Cases reported "Aspergillosis"

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1/32. femur osteomyelitis due to a mixed fungal infection in a previously healthy man.

    We describe a previously healthy, 22-year-old man who, after a closed fracture of the femur and subsequent operation, developed chronic osteomyelitis. Within a few days, infected bone fragments, bone, and wound drainage repeatedly yielded three different filamentous fungi: aspergillus fumigatus, aspergillus flavus, and Chalara ellisii. Histologic examination of the bone revealed septate hyphae. After sequential necrotomies of the femur and irrigation-suction drainage with added antimycotic therapy, the infection ceased and the fracture healed. This case is unique in that it is the only known instance in which a long bone was affected in an immunocompetent individual, with no evidence of any systemic infection, by a mixed population of two different Aspergillus spp. and the rare filamentous fungus C. ellisii. Environmental factors that could potentiate the infection include blood and edema fluid resulting from the surgical procedure and the presence of the osteosynthetic plate.
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2/32. Pseudoepitheliomatous hyperplasia secondary to cutaneous aspergillus.

    Cutaneous aspergillosis commonly occurs in immunocompromised hosts and may also complicate burn wounds. Pseudoepitheliomatous hyperplasia (PH) is a histologic reaction secondary to a wide range of stimuli, including fungal infection. We describe a case of an 18-year-old man, status-post burns over 70% of his total body surface area, with cutaneous aspergillosis of the axilla and secondary PH. A single case of PH secondary to primary aspergillosis has been described in the larynx but, to our knowledge, has never been described cutaneously. Histologic examination of the lesion reveals an irregularly acanthotic epidermis with deep invaginations within the dermis. There is an intense inflammatory reaction within the superficial and deep dermis. Numerous fungal forms are identified within the dermis. Special stains demonstrate septate hyphae with dichotomous branching, which is morphologically consistent with Aspergillus. Therefore, we conclude that cutaneous aspergillosis should be included in the differential diagnosis of causes of PH, especially in a patient population at risk for this infection.
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3/32. aspergillus fumigatus cranial infection after accidental traumatism.

    Described here is a case of aspergillus fumigatus cranial infection secondary to accidental cranial traumatism that occurred in an immunocompetent patient and the questions that arose concerning treatment. No reports of post-traumatic cranial osteomyelitis caused by Aspergillus spp. and the ideal treatment to be followed have yet been described in the literature. In the present case, surgical debridement of the wound followed by treatment with 1 mg/kg/iv/day of amphotericin b for 21 days and then 200 mg/vo/12 h of itraconazole for 6 months obtained good results.
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4/32. An unusual example of Aspergillus species lung disease.

    A 37-year-old man developed persistent hemoptysis after sustaining a gunshot wound to the right shoulder and lung. A right upper lobectomy was performed, in which Aspergillus species microorganisms were identified within retained bullet fragments. The role of infected bullet fragments in the pathogenesis of hemoptysis in this patient is discussed.
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5/32. Cluster of cases of invasive aspergillosis in a transplant intensive care unit: evidence of person-to-person airborne transmission.

    In October 1998, a patient developed deep surgical-site and organ-space infection with aspergillus fumigatus 11 days after undergoing liver retransplantation; subsequently, 2 additional patients in the transplant intensive care unit had invasive pulmonary infection with A. fumigatus diagnosed. It was determined that debriding and dressing wounds infected with Aspergillus species may result in aerosolization of spores and airborne person-to-person transmission.
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6/32. scalp necrotizing fasciitis with osteomyelitis of the skull from Aspergillus.

    Necrotizing fasciitis of the scalp is a life-threatening condition. When Aspergillus is the infectious organism, treatment of the wound and salvage of the patient become a formidable challenge. The authors present an extremely rare case of the successful treatment of scalp necrotizing fasciitis combined with osteomyelitis of the calvarium involving Aspergillus.
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7/32. aspergillus flavus wound infection following repair of a ruptured duodenum in a non-immunocompromised host.

    aspergillus flavus is generally considered to be an opportunistic organism, rarely causing clinical infections in the immunocompetent host. We present a case of a 79-year-old man without history of immunocompromise who developed a severe aspergillus wound infection in an open wound following repair of a traumatic duodenal perforation. Despite aggressive treatment, this invasive infection contributed significantly to his eventual demise.
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keywords = wound infection, wound
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8/32. Outbreak of invasive Aspergillus infection in surgical patients, associated with a contaminated air-handling system.

    An outbreak of Aspergillus infection at a tertiary care hospital was identified among inpatients who had amputation wounds, peritonitis, allograft nephritis, or mediastinitis. During a 2-year period, 6 patients were identified, all of whom had Aspergillus species recovered from samples from normally sterile sites. All cases clustered in the operating theater during a single 12-day period. To assess operating theater air quality, particle counts were measured as surrogate markers for Aspergillus conidia. A substantial increase in the proportion of airborne particles > or =3 microm in size (range, 3-fold to 1000-fold) was observed in many operating rooms. A confined space video camera identified moisture and contamination of insulating material in ductwork and variable airflow volume units downstream of final filters. No additional invasive Aspergillus wound infections were identified after the operating theater air-handling systems were remediated, suggesting that this unusual outbreak was due to the deterioration of insulating material in variable airflow volume units.
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keywords = wound infection, wound
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9/32. Tibial osteomyelitis due to aspergillus flavus in a heart transplant patient.

    aspergillus flavus was identified as the causative organism of a case of osteomyelitis involving the proximal epiphysis of the left tibia in a heart transplant patient. history revealed a previous pretibial wound due to a fall in the street as the consequence of a sudden cardiac arrest. Surgical debridement combined with fungostatic treatment including amphotericin b and itraconazole was followed by clinical improvement, although the fungus could still be recovered by culture on subsequent samples.
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10/32. Concomitant mycobacterium tuberculosis and aspergillus niger infection in a patient with acute myeloid leukemia.

    Primary cutaneous infection by Aspergillus spp. is an uncommon form of aspergillosis in patients with severe immunosuppression, e.g. patients with hiv infection or hematological malignancies. Disruption of the dermal integrity by trauma or maceration, followed by colonization of the wound by Aspergillus spp. creates a suitable environment for cutaneous infection. Despite aggressive therapy with amphotericin, primary cutaneous aspergillosis can lead to disseminated disease with fatal consequences. Tuberculosis is another rare infection in patients with hematological malignancies, but when present it is usually disseminated. We present a 46-year-old woman with acute myeloid leukemia who developed concomitantly mycobacterium tuberculosis and aspergillus niger infection. Cutaneous aspergillosis was diagnosed during neutropenia after induction therapy, which later became disseminated disease during antifungal therapy. Tuberculosis infection was diagnosed in a scalene lymph node biopsy specimen. The patient achieved remission of her underlying disease and responded very well to antituberculous and antifungal therapy.
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