Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 19 , ISSUE 12 ( 2015 ) > List of Articles

CASE REPORT

Invasive aspergillosis in near drowning nonneutropenic patient

Kartik Munta, Palepu B. N. Gopal, Ajit Vigg

Keywords : Acute respiratory distress syndrome, invasive aspergillosis, near drowning, voriconazole

Citation Information : Munta K, Gopal PB, Vigg A. Invasive aspergillosis in near drowning nonneutropenic patient. Indian J Crit Care Med 2015; 19 (12):739-742.

DOI: 10.4103/0972-5229.171413

License: CC BY-ND 3.0

Published Online: 01-12-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Invasive aspergillosis in immunosuppressed people has been well documented, but to diagnose and treat in an immunocompetent individual after near drowning, it requires early suspicion and proper empirical treatment. We report a case diagnosed to have invasive aspergillosis with systemic dissemination of the infection to the brain, gluteal muscles, and kidneys after a fall in a chemical tank of a paper manufacturing company. He was ventilated for acute respiratory distress syndrome and managed with antibiotics and vasopressors. Due to nonresolving pneumonia and positive serum galactomannan, trans-tracheal biopsy was performed which confirmed invasive aspergillosis and was treated with antifungals. With the availability of galactomannan assay and better radiological investigative modalities, occurrence of such invasive fungal infections in cases of drowning patients should be considered early in such patients and treated with appropriate antifungals.


PDF Share
  1. Ender PT, Dolan MJ. Pneumonia associated with near-drowning. Clin Infect Dis 1997;25:896-907.
  2. Levy H, Horak DA, Tegtmeier BR, Yokota SB, Forman SJ. The value of bronchoalveolar lavage and bronchial washings in the diagnosis of invasive pulmonary aspergillosis. Respir Med 1992;86:243-8.
  3. Andreas S, Heindl S, Wattky C, Möller K, Rüchel R. Diagnosis of pulmonary aspergillosis using optical brighteners. Eur Respir J 2000;15:407-11.
  4. Collins J. CT signs and patterns of lung disease. Radiol Clin North Am 2001;39:1115-35.
  5. Greene R. The radiological spectrum of pulmonary aspergillosis. Med Mycol 2005;43 Suppl 1:S147-54.
  6. Horger M, Einsele H, Schumacher U, Wehrmann M, Hebart H, Lengerke C, et al. Invasive pulmonary aspergillosis: Frequency and meaning of the "hypodense sign" on unenhanced CT. Br J Radiol 2005;78:697-703.
  7. Kami M, Kishi Y, Hamaki T, Kawabata M, Kashima T, Masumoto T, et al. The value of the chest computed tomography halo sign in the diagnosis of invasive pulmonary aspergillosis. An autopsy-based retrospective study of 48 patients. Mycoses 2002;45:287-94.
  8. Lee YR, Choi YW, Lee KJ, Jeon SC, Park CK, Heo JN. CT halo sign: The spectrum of pulmonary diseases. Br J Radiol 2005;78:862-5.
  9. Pasmans HL, Loosveld OJ, Schouten HC, Thunnissen F, van Engelshoven JM. Invasive aspergillosis in immunocompromised patients: Findings on plain film and (HR)CT. Eur J Radiol 1992;14:37-40.
  10. Won HJ, Lee KS, Cheon JE, Hwang JH, Kim TS, Lee HG, et al. Invasive pulmonary aspergillosis: Prediction at thin-section CT in patients with neutropenia - A prospective study. Radiology 1998;208:777-82.
  11. Maertens J, Verhaegen J, Lagrou K, Van EJ, Boogaerts M. Screening for circulating galactomannan as a noninvasive diagnostic tool for invasive aspergillosis in prolonged neutropenic patients and stem cell transplantation recipients: A prospective validation. Blood 2001;97:1604-10.
  12. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: A meta-analysis. Clin Infect Dis 2006;42:1417-27.
  13. Maertens J, Van Eldere J, Verhaegen J, Verbeken E, Verschakelen J, Boogaerts M. Use of circulating galactomannan screening for early diagnosis of invasive aspergillosis in allogeneic stem cell transplant recipients. J Infect Dis 2002;186:1297-306.
  14. Denning DW. Early diagnosis of invasive aspergillosis. Lancet 2000;355:423-4.
  15. Schwartz S, Theil E. CNS aspergillosis: Are there new treatment options? Mycoses 2003;46:8-14.
  16. Imhof A, Walter RB, Schaffner A. Continuous infusion of escalated doses of amphotericin B deoxycholate: An open-label observational study. Clin Infect Dis 2003;36:943-51.
  17. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002;347:408-15.
  18. Böhme A, Ruhnke M, Buchheidt D, Karthaus M, Einsele H, Guth S, et al. Treatment of fungal infections in hematology and oncology - Guidelines of the Infectious diseases working party (AGIHO) of the German society of hematology and oncology (DGHO). Ann Hematol 2003;82 Suppl 2:S133-40.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.