Acquiring accidental aspergillosis

Aspergillus is an all-pervasive mold with the potential to cause severe invasive infections in the immunocompromised. A rare cutaneous manifestation of Aspergillus infection, primary cutaneous aspergillosis (PCA), occurs in just 1-5% of invasive aspergillosis cases. Prompt treatment is indicated as PCA may progress to a disseminated state. We present a unique case of an immunocompetent individual diagnosed with PCA two weeks after trauma and subsequent surgery.

The effects of antifungal therapy on the recurrence of aspergillus infection after pulmonary aspergilloma resection: a study protocol for a single-center, prospective, non-blind, randomized, 24-month, parallel group study

Background In recent years, the incidence of pulmonary aspergilloma has increased. The harm of aspergilloma is life-threatening massive hemoptysis, and the conventional treatment is surgical treatment. However, whether the antifungal treatment after surgery is required and the course of treatment before and after surgery are still unclear. Methods In this study, patients with pulmonary aspergilloma confirmed pathologically after surgery will be selected as subjects to conduct a single-center, randomized, parallel grouping, prospective, 2-year clinical study. Through regular visits, the recurrence of aspergillus infection, quality of life, lung function indicators, safety of antifungal therapy and other indicators were recorded to evaluate the recurrence risk of aspergillus infection and safety of antifungal agents. Cox proportional risk regression model was used to analyze the influencing factors of antifungal therapy on aspergillus infection recurrence after aspergillus bulbectomy. Cox multiple regression model was used for optimal model fitting, and regression coefficient (β), relative risk (RR) and 95% confidence interval of RR were calculated. Discussion The study will explore whether antifungal therapy could improve the quality of life, reduce the recurrence of aspergillus infection, and ultimately improve the prognosis of patients with aspergilloma. The study results will provide high-quality evidence-based medical evidence for the formulation, revision and optimization of international and domestic clinical guidelines and expert consensus on chronic aspergillus lung disease, effectively improve the clinical treatment effect of aspergilloma, and form the latest concept of diagnosis and treatment of aspergilloma. Trial registration: The trial was registered on the Chinese Clinical Trial Registry website (https://www.chictr.org.cn/showprojen.aspx?proj=33231). Registration number: ChiCTR1800019990.

Atypical Optic Neuritis in an Immunocompetent Patient with Orbital

Aspergillosis infection in immunocompetent individuals is an uncommon entity. Non-specific presentation could delay in the diagnosis and management. We describe a case of orbital aspergillosis with cavernous sinus extension in a healthy lady. A 67-year-old lady presented with left eye decreased vision, preceded by non-specific headache for three weeks. Visual acuity deteriorated followed by ptosis and left ocular restrictions after corticosteroids therapy. Examination revealed poor left eye visual acuity with ptosis, anisocoria and total ophthalmoplegia. MRI orbit and brain demonstrated a heterogenous left orbital apex lesion extending to cavernous sinus. Transsphenoidal endoscopic biopsy revealed Aspergillus infection at the left retro-orbital space and the sphenoid sinus. Patient was treated with long duration of oral voriconazole. Ptosis and ophthalmoplegia resolved but left optic atrophy remained. In conclusion, orbital aspergillosis may carry a poor visual prognosis and intracranial spread does easily occur. Early treatment may lead to a better outcome in immunocompetent patients.

Pulmonary sequestration with Aspergillus infection presenting as massive hemoptysis and hemothorax with highly elevated carcinoembryonic antigen in pleural effusion that mimics advanced lung malignancy

Background Pulmonary sequestration (PS) associated with massive hemoptysis, hemothorax, and elevated tumor markers or even lung malignancy has been reported in several studies. These clinical features combined with lung lesions on chest imaging are sometimes hard to differentiate from lung malignancies and often complicate the diagnostic procedure. Case presentation A 45-year-old man with PS presented with massive hemoptysis, hemothorax, and extremely elevated carcinoembryonic antigen (CEA) in pleural effusion was initially misdiagnosed with advanced lung carcinoma, but was ultimately diagnosed with PS with Aspergillus infection. Conclusions PS is rarely concurrent with lung cancer; most of the time, it is misdiagnosed as a malignancy, especially when presenting with a fungal infection, which could remarkably elevate CEA in pleural effusion.

Pulmonary Sequestration With Fungus Infection Presenting as Highly Elevated Carcinoembryonic Antigen

Background: Pulmonary sequestration (PS) associated with massive hemoptysis, hemothorax, and elevated tumor markers or even diagnosed with lung malignancy has been reported many times. But all these clinical features have never been reported in the patient diagnosed with PS without malignant disease.Case presentation: A 45-year-old man with PS presented with massive hemoptysis, hemothorax, extremely elevated carcinoembryonic antigen (CEA) in the pleural effusion, was initially misdiagnosed with advanced lung carcinoma, and was finally diagnosed with PS with Aspergillus infection.Conclusions: PS is rarely concurrent with lung cancer; most of the time, it is easily misdiagnosed as a malignancy, especially when presenting with a fungal infection, which could remarkably elevate CEA in the pleural effusion.

Severe extensive community acquired aspergillus infection in a full‐term infant accompanied with increases in white blood cell counts and C-reactive protein: a case report

Background Aspergillus infection is more common among premature infants in neonatal intensive care units, who have decreased qualitative immune defenses and need various invasive treatment procedures. It is rare in normal full-term neonates, especially in newborn babies from the community. Moreover, the white blood cell (WBC) count and C-reactive protein (CRP) level may be normal or slightly changed in fungal infections, but the neonate reported in this study had significant increases in WBC and CRP. To the best of our knowledge, this is the first report on a full-term neonate from the community with aspergillus infection accompanied by significant increases in WBC and CRP levels. Case presentation A 28-day-old infant, who received empirical antibiotic treatment for 10 days because of neonatal pneumonia, was referred to our neonatal department from the local hospital. The infant had persistent infection and multiple organ failure syndromes. Bronchoscopy and deep sputum smear were performed to identify the pathogen, which confirmed aspergillus infection in the sputum. Fluconazole was immediately administered, but the baby died after three days. Thereafter, an autopsy was performed with parental consent. There were multiple necrotic areas in the lungs and liver, and pathological examination revealed aspergillus. Conclusions The present case emphasized that community-sourced aspergillus infection can exist in full-term neonates, with significantly increased WBC count and CRP level. Advanced antibiotics were not effective in this case, and fungal infections should have been considered earlier.