Published online July 24, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. e509-e513 (doi:10.1542/peds.2005-2901)
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EXPERIENCE AND REASON

Invasive Pulmonary and Central Nervous System Aspergillosis After Near-Drowning of a Child: Case Report and Review of the Literature

Piet Leroy, MDa, Annick Smismans, MD, PhDb and Tatjana Seute, MDc

a Divisions of Pediatric Intensive Care
b Medical Microbiology
c Pediatric Neurology, University Hospital Maastricht, Maastricht, Netherlands

Invasive aspergillosis is extremely rare in immunocompetent children. Here we describe the clinical, radiologic, and laboratory course of fatal invasive pulmonary and central nervous system aspergillosis in a previously healthy child after a near-drowning incident with submersion in a pond. Findings were compared with data from the literature, which is reviewed. Serum Aspergillus galactomannan levels were determined retrospectively and were compared with the results of routine microbiological and radiologic examinations, showing a significant diagnostic and therapeutic delay of the routine diagnostic approach in comparison with the use of the Aspergillus galactomannan assay. This delay may have contributed to the fatal course. Serial determination of serum Aspergillus galactomannan may be helpful in diagnosing invasive aspergillosis early in case of pulmonary disease after near-drowning and may contribute to an early appropriate treatment. Currently voriconazole, eventually in combination with caspofungin, should be considered as the drug of choice in the management of invasive aspergillosis after near-drowning.

Key Words: near-drowning • invasive aspergillosis • central nervous system • galactomannan • children

Abbreviations: CNS, central nervous system • IA, invasive aspergillosis • IV, intravenous • OD, optical density • HRCT, high-resolution computed tomography

Accepted Feb 28, 2006.




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