Abstract：
Patients with burn injury and inhalation injury are highly susceptible to infectious complications, including opportunistic pathogens, due to the loss of skin cover and mucosal damage of respiratory tract as well as the disruption of homeostasis. This case report, a 34-year-old man suffered critical burns, provides the first literature description of triple-impact immunoparalysis (critical burns, inhalation injury, and SARS-CoV-2 infection), leading to a lethal multifocal infection caused by several fungi including very rare environmental representatives Metschnikowia pulcherrima and Wickerhamomyces anomalus. The co-infection by these common environmental yeasts in a human is unique and has not yet been described in the literature. Importantly, our patient developed refractory septic shock and died despite targeted antifungal therapy including the most potent current antifungal agent-isavuconazole. It can be assumed that besides immunoparalysis, effectiveness of therapy by isavuconazole was impaired by the large distribution volume in this case. As this is a common situation in intensive care patients, routine monitoring of plasmatic concentration of isavuconazole can be helpful in personalization of the treatment and dose optimization. Whatmore, many fungal species often remain underdiagnosed during infectious complications, which could be prevented by implementation of new methods, such as next-generation sequencing, into clinical practice.
摘要：
烧伤和吸入性损伤患者极易发生感染性并发症,包括机会性病原体，由于皮肤覆盖和呼吸道粘膜损伤的丧失以及体内平衡的破坏。这个病例报告,一名34岁男子严重烧伤,提供了三重影响免疫麻痹(临界烧伤，吸入性损伤,和SARS-CoV-2感染），导致由几种真菌引起的致命多灶性感染，其中包括非常罕见的环境代表Metschnikowiapulcherrima和Wickerhamomycesanalomus。这些常见环境酵母在人类中的共同感染是独特的，并且尚未在文献中描述。重要的是,我们的患者出现难治性脓毒性休克,尽管有针对性的抗真菌药物治疗,包括目前最有效的抗真菌药物伊沙武康唑,但仍死亡.可以假设，除了免疫麻痹，在这种情况下，以沙康康唑的治疗效果因分布量大而受损。由于这是重症监护患者的常见情况，常规监测伊沙康唑的血浆浓度有助于治疗的个性化和剂量优化。Whatmore,在感染并发症期间，许多真菌物种通常仍未被诊断，这可以通过实施新的方法来防止，比如下一代测序，进入临床实践。
