title: Invasive pulmonary and central nervous system aspergillosis after near-drowning of a child: case report and review of the literature.
abstract: Invasive aspergillosis is extremely rare in immunocompetent children. Here we describe the clinical, radiologic, and laboratory course of fatal invasive pulmonary and central nervous system aspergillosis in a previously healthy child after a near-drowning incident with submersion in a pond. Findings were compared with data from the literature, which is reviewed. Serum Aspergillus galactomannan levels were determined retrospectively and were compared with the results of routine microbiological and radiologic examinations, showing a significant diagnostic and therapeutic delay of the routine diagnostic approach in comparison with the use of the Aspergillus galactomannan assay. This delay may have contributed to the fatal course. Serial determination of serum Aspergillus galactomannan may be helpful in diagnosing invasive aspergillosis early in case of pulmonary disease after near-drowning and may contribute to an early appropriate treatment. Currently voriconazole, eventually in combination with caspofungin, should be considered as the drug of choice in the management of invasive aspergillosis after near-drowning.
authors.affiliation: Division of Pediatric Intensive Care, Department of Pediatrics, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, Netherlands. pler@paed.azm.nl
authors.forename: Piet
authors.initials: P
authors.lastname: Leroy
authors.forename: Annick
authors.initials: A
authors.lastname: Smismans
authors.forename: Tatjana
authors.initials: T
authors.lastname: Seute
mesh_terms: D001228:Aspergillosis / Q000175:diagnosis / Q000209:etiology*; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D004198:Disease Susceptibility; D042241:Early Diagnosis; D004827:Epilepsy / Q000209:etiology; D017809:Fatal Outcome; D005260:Female; D005618:Fresh Water; D005690:Galactose / Q000031:analogs & derivatives; D016905:Gram-Negative Bacterial Infections / Q000209:etiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000209:etiology*; D008351:Mannans / Q000097:blood; D015701:Near Drowning / Q000150:complications* / Q000628:therapy; D020953:Neuroaspergillosis / Q000175:diagnosis / Q000209:etiology*; D010264:Paraplegia / Q000209:etiology; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000209:etiology / Q000382:microbiology; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012131:Respiratory Insufficiency / Q000209:etiology; D020615:Stenotrophomonas maltophilia / Q000302:isolation & purification; D014871:Water Microbiology
chemical_list: D008351:Mannans; C012990:galactomannan; D005690:Galactose