Primary cutaneous opportunistic mold infections in a pediatric population

Deep cutaneous fungal infections in immunocompromised children

“…Furthermore, in another 3, the primary cutaneous infection occurred at the skin site of contact with wooden boards used to restrain arm movement to secure IV lines (two Aspergillus species and one Exserohilum rostratum). Contaminated IV lines and/or tapes, adjoining arm boards, bandages and/or other medical devices used for restraint, 5,[9][10][11][12][13][14] oxygen saturation monitors 15 (almost invariably used in these children), and contaminated skin care products 16 may lead to direct fungal inoculation, particularly through macerated skin. In the other cases of upper limb involvement, an association with peripheral venous line sites or contact with arm boards, tapes, or dressing could not be ruled out.…”

“…Although PCA is rare and reportedly more common with trauma and burns, it has been described in premature neonates with increasing frequency, particularly over the last decade. 5,[22][23][24][25] Interestingly, 16 of 17 of the PCA cases reviewed by Woodruff and Hebert 24 occurred after 1990; 15 of 17 were in premature neonates. In our group, no cases of primary or secondary aspergillosis were encountered in neonates.…”

“…Our case of invasive C albicans infection in a premature newborn with diffuse, crusty, and erosive lesions is very similar to the one reported by Rowen et al 26 Gestational age and low birth weight, as well as vaginal birth, steroid administration, and hyperglycemia are recognized risk factors. 5 The immature stratum corneum barrier may allow microbial cutaneous invasion and dissemination during the first 2 weeks of a premature newborn's extrauterine life. Our premature patient died at 8 days of life.…”

“…2,3 A shift in the fungal species underlying infections in immunocompromised adults has been observed, and Aspergillus and Candida species are now reportedly the most frequent agents. 2,4,5 Most studies on IFI and invasive aspergillosis (IA) have been conducted on adults. A recently published multicenter analysis of a large pediatric cohort of patients with IA revealed that deep cutaneous fungal disease was more frequent in children.…”

“…6,7 A review of cutaneous mold infections in pediatric patients in Houston, TX (1991TX ( -2000 showed that neonates were involved in 50% of the cases and that extremely low birth weight (ELBW) premature infants, immunocompromised hosts, and cutaneous trauma were major risk factors. 5 This study reports DCFI in 26 pediatric patients ( # 18 years old) given a diagnosis in a pediatric tertiary care center in Montreal, Quebec, Canada, and describes their clinical characteristics, the diagnostic methods used, and patient outcomes. Predisposing factors were identified from collected data and their roles are discussed.…”