title: Gardening can induce pulmonary failure: Aspergillus ARDS in an immunocompetent patient, a case report.
abstract: BACKGROUND
  Acute Aspergillus fumigatus infection in immunocompetent patients is rare. This is the first known case of a patient who survived Aspergillus sepsis after being treated early with veno-venous extracorporeal membrane (ECMO) and antifungal therapy.
  
  
  METHODS
  An immunocompetent 54-year-old woman was exposed to plant mulch during gardening and subsequently developed pulmonary failure that progressed to sepsis with multiorgan failure. Owing to her severe clinical condition, she was treated for acute respiratory distress syndrome (ARDS) with veno-venous ECMO. Empiric antifungal therapy comprising voriconazole was also initiated owing to her history and a previous case report of aspergillosis after plant mulch exposure, though there was no microbiological proof at the time. A. fumigatus was later cultured and detected on antibody testing. The patient recovered, and ECMO was discontinued 1 week later. After 7 days of antifungal treatment, Aspergillus antibodies were undetectable.
  
  
  CONCLUSIONS
  In cases of sepsis that occur after gardening, clinicians should consider Aspergillus inhalation as an aetiology, and early antimycotic therapy is recommended.
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany. jungnin@med.uni-marburg.de.
authors.forename: Nina
authors.initials: N
authors.lastname: Jung
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany. mronga@med.uni-marburg.de.
authors.forename: Silke
authors.initials: S
authors.lastname: Mronga
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany. schroth@med.uni-marburg.de.
authors.forename: Susanne
authors.initials: S
authors.lastname: Schroth
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Marburg, Germany. Timon.Vassiliou@med.uni-marburg.de.
authors.forename: Timon
authors.initials: T
authors.lastname: Vassiliou
authors.affiliation: Department Institute for Medical Microbiology and Hygiene, Marburg, Germany. sommerf@med.uni-marburg.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Sommer
authors.affiliation: Department of Diagnostic and Interventional Radiology, Marburg, Germany. walthers@med.uni-marburg.de.
authors.forename: Eduard
authors.initials: E
authors.lastname: Walthers
authors.affiliation: Department Institute for Virology, Marburg, Germany. aepinus@staff.uni-marburg.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Aepinus
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany. jerrentr@med.uni-marburg.de.
authors.forename: Andreas
authors.initials: A
authors.lastname: Jerrentrup
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany. vogelmei@med.uni-marburg.de.
authors.forename: Claus
authors.initials: C
authors.lastname: Vogelmeier
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany. holland@med.uni-marburg.de.
authors.forename: Angelique
authors.initials: A
authors.lastname: Holland
authors.affiliation: Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany. koczulla@med.uni-marburg.de.
authors.forename: Rembert
authors.initials: R
authors.lastname: Koczulla
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D051639:Gardening; D006801:Humans; D007121:Immunocompetence; D008875:Middle Aged; D055732:Pulmonary Aspergillosis / Q000150:complications / Q000382:microbiology* / Q000628:therapy; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000628:therapy; D018805:Sepsis / Q000150:complications / Q000382:microbiology* / Q000628:therapy
chemical_list: D000935:Antifungal Agents