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Successful treatment of hepatic and mesh Aspergillosis in a neonate with giant omphalocele - 18/05/22

Doi : 10.1016/j.mycmed.2022.101245 
S.Yildirim Arslan a, Z.Sahbudak Bal a, , G.Guner Ozenen a, N.M. Bilen a, J. Naghiyev b, G. Sakul b, F. Ozkinay a, O. Ergun b, A. Ozarslan c, Z. Kurugol a
a Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Izmir, Turkey 
b Medical School of Ege University, Department of Pediatric Surgery, Izmir, Turkey 
c Medical School of Ege University, Department of Microbiology, Izmir, Turkey 

Corresponding author at: Medical School of Ege University, Division of Infectious Disease, Department of Pediatrics, Bornova/Izmir, 35100, Turkey.Medical School of Ege UniversityDivision of Infectious DiseaseDepartment of PediatricsBornova/Izmir35100Turkey

Abstract

Aspergillosis is a rare and life-threatening fungal infection in immunocompetent children, particularly in infants. We present a case of invasive Aspergillosis (IA) that developed hepatic and mesh infection due to Aspergillus flavus following the rupture of a giant omphalocele. A male baby was born at 37 weeks of gestation with a giant omphalocele. No other congenital abnormalities were found. In the pediatric surgery operation room, the amniotic membrane seemed to be ruptured in some parts, which had been repaired within a few hours of birth. No further intervention to reduce the volume of visceral organs could be performed due to the tiny abdominal cavity. Postoperatively piperacillin-tazobactam and fluconazole were empirically initiated. Abdominal defects had been covered with polypropylene polylactic acid synthetic Mesh on postnatal day 11 to protect the organs and prevent abdominal infections. Fungal hepatic lesions were observed during surgery, and black necrotic lesions were also observed on the mesh on day 12. On the 16th postnatal day, Aspergillus flavus grew in the wound, graft, hepatic biopsy cultures. Serum galactomannan (GM) assay test was positive (GM:2.9), and voriconazole was initiated. All necrotic lesions resolved with liposomal amphotericin B (L-AmB) and voriconazole treatment, and antifungal therapy was discontinued after 134 days. Eye examination for the retinopathy didn't show any abnormalities. The patient was discharged with full recovery on day 155.

In conclusion, IA is a rare and life-threatening infection in the neonatal period. To the best of our knowledge, this is the first case of hepatic and mesh infection caused by Aspergillus flavus that was successfully treated with voriconazole and l-AmB.

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Keywords : Aspergillus flavus, Neonate, Giant omphalocele, Voriconazole, Liposomal amphotericin b


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Vol 32 - N° 2

Article 101245- mai 2022 Retour au numéro
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