Perinatal/Neonatal Case Presentation: Aspergillosis in a 24-Week Newborn: A Case Report

Abstract

Aspergillosis is an uncommon neonatal infection, diagnosed with an increasing frequency over the last two decades. We report a premature neonate who developed aspergillosis while receiving amphotericin B and fluconazole for candidiasis. Despite early recognition and diagnosis, the infant died. We review the clinical appearance of Aspergillus species, the distinctions between primary cutaneous aspergillosis and invasive aspergillosis, and advances in diagnosis and treatment.

Severe primary cutaneous aspergillosis refractory to amphotericin B and the successful treatment with systemic voriconazole in two premature infants with extremely low birth weight

“…8,9,12 Voriconazole apparently prevented life-threatening systemic dissemination of the mold infection, resulting in a vastly improved outcome compared to previous reports on this condition in premature infants. [1][2][3][4] …”

“…[1][2][3][4] Several authors have pointed out the difficulties of an early clinical or microbiological diagnosis and have emphasized the need for an immediate and effective antifungal therapy. [1][2][3] Woodruff et al 1 reviewed 16 cases of primary cutaneous aspergillosis in neonates, eight of whom died from fulminant fungal sepsis.…”

“…Classical antifungal treatment did not prevent dissemination of these mold infections, which were initially limited to skin lesions. 1,3 Although liposomal amphotericin B has been the drug of choice in these patients, [1][2][3][4] several reports indicate that a substantial fraction of Aspergillus species may be refractory to amphotericin B. 1,5,6 During the past few years, voriconazole, an extendedspectrum triazole antifungal, has become increasingly established as an agent of choice in severe fungal infections.…”

Free Flap Coverage of Extensive Soft Tissue Defect in Cutaneous Aspergillosis: A Case Report

“…Cutaneous aspergillosis may be primary or secondary to systemic dissemination. It presents as erythematous papules or plaques that evolve into necrotic skin lesions, often at sites of skin trauma associated with intravenous catheters and placement of adhesive tape or monitor leads, or at sites of surgical or other traumas (5, 6). If hyphae are somehow able to develop, functioning neutrophils remove them efficiently.…”

“…Aspergillosis may initially present to the clinician as a painful and locally destructive lesion. The typical lesion is an erythematous (or violaceous), edematous, indurated papule or nodule that progresses to a blue-black necrotic ulcer with a black eschar due to regular invasion into blood vessels, causing local thrombosis and hemorrhage (2-5). Tissue biopsy with special stains and tissue culture are the preferred methods for the diagnosis of aspergillosis.…”