Outbreak of systemic aspergillosis in a neonatal intensive care unit

Abstract

Small pre-term neonates are susceptible to cutaneous aspergillosis because of their immature immune system and because of the vulnerability of their skin. In addition, the common therapy with broad-spectrum antibiotic drugs and corticoids creates a favourable milieu for fungal superinfections. We present four pre-term neonates who succumbed to cutaneous aspergillosis that subsequently developed into a systemic infection. The source of the infection proved to be contaminated latex finger stalls. Three of the four patients died. The poor prognosis for systemic aspergillosis can only be improved by an early therapy with amphotericin B, possibly in liposomal form.

Neonatal Development of the Stratum Corneum pH Gradient: Localization and Mechanisms Leading to Emergence of Optimal Barrier Function

“…In fact, neonatal skin displays a well-known propensity to develop dermatitis and microbial infections (Berg et al, 1994;Rowen et al, 1995;Singer et al, 1998). Thus, newborn skin must undergo further postnatal developmental adjustments to achieve optimal function in the dry ex-utero environment.…”

CNS-manifestation of aspergillosis in an extremely low-birth-weight infant

“…The increased susceptibility of the preterm infants during the first weeks of life has been emphasized by the report of Singer et al [25]. Contamination with high doses of Aspergillus spores via contaminated finger stalls led to four invasive infections with Aspergillus in preterm babies in one neonatal care unit within a 2-month period [25]. A similar outbreak of mucormycosis was reported after the use of contaminated wooden tongue depressors [15].…”

“…However very early postnatal nosocomial infection appears to be more common [6]. The increased susceptibility of the preterm infants during the first weeks of life has been emphasized by the report of Singer et al [25]. Contamination with high doses of Aspergillus spores via contaminated finger stalls led to four invasive infections with Aspergillus in preterm babies in one neonatal care unit within a 2-month period [25].…”

Invasive Aspergillosis in Paediatric Patients

“…In contrast, outcome was relatively favourable, with 73% survival in the 22 patients receiving systemic antifungal therapy and/or surgical treatment [6]. Up to 2008, further 20 cases of IA in children ≤3 months of age have been reported without new aspects in presentation and clinical course [9][10][11]. Thoughtful use of corticosteroids, avoidance of skin trauma, careful attention to ventilation systems and room care may prevent the occurrence of nosocomial aspergillosis in neonatal medicine.…”

“…They tend to have a predilection for the skin and the gastrointestinal tract, resulting in necrotizing skin lesions and devastating necrotizing enterocolitis, respectively. Potential sources of the organisms are contaminated water, ventilation systems and dressing materials or infusion boards [5][6][7][8][9]; institutional outbreaks from a common environmental source have been reported [7,8]. A comprehensive literature review covering the period from 1955 to 1996 identified 44 reported cases of IA in children of ≤3 months of age.…”