title: Acute invasive pulmonary aspergillosis, shortly after occupational exposure to polluted muddy water, in a previously healthy subject.
abstract: Invasive pulmonary aspergillosis (IPA) predominantly occurs in severely neutropenic immunocompromised subjects. The occurrence of acute IPA after brief but massive exposure to Aspergillus conidia in previously healthy subjects has been documented, although only six such cases have been reported. The diagnosis was delayed in all six of the affected patients, five of whom died. We report the case of a 50-year-old HIV-negative male, a water pipeline maintenance worker, who presented with acute-onset dyspnea and fever one day after working for 2 h in a deep pit containing polluted, muddy water. Over a one-month period, his general condition deteriorated markedly, despite antibiotic therapy. Imaging showed bilateral diffuse nodules with cavitation, some of which were surrounded by ground-glass opacity suggestive of a halo sign (a hallmark of IPA). Cultures (of sputum/bronchial aspirate samples) and serology were positive for Aspergillus fumigatus. After being started on itraconazole, the patient improved. We conclude that massive exposure to Aspergillus conidia can lead to acute IPA in immunocompetent subjects.
authors.affiliation: Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, Italia.
authors.forename: Vikas
authors.initials: V
authors.lastname: Pilaniya
authors.affiliation: Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, Italia.
authors.forename: Kamal
authors.initials: K
authors.lastname: Gera
authors.affiliation: Department of Radiology and Imaging, Saket City Hospital, Saket, New Delhi, Italia.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gothi
authors.affiliation: Department of Respiratory Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, Italia.
authors.forename: Ashok
authors.initials: A
authors.lastname: Shah
mesh_terms: D000208:Acute Disease; D000935:Antifungal Agents / Q000627:therapeutic use; D006801:Humans; D007121:Immunocompetence; D055744:Invasive Pulmonary Aspergillosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D011859:Radiography; D016896:Treatment Outcome; D014876:Water Pollution / Q000009:adverse effects*
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole