia: An observational study from Pakistan","volume":"63","author":"Nasir","year":"2020","journal-title":"Mycoses"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1111\/myc.13155","article-title":"Isolation of Aspergillus spp. in respiratory samples of patients with COVID-19 in a Spanish Tertiary Care Hospital","volume":"63","author":"Maseda","year":"2020","journal-title":"Mycoses"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e48","DOI":"10.1016\/S2213-2600(20)30237-X","article-title":"Prevalence of putative invasive pulmonary aspergillosis in critically ill patients with COVID-19","volume":"8","author":"Alanio","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1111\/anae.15425","article-title":"Mortality in patients admitted to intensive care with COVID-19: An updated systematic review and meta-analysis of observational studies","volume":"76","author":"Armstrong","year":"2021","journal-title":"Anaesthesia"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1111\/j.1439-0507.2004.00960.x","article-title":"Aspergillus niger Infection in Patients with Haematological Diseases: A Report of Eight Cases","volume":"47","author":"Fianchi","year":"2004","journal-title":"Mycoses"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.jinf.2019.04.002","article-title":"Development and internal validation of a model for predicting 60-day risk of invasive mould disease in patients with haematological malignancies","volume":"78","author":"Stanzani","year":"2019","journal-title":"J. Infect."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1016\/j.cmi.2020.02.017","article-title":"Antifungal susceptibility testing in Candida, Aspergillus and Cryptococcus infections: Are the MICs useful for clinicians?","volume":"26","author":"Bassetti","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Erg\u00fcn, M., Br\u00fcggemann, R.J.M., Alanio, A., Delli\u00e8re, S., van Arkel, A., Bentvelsen, R.G., Rijpstra, T., Brugge, S.V.D.S.-V.D., Lagrou, K., and Janssen, N.A.F. (2021). Aspergillus test profiles and mortality in critically ill COVID-19 patients. J. Clin. Microbiol., 59.","DOI":"10.1128\/JCM.01229-21"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.jointm.2021.07.001","article-title":"COVID-19-associated pulmonary aspergillosis (CAPA)","volume":"1","author":"Dimopoulos","year":"2021","journal-title":"J. Intensive Med."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/3\/300\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:25:34Z","timestamp":1760135134000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/11\/3\/300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,23]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["antibiotics11030300"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics11030300","relation":{},"ISSN":["2079-6382"],"issn-type":[{"type":"electronic","value":"2079-6382"}],"subject":[],"published":{"date-parts":[[2022,2,23]]}}}