Cutaneous and Wound Aspergillosis

DOI: 10.1007/978-90-481-2408-4_55 In book: Aspergillosis: From Diagnosis to Prevention, pp.939-959


Aspergillus infections of skin and wound have been increasingly reported in recent years. These diseases can range from non-invasive
colonisation of wounds to invasive lesions that may serve as the aspergillosis portal of entry in immunosuppressed patients.
Cutaneous aspergillosis can be broadly divided into: primary infections (starting from skin) and secondary infections (extending
to skin from deeper tissues either contiguously or haematogenously). There has been marked increase in number of primary cutaneous
aspergillosis cases in conjugation with prematurity, burn, HIV infection, organ transplantation, and malignancy. Wound aspergillosis
affects mainly solid organ transplant recipients and those submitted to open-heart surgery. Small outbreaks of primary cutaneous
aspergillosis have been reported in neonatal and surgical wards, and intensive care units in association with a contaminated
environment. Simultaneous breach of skin and neutropenia predisposes a patient for cutaneous aspergillosis, though rare infection
in healthy hosts has been reported. Demonstration of septate hyphae in tissue and isolation of Aspergilli help in diagnosis. Early diagnosis depends on increased awareness. These diseases can be of considerable morbidity and mortality
if the patients are not managed aggressively. Combined surgery and antifungal therapy prevents the progression to disseminated
aspergillosis, though surgery may be difficult in neonates and in HIV-infected patients.


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    ABSTRACT: To review invasive aspergillosis (IA) in developing countries, we included those countries, which are mentioned in the document of the International Monetary Fund (IMF), called the Emerging and Developing Economies List, 2009. A PubMed/Medline literature search was performed for studies concerning IA reported during 1970 through March 2010 from these countries. IA is an important cause of morbidity and mortality of hospitalized patients of developing countries, though the exact frequency of the disease is not known due to inadequate reporting and facilities to diagnose. Only a handful of centers from India, China, Thailand, Pakistan, Bangladesh, Sri Lanka, Malaysia, Iran, Iraq, Saudi Arabia, Egypt, Sudan, South Africa, Turkey, Hungary, Brazil, Chile, Colombia, and Argentina had reported case series of IA. As sub-optimum hospital care practice, hospital renovation work in the vicinity of immunocompromised patients, overuse or misuse of steroids and broad-spectrum antibiotics, use of contaminated infusion sets/fluid, and increase in intravenous drug abusers have been reported from those countries, it is expected to find a high rate of IA among patients with high risk, though hard data is missing in most situations. Besides classical risk factors for IA, liver failure, chronic obstructive pulmonary disease, diabetes, and tuberculosis are the newly recognized underlying diseases associated with IA. In Asia, Africa and Middle East sino-orbital or cerebral aspergillosis, and Aspergillus endophthalmitis are emerging diseases and Aspergillus flavus is the predominant species isolated from these infections. The high frequency of A. flavus isolation from these patients may be due to higher prevalence of the fungus in the environment. Cerebral aspergillosis cases are largely due to an extension of the lesion from invasive Aspergillus sinusitis. The majority of the centers rely on conventional techniques including direct microscopy, histopathology, and culture to diagnose IA. Galactomannan, β-D glucan test, and DNA detection in IA are available only in a few centers. Mortality of the patients with IA is very high due to delays in diagnosis and therapy. Antifungal use is largely restricted to amphotericin B deoxycholate and itraconazole, though other anti-Aspergillus antifungal agents are available in those countries. Clinicians are aware of good outcome after use of voriconazole/liposomal amphotericin B/caspofungin, but they are forced to use amphotericin B deoxycholate or itraconazole in public-sector hospitals due to economic reasons.
    Full-text · Article · Apr 2011 · Medical mycology: official publication of the International Society for Human and Animal Mycology