title: [Invasive aspergillosis after near-drowning: case reports and review of the literature].
abstract: OBJECTIVE
  The purpose of this study was to analyze the clinical presentations and disease courses of invasive aspergillosis (IA) in patients after near-drowning.
  
  
  METHODS
  The clinical data of 3 cases of invasive aspergillosis after near-drowning from Oct. 2005 to Aug. 2010 in this hospital were retrospectively analyzed, and the related literature was reviewed.
  
  
  RESULTS
  There were 1 male and 2 female patients, aged from 18 to 72 years. All of them had been immunocompetent before drowning. Two patients drowned because of traffic accident, and 1 fell in sewage by accident. All of the 3 patients were intubated because of acute respiratory failure, and received broad-spectrum antibiotic therapy. One had transient leucopenia, and 2 patients received glucocorticoid therapy. The condition of the 3 cases deteriorated 9 to 11 days after near-drowning. Aspergillus was isolated from sputum samples of 2 patients at the same time. Thoracic CT findings included multiple nodules, consolidation and cavity formation. Multiple abscesses in cerebral parenchyma were found in 1 patient with invasive cerebral aspergillosis. One patient died, whose lungs, cerebral parenchyma, myocardium and kidney were all infected by aspergillus. The other 2 patients, whose infection limited to the lungs, had a positive prognosis. Using the terms "aspergillosis" and "near-drowning" a PUBMED search yielded 7 articles, published between 1984 and 2010. Using the terms "invasive pulmonary aspergillosis" and "near-drowning", searching Wangfang data and CHED data, encompass 1 article, published in 2009. In all of the 8 articles, there are 5 final diagnosis cases and 3 clinical diagnosis cases.
  
  
  CONCLUSIONS
  IA was very rare in immunocompetent hosts but had been reported in previously healthy individuals after near-drowning. Aspergillosis might develop 1 to 2 weeks after near-drowning, and the prognosis was poor in patients with central nervous system involvement.
authors.affiliation: Department of Respiratory Disease, Clinical School of Medical College of Nanjing University, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China.
authors.forename: Pei
authors.initials: P
authors.lastname: Li
authors.forename: E-hong
authors.initials: EH
authors.lastname: Cao
authors.forename: Bei-lei
authors.initials: BL
authors.lastname: Zhao
authors.forename: Hui-ming
authors.initials: HM
authors.lastname: Sun
authors.forename: Miao-miao
authors.initials: MM
authors.lastname: Li
authors.forename: Jin
authors.initials: J
authors.lastname: Xu
authors.forename: Yong
authors.initials: Y
authors.lastname: Song
authors.forename: Yi
authors.initials: Y
authors.lastname: Shi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000209:etiology*; D001232:Aspergillus fumigatus; D005260:Female; D006801:Humans; D008297:Male; D015701:Near Drowning / Q000150:complications*