Simultaneous primary invasive cutaneous aspergillosis in two preterm twins: case report and review of the literature

BMC Infectious Diseases

Case Report

Floriane Gallais¹  Julie Denis²  Ermanno Candolfi²  Marcela Sabou²  Valérie Letscher-Bru²  Laurence Dillenseger³  Olfa Koobar³  Dominique Astruc³  Raoul Herbrecht⁴ 

[1] Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie ; Hôpitaux Universitaires de Strasbourg. 1 Place de l’Hôpital, F-67000, Strasbourg, France;Laboratoire de Parasitologie et de Mycologie Médicale, Plateau Technique de Microbiologie ; Hôpitaux Universitaires de Strasbourg. 1 Place de l’Hôpital, F-67000, Strasbourg, France;Université de Strasbourg, Institut de Parasitologie et de Pathologie Tropicale, DIHP EA 7292, Fédération de Médecine Translationnelle, 3 rue Koeberlé, F-67000, Strasbourg, France;Service de Réanimation Néonatale, Hôpital de Hautepierre ; Hôpitaux Universitaires de Strasbourg, Avenue Molière, F-67200, Strasbourg, France;Service d’Oncologie et d’Hématologie, Hôpital de Hautepierre ; Hôpitaux Universitaires de Strasbourg et Université de Strasbourg, Strasbourg, France;

关键词: Primary cutaneous aspergillosis;    Newborn;    Aspergillus;    A. fumigatus;    Preterm;    Premature;    Invasive aspergillosis;   

DOI  :  10.1186/s12879-017-2646-8

 received in 2017-01-27, accepted in 2017-07-27,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundPrimary invasive cutaneous aspergillosis is a rare fungal infection that occurs mostly in immunocompromised patients. Newborns of very low birth weight present a high risk for this type of infection due to an immaturity of the cutaneous barrier and of the immune system.Case presentationWe describe here a case of simultaneous invasive cutaneous aspergillosis in two preterm twins. Two male preterm bichorionic biamniotic twins (A & B) were born at a general hospital by spontaneous normal delivery at 24 weeks and 6 days of gestation. They were transferred to our hospital where they receive surfactant, antibiotics and hydrocortisone. Six days later, twin A showed greenish lesions in the umbilical region. The spectrum of antibiotic therapy was broadened and fluconazole was added. The umbilical catheters of the two twins were removed and replaced by epicutaneo-cava venous catheters and the cultures were positive for Aspergillus fumigatus. Fluconazole was replaced in both twins by liposomal amphotericin B and the incubators were changed. The serum galactomannan was also positive for both twins. At day 10, yellowish lesions appeared in the abdominal region in twin B. He died on day 18 following complications related to his prematurity. Concerning the twin A, serum galactomannan was negative on day 30; liposomal amphotericin B was stopped 1 week later, with a relay by econazole (cream). His condition improved and on day 66 he was transferred for follow-up at the general hospital where he was born.ConclusionThe source of contamination by A. fumigatus was not identified, but other similar cases from the literature include construction work at or near the hospital, oximeter sensors, latex finger stalls, non-sterile gloves, humidifying chambers of incubators, bedding and adhesive tapes. The skin fragility of preterm newborns is an excellent potential entry point for environmental fungal infections. These cases highlight the importance of suspecting primary cutaneous aspergillosis in extremely low birth weight neonates with rapidly progressive necrotic lesions.

【 授权许可】

CC BY   
© The Author(s). 2017