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“I’m having trouble breathing and I have a worsening cough.”
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History of Present Illness
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48-year-old female s/p COVID-19 pneumonia 2 months prior with new-onset shortening of breath and coughing on broad-spectrum antibiotic therapy and fluconazole with no symptomatic improvement
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Which patient risk factors are present for an opportunistic mycosis infection?
Hint: See Opportunistic Mycoses in PPP.
How does the spectrum of activity differ among the triazole medication class?
Hint: See Primary (Endemic) Mycoses in PPP.
What are some clinically significant drug interactions associated with triazoles?
Hint: See Primary (Endemic) Mycoses in PPP.
What is the most likely opportunistic mycosis infection considering lack of clinical improvement on current empiric antimicrobial therapy?
Hint: See Invasive Aspergillosis in PPP.
What are some potential advantages and disadvantages of the various treatment options for this patient?
Hint: See Opportunistic Mycoses and Table 86-4 in PPP.
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Voriconazole IV every 12 hours was initiated in this patient due to concerns for Aspergillosis infection. A week later, the team is planning to discharge the patient. An electrocardiogram was performed to monitor her QT interval. She was noted to have QTc prolongation at 510 msec. What is your recommendation in regard to outpatient management of this infection?
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Aspergillosis is an infection caused by a type of mold that is ubiquitous within indoor and outdoor environments. Most species of Aspergillus are harmless, however immunocompromised individuals or those with underlying pulmonary diseases may have illnesses triggered by Aspergillus species that typically affect the respiratory tract. Aspergillosis infections may include pneumonia, sinus infections, or severe tracheobronchitis. Several case reports and observational studies have observed Aspergillosis in previously healthy patients who were hospitalized for severe illness associated with either influenza or Coronavirus Disease 2019 (COVID-19).