Invasive pulmonary aspergillosis after near-drowning

Vieira, Débora Feijó Villas Boas; Saene, H. K. F. van; Miranda, Dinis Reis

doi:10.1007/bf00259439

Cited by 30 publications

(10 citation statements)

References 4 publications

(3 reference statements)

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“…Taken together, our data provide good circumstantial evidence of invasive aspergillosis and a link to water. Earlier suggestions that a wet route of transmission might exist can be found in anecdotal reports linking invasive aspergillosis with aspiration of contaminated surface water in near-drowning patients (22,26). Furthermore, molecular characterization (RAPD) of a clinical A. fumigatus isolate with an isolate recovered from the shower wall showed genotypically indistinguishable A. fumigatus isolates (2).…”

Section: Discussionmentioning

confidence: 99%

Molecular Epidemiology of Aspergillus fumigatus Isolates Recovered from Water, Air, and Patients Shows Two Clusters of Genetically Distinct Strains

et al. 2003

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There has been an increase in data suggesting that besides air, hospital water is a potential source of transmission of filamentous fungi, and in particular Aspergillus fumigatus. Molecular characterization of environmental and clinical A. fumigatus isolates, collected prospectively during an 18-month period, was performed to establish if waterborne fungi play a role in the pathogenesis of invasive aspergillosis. Isolates recovered from water (n ‫؍‬ 54) and air (n ‫؍‬ 21) at various locations inside and outside the hospital and from 15 patients (n ‫؍‬ 21) with proven, probable, or possible invasive aspergillosis were genotyped by amplified fragment length polymorphism analysis. Based on genomic fingerprints, the environmental A. fumigatus isolates could be grouped into two major clusters primarily containing isolates recovered from either air or water. The genotypic relatedness between clinical and environmental isolates suggests that patients with invasive aspergillosis can be infected by strains originating from water or from air. In addition, 12 clusters with genetically indistinguishable or highly related strains were differentiated, each containing two to three isolates. In two clusters, clinical isolates recovered from patients matched those recovered from water sources, while in another cluster the clinical isolate was indistinguishable from one cultured from air. This observation might open new perspectives in the development of infection control measures to prevent invasive aspergillosis in high-risk patients. The genetic variability found between airborne and waterborne A. fumigatus strains might prove to be a powerful tool in understanding the transmission of invasive aspergillosis and in outbreak control.With the continuing increase in the number of severely immunocompromised patients, hospitals are faced with the growing problem of invasive aspergillosis and other opportunistic fungal infections (17). Since treatment of these infections is difficult and the outcome is often fatal, preventive measures are of major importance in the control of invasive filamentous fungal infections. Nosocomial invasive aspergillosis is thought to be primarily airborne; however, despite the use of appropriate hospital air filtration systems, the incidence of this infection continues to increase. Together with the lack of genetic relatedness between airborne strains and those causing invasive disease (10, 12), it is tempting to speculate about the existence of other routes of transmission.As early as 1985, Aspergillus species and other filamentous fungi were shown to inhabit water distribution systems that deliver water to hospitals in Europe and the United States (13). Recently, there has been an increase in data supporting water as a potential source of filamentous fungi and, in particular, Aspergillus fumigatus (1, 2, 4, 28). However, direct evidence that waterborne A. fumigatus strains are involved in human infection is lacking. To test the hypothesis that a wet route of transmission might exist, we performed molecu...

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Section: Discussionmentioning

confidence: 99%

Molecular Epidemiology of Aspergillus fumigatus Isolates Recovered from Water, Air, and Patients Shows Two Clusters of Genetically Distinct Strains

et al. 2003

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“…4,15 Of note, aspergillosis after near-drowning appears to be more rarer than scedosporiosis with seven cases reported so far. [35][36][37][38][39][40][41] Among the diagnostic difficulties are also the cross-reactivity noted to Cryptococcus capsular antigens 30,42 and the false negative immune reactions because of high genetic variability of Pseudallascheria spp. 43 In view of these difficulties, immunological 9,44,45 and molecular techniques 26,46 may provide a rapid and sensitive alternative to diagnose S. apiospermum infections after near-drowning.…”

Section: Discussionmentioning

confidence: 99%

Scedosporium apiospermum infection after near‐drowning

Katragkou

Dotis

Kotsiou

et al. 2007

Mycoses

106

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Scedosporium apiospermum and its teleomorph (sexual form) Pseudallescheria boydii are ubiquitous saprophytic fungi, which under specific conditions, such as near-drowning, may cause therapy-refractory and life-threatening infections. We reviewed 22 cases (eight children and 14 adults) of S. apiospermum infection after near-drowning reported in the literature including an additional paediatric case from our institution. Scedosporiosis after near-drowning was associated with high mortality (16/23, 70%) even in immunocompetent hosts. It affected mainly young (mean age 24 years) and immunocompetent (83% with no apparent immune defect) males (male to female ratio 2.5 : 1). Scedosporiosis after near-drowning was a slow progressive disease (mean survival time 87 days) involving virtually all body organs. However, central nervous system (CNS) dissemination predominated (21/23, 91%) presenting mainly as multiple brain abscesses (15/23, 65%). All 23 patients showed preceding clinical and/or radiological evidence of lung disease indicating the mode of invasion. Diagnosis was delayed (median time to diagnosis 28 days) and was made by culture (16/23, 69.5%) or culture and tissue examination (7/23, 30.5%). The majority of the patients (20/23, 87%) received antifungal treatment and underwent neurosurgery. While the optimal treatment remains undefined, the most recent reports indicated voriconazole as a potentially effective option. Better knowledge of scedosporiosis after near-drowning could lead to improved intervention and ultimately to more favourable outcome.

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“…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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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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Invasive pulmonary aspergillosis after near-drowning

Cited by 30 publications

References 4 publications

Molecular Epidemiology of Aspergillus fumigatus Isolates Recovered from Water, Air, and Patients Shows Two Clusters of Genetically Distinct Strains

Molecular Epidemiology of Aspergillus fumigatus Isolates Recovered from Water, Air, and Patients Shows Two Clusters of Genetically Distinct Strains

Scedosporium apiospermum infection after near‐drowning

A Challenging Case of Invasive Pulmonary Aspergillosis After Near-Drowning

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