Primary Cutaneous Aspergillosis Associated with Hickman Intravenous Catheters

Abstract

We describe nine patients with underlying hematologic cancer in whom primary cutaneous aspergillosis developed at the sites of Hickman intravenous catheters. Our patients, 17 to 74 years of age, were all immunocompromised either from their primary disease or from chemotherapy, and the Hickman catheters had been placed to provide venous access for chemotherapy or hyperalimentation or both. Clinical signs of infection included erythema, induration, and cutaneous or subcutaneous necrosis at the point of entry into the subclavian vein, in the subcutaneous tunnel, or at the exit site from the skin. Diagnosis was confirmed by positive wound culture for Aspergillus flavus in all but one patient. Treatment consisted of intravenous amphotericin B, oral flucytosine, and local wound care. Three patients recovered completely without operative débridement; three others recovered after operative débridement and delayed grafting. Two patients died of disseminated aspergillosis, and one died of unrelated causes while recovering from primary cutaneous aspergillosis. Successful treatment required resolution of aplasia or leukopenia, catheter removal, systemic treatment with amphotericin B, and local wound care. We conclude that primary cutaneous aspergillosis, a rare infection, may occur at the sites of Hickman catheters in immunocompromised patients, and that it is a serious complication requiring prompt diagnosis and treatment.

Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: Before and after chemoprophylaxis and institution of HEPA filters

“…The median length of neutropenia was 18 days (range 5-33). Eighteen of 28 patients had AML with a median neutropenic length of 20 days (range 5-33), and 10/18 patients had ALL with a median neutropenic period of 13 days (range [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22].…”

“…Prolonged neutropenia has been the major risk factor for invasive aspergillosis [1,2]. In the immunocompromised or neutropenic host, invasive pulmonary aspergillosis (IPA) characterized by hyphal invasion and destruction of pulmonary tissue is the most common manifestation of an aspergillus infection, although local infections also occur in the sinuses, the skin, or intravenous catheter sites [3][4][5][6].…”

Recomendaciones para el tratamiento de la infección por Aspergillus spp.

“…Es necesario practicar una biopsia y cultivo del material para diferenciarlo de otros procesos de características similares. Se han descrito lesiones en relación con cintas adhesivas para la sujeción de catéteres contaminadas con esporas 49 . Debe realizarse tratamiento antifúngico sistémico (BIII) como en el resto de formas diseminadas.…”

Cutaneous aspergillosis

“…Although most of these patients had leukemia as the underlying oncologic diagnosis, reports have described other diseases, including aplastic anemia (2,51,66), astrocytoma (38), chronic granulomatous disease (14), and agranulocytosis treated with antithymocyte globulin (45). In greater than 85% of cancerrelated cases, primary cutaneous aspergillosis was associated with intravenous catheters, arm boards, or tape securing arm boards (2,9,11,17,22,25,37,38,51,68). Other associations have included breaks in the epithelium during insertion of a vaginal clotrimazole troche (53) and phlebotomy (34).…”

“…Previous reports have described cutaneous aspergillosis as either primary (2,17,25,38) or secondary (15,19) infection. Primary cutaneous aspergillosis usually involves sites of skin injury, namely, at or near intravenous access catheter sites, at sites of traumatic inoculation, and at sites associated with occlusive dressings, burns, or surgery.…”