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Primary cutaneous aspergillosis in six leukemic children
Abstract:
We report a cluster of primary cutaneous aspergillosis in six children with hematologic malignancy. When first seen, they had hemorrhagic bullae caused by Aspergillus flavus, Aspergillus fumigatus, and Aspergillus niger at the sites of insertion of intravenous cannulas or where arm boards had been taped to the extremities. Rapid diagnosis of cutaneous aspergillosis was made by direct examination of the blister roof with potassium hydroxide before it progressed to a necrotic ulcer. Intravenous amphotericin was instituted promptly in five of six patients, and none died of disseminated aspergillosis. Epidemiologic investigation tracked the source of aspergillus to a storeroom with a false ceiling that had recently been repaired for a water leak.
Insights
A cluster of primary cutaneous aspergillosis occurred in six children with hematologic malignancy. Early diagnosis and treatment with amphotericin prevented disseminated disease and fatalities.
Area of Science:
- Medical Mycology
- Pediatric Hematology
- Infectious Diseases
Background:
- Primary cutaneous aspergillosis is a rare fungal infection.
- Children with hematologic malignancy are particularly susceptible to invasive fungal infections.
- Infections can arise from environmental sources, especially in healthcare settings.
Purpose of the Study:
- To describe a cluster of primary cutaneous aspergillosis in pediatric patients with hematologic malignancy.
- To highlight the diagnostic challenges and effective management strategies.
- To identify the source of infection to prevent further cases.
Main Methods:
- Case series reporting six pediatric patients.
- Clinical presentation: hemorrhagic bullae at sites of medical devices.
- Diagnostic methods: potassium hydroxide (KOH) examination of blister roof.
- Treatment: intravenous amphotericin B.
- Epidemiological investigation to identify the source.
Main Results:
- Six children with hematologic malignancy developed primary cutaneous aspergillosis.
- Lesions appeared at intravenous cannula insertion sites or where arm boards were applied.
- Rapid KOH examination facilitated early diagnosis.
- Five patients received intravenous amphotericin B; none developed disseminated aspergillosis.
- The source was traced to a contaminated storeroom with a recent water leak.
Conclusions:
- Primary cutaneous aspergillosis can manifest in immunocompromised children.
- Prompt diagnosis via KOH examination and early antifungal treatment are crucial for favorable outcomes.
- Environmental contamination control is vital in healthcare facilities to prevent outbreaks.