Fulminant Invasive Pulmonary Aspergillosis After a Near-Drowning Accident in an Immunocompetent Patient

Ratermann, Kelley; Ereshefsky, Benjamin; Fleishaker, Elise L.; Thornton, Alice; Buch, Ketan; Martin, Craig A.

doi:10.1177/1060028014537611

Cited by 13 publications

(20 citation statements)

References 18 publications

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“…Although samples from the site of the near-drowning episode were not sent for A. fumigatus culture, aspirated seawater and surrounding particulate material were presumed to be the source of his infection. We reviewed all cases of invasive pulmonary aspergillosis reported in the English literature, with one additional case in Japanese that was documented in another reference [9]. …”

Section: Discussionmentioning

confidence: 99%

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A Challenging Case of Invasive Pulmonary Aspergillosis After Near-Drowning

Jenks

Preziosi

2015

Infectious Diseases in Clinical Practice

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Near-drowning, a relatively common event, is often complicated by subsequent pneumonia. While endogenous and exogenous bacteria are typical pathogens, rarely fungi are as well. We report a complicated case of invasive pulmonary aspergillosis in a 30-year-old man after a near-drowning event. We also review the medical literature for similar cases. All cases of invasive pulmonary aspergillosis after near-drowning reported in the literature involve Aspergillus fumigatus. The majority of cases involved submersion in stagnant water after a motor vehicle accident (MVA). Treatment varied considerably, with amphotericin B used in the majority of cases. Morbidity was considerable with prolonged hospitalization occurring in every case, and mortality occurring in fifty percent of the reported cases. Although a rare complication of near-drowning, invasive pulmonary aspergillosis can occur and lead to significant morbidity and mortality. After neardrowning A. fumigatus isolated from the respiratory tract should be assumed to be a true pathogen and treated accordingly.

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Section: Discussionmentioning

confidence: 99%

“…Treatment varied considerably, although amphotericin B was used in the majority of cases. Unfortunately, invasive pulmonary aspergillosis after near-drowning is associated with significant morbidity, leading to prolonged hospitalization in every case and mortality in 50% of reported cases [4 – 9]. …”

Section: Discussionmentioning

confidence: 99%

A Challenging Case of Invasive Pulmonary Aspergillosis After Near-Drowning

Jenks

Preziosi

2015

Infectious Diseases in Clinical Practice

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“…Pulmonary function tests showed that our patients had better forced expiratory volume in 1 second compared with European and North American reports. The underlying lung condition varied among patients given the diverse cause of PA, which can also develop in patients without underlying disease after intensive environmental exposure to Aspergillus spores [1,20,21]. Spectrum studies have also revealed a wide range of prevalence of tuberculosis or other underlying lung disease in PA patients, from 15.3% in Manchester, United Kingdom, to 93% in Korea [22][23][24].…”

Section: Commentmentioning

confidence: 98%

Sublobar Resection for Pulmonary Aspergilloma: A Safe Alternative to Lobectomy

Yuan

Huang

Zhang

et al. 2017

The Annals of Thoracic Surgery

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“…By contrast, immunocompetent subjects can have manifested features of invasive disease as soon as one day after massive environmental exposure to Aspergillus spores. 6 In the literature, a spectrum of disease is reported. Allergic broncho-pulmonary aspergillosis (ABPA) 7 and hypersensitivity pneumonitis to Aspergillus 2 and invasive pulmonary Aspergillus disease 4 can all occur following inhalation of high levels of spores.…”

Section: Discussionmentioning

confidence: 99%

“…Previously reported sources for massive inhalation of Aspergillus spores include mouldy hay, 2 bark chippings 3 and rotten tree stumps, 4 mushroom pickers 5 and following near drowning 6 . With underlying immunosuppression, onset of disease is often insidious.…”

Section: Discussionmentioning

confidence: 99%

Lesson of the month 1: A cough that doesn’t fit the mould

Baggott

Sharp

Bhatt³

et al. 2015

Clinical Medicine

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Aspergillus disease has a wide spectrum of manifestations within the lungs; however invasive Aspergillus is most commonly associated with immunocompromise or preexisting respiratory disease. Here we present a case of Aspergillus tracheobronchitis causing right middle lobe collapse, masquerading as late-onset asthma in a patient with no pre-existing risk factors following massive inhalation of Aspergillus spores from working with compost. This case highlights the importance of having a high index of suspicion for Aspergillus-related disease even in those with no traditional risk factors. KEYWORDS: Aspergillus tracheobronchitis, immunocompetent, invasive Aspergillus, spore inhalation Case reportA 67-year-old man was referred to respiratory outpatients with a nine-month history of breathlessness, wheeze and cough productive of light-brown tenacious sputum plugs. He had no significant past medical history. In the previous spring, while turning a pile of dry compost he had aspirated a significant amount of the resultant dust. That evening he became breathlessness, however this resolved after a few hours.The following week, while moving a pile of decaying weeds to the compost, he once again became breathless. This recurred a month later after disposing of weeds into the compost again, with an additional cough on this occasion. His symptoms now persisted, with progressive dyspnoea, cough and occasional wheeze.Following pulmonary function tests and initial review in the clinic, asthma was suspected, however the prescribed inhaled corticosteroid and short acting β2-agonist had little effect on his symptoms. A chest radiograph at this time was normal. His breathlessness increased and when he was seen in respiratory clinic he was struggling to walk 30 yards. He was expectorating brown cylindrical mucus plugs. Examination in clinic was consistent with right lower lobe collapse and oxygen saturations were 91% on air. A chest radiograph in the clinic revealed right middle and lower lobe collapse (Fig 1) and a sputum sample grew Aspergillus fumigatus. A computed tomography of the patient's chest, abdomen and pelvis showed occlusion of the bronchus intermedius with soft tissue. There was no evidence of a mass lesion (Fig 2). Blood tests are shown in Table 1. Peripheral eosinophils were raised, as were total immunoglobulin (Ig) E, IgE to Aspergillus and IgG to Aspergillus.Flexible bronchoscopy was performed, demonstrating a substantial, thick mucus plug in the bronchus intermedius (Fig 3). This was aspirated and a broncho-alvelolar lavage was undertaken. Endobronchial biopsies showed significant eosinophilia and there was no evidence of malignancy. Microscopy of the mucus plug showed branching Aspergillus hyphae (Fig 3) and Aspergillus fumigatus complex was cultured which was sensitive to voriconazole and itraconazole.The patient was seen by the respiratory physiotherapists to teach sputum clearance techniques which led to partial reinflation of the right lower lobe; however this was not maintained so he was commenced on oral pr...

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Fulminant Invasive Pulmonary Aspergillosis After a Near-Drowning Accident in an Immunocompetent Patient

Cited by 13 publications

References 18 publications

A Challenging Case of Invasive Pulmonary Aspergillosis After Near-Drowning

A Challenging Case of Invasive Pulmonary Aspergillosis After Near-Drowning

Sublobar Resection for Pulmonary Aspergilloma: A Safe Alternative to Lobectomy

Lesson of the month 1: A cough that doesn’t fit the mould

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