Ko-infeksi Jamur pada COVID-19 dengan Terapi Steroid

*Septian Adi Permana orcid  -  Departemen Anestesiologi dan Terapi Intensif; Fakultas Kedokteran; Universitas Indonesia; Jakarta, Indonesia
Adhrie Sugiarto  -  Departemen Anestesiologi dan Terapi Intensif; Fakultas Kedokteran; Universitas Indonesia; Jakarta, Indonesia
Muhammad Husni Thamrin  -  Instalasi Perawatan Intensif; RSUD Dr Moewardi; Surakarta, Indonesia
Purwoko Purwoko  -  Instalasi Perawatan Intensif; RSUD Dr Moewardi; Surakarta, Indonesia
Arifin Arifin  -  Instalasi Perawatan Intensif; RSUD Dr Moewardi; Surakarta, Indonesia
Eko Setijanto  -  Instalasi Perawatan Intensif; RSUD Dr Moewardi; Surakarta, Indonesia
Published: 1 Nov 2020.
Open Access
Citation Format:
Abstract

Latar belakang: Ko-infeksi jamur pada pasien Corona Virus Disease 2019 (COVID-19) acapkali terjadi. Hal itu dikarenakan kegagalan sistem imun karena infeksi COVID-19 maupun karena pengobatan anti inflamasi yang diberikan.

Kasus: Seorang laki-laki 39 tahun dengan acute respiratory distress syndrome (ARDS) berat akibat infeksi COVID-19 dan disertai dengan ko-infeksi jamur. Pasien ini mendapatkan pengobatan steroid dari awal masuk dan pada hari ke-6 hasil kultur sputumnya menunjukkan adanya ko-infeksi jamur. Pasien ini memiliki komorbid berupa riwayat diabetes mellitus. Dari pemeriksaan fisik ditemukan dispnea, takipnea, takikardia sejak hari pertama. Dari hasil laboratorium menunjukkan angka leukosit, high sensitivity c-reactive protein (HsCRP), serum glutamic oxaloacetic (SGOT), gula darah, d-dimmer, lactat dehydrogenase (LDH) dan limfosit netrophyl ratio (LNR) yang tinggi. Pada pasien ini didapatkan rasio PaO2 / FiO2 rendah dan procalcitonin (PCT) yang normal. Dari kultur sputum ditemukan adanya infeksi jamur dan dari hasil rontgen toraks (CXR) menunjukkan pneumonia bilateral.

Pasien ini dirawat dengan terapi standar dan mendapatkan dexametason 5 mg / 8 jam, setelah kultur sputum menunjukkan infeksi jamur, pasien juga mendapat mycafungin untuk pengobatan jamurnya.

Diskusi: Kecurigaan terhadap ko-infeksi jamur pada pasien COVID-19 yang mendapatkan terapi steroid dalam jangka waktu lama maupun adanya penyerta diabetes harus dipikirkan. Penggunaan terapi anti jamur empiris pun acapkali diperlukan untuk mengurangi morbiditas dan mortalitas.

Kesimpulan: Infeksi COVID-19 memiliki risiko terjadinya ko-infeksi, salah satunya adalah infeksi jamur. Insiden koinfeksi jamur diperberat dengan pemberian pengobatan steroid dan riwayat diabetes mellitus. 

Keywords: COVID-19; diabetes mellitus; infeksi jamur; ko-infeksi; steroid

Article Metrics:

  1. Organization WH. WHO Coronavirus Disease (COVID-19) Dashboard. WHO Coronavirus Disease (COVID-19) Dashboard. 2020. p. https://covid19.who.int/
  2. Song G, Liang G, Liu W. Fungal Co-infections Associated with Global COVID-19 Pandemic: A Clinical and Diagnostic Perspective from China. Mycopathologia [Internet]. 2020/07/31. 2020 Aug;185(4):599–606. Available from: https://pubmed.ncbi.nlm.nih.gov/32737747
  3. Fekkar A, Poignon C, Blaize M, Lampros A. Fungal Infection during COVID-19: Does Aspergillus Mean Secondary Invasive Aspergillosis? Am J Respir Crit Care Med [Internet]. 2020 Jul 20;202(6):902–3. Available from: https://doi.org/10.1164/rccm.202005-1945LE
  4. Shamim S, Agarwal A, Ghosh B, Mitra M. Fungal pneumonia in intensive care unit: When to suspect and decision to treatment: A critical review. J Assoc Chest Physicians. 2015 Jan 1;3
  5. Rawson TM, Wilson RC, Holmes A. Understanding the role of bacterial and fungal infection in COVID-19. Clin Microbiol Infect [Internet]. 2020 Nov 12; Available from: https://doi.org/10.1016/j.cmi.2020.09.025
  6. Yang J-W, Yang L, Luo R-G, Xu J-F. Corticosteroid administration for viral pneumonia: COVID-19 and beyond. Clin Microbiol Infect [Internet]. 2020 Jun 27;26(9):1171–7. Available from: https://pubmed.ncbi.nlm.nih.gov/32603802
  7. Erener S. Diabetes, infection risk and COVID-19. Mol Metab [Internet]. 2020/06/23. 2020 Sep;39:101044. Available from: https://pubmed.ncbi.nlm.nih.gov/32585364
  8. Sharun K, Tiwari R, Dhama J, Dhama K. Dexamethasone to combat cytokine storm in COVID-19: Clinical trials and preliminary evidence. Int J Surg [Internet]. 2020/09/04. 2020 Oct;82:179–81. Available from: https://pubmed.ncbi.nlm.nih.gov/32896649
  9. Narain S, Stefanov DG, Chau AS, Weber AG, Marder G, Kaplan B, et al. Comparative Survival Analysis of Immunomodulatory Therapy for Coronavirus Disease 2019 Cytokine Storm. Chest [Internet]. 2020 Nov 23; Available from: https://doi.org/10.1016/j.chest.2020.09.275
  10. Calcagno A, Ghisetti V, Burdino E, Trunfio M, Allice T, Boglione L, et al. Coinfection with other respiratory pathogens in COVID-19 patients. Clin Microbiol Infect [Internet]. 2020 Oct 25; Available from: https://doi.org/10.1016/j.cmi.2020.08.012
  11. Ahmed MM, Farghaly AA, Raafat RH, Abd Elsattar WM. Study of the prevalence and pattern of fungal pneumonias in respiratory intensive care units. Egypt J Bronchol [Internet]. 2019;13(4):545–50. Available from: https://doi.org/10.4103/ejb.ejb_37_19
  12. Silva L, Mello T, Ramos L, Branquinha M, Roudbary M, Santos A. Fungal Infections in COVID-19-Positive Patients: a Lack of Optimal Treatment Options. Curr Top Med Chem. 2020 Aug 25;20
  13. Kotsopoulou M, Papadaki C, Anargyrou K, Spyridonidis A, Baltadakis I, Papadaki HA, et al. Effectiveness and Safety of Micafungin in Managing Invasive Fungal Infections among Patients in Greece with Hematologic Disorders: The ASPIRE Study. Infect Dis Ther [Internet]. 2019/02/14. 2019 Jun;8(2):255–68. Available from: https://pubmed.ncbi.nlm.nih.gov/30767170
  14. Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: a systematic review and meta-analysis. J Infect [Internet]. 2020/05/27. 2020 Aug;81(2):266–75. Available from: https://pubmed.ncbi.nlm.nih.gov/32473235
  15. Patel SK, Saikumar G, Rana J, Dhama J, Yatoo MI, Tiwari R, et al. Dexamethasone: A boon for critically ill COVID-19 patients? Travel Med Infect Dis [Internet]. 2020/08/10. 2020;37:101844. Available from: https://pubmed.ncbi.nlm.nih.gov/32791213

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Last update: 2021-03-07 23:01:05

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