Infections due to gender Neosartorya are rarely reported. The genus belongs to the Fumigati section and the differential diagnosis is not always easy with Aspergillus fumigatus. Three species are responsible for human infections, fischeri species is less frequently involved in pathology. We report the case of an invasive infectionNeosartorya fischeri at the origin of multiple organ failure. The patient is a 40 year old man discharged from a foreign country following an explosion; thermal burns involving more than 96% of the body surface and are associated with a blast and significant inhalation injury. Before arriving in France 11 red cell concentrates were administered. Treatment with liposomal amphotericin be started several weeks because of diffuse lesions associated with mucormycosis due to Rhizomucor variabilis. Seven weeks after his admission when he was provided a pose cell cultures, clinical course marked by multiple organ failure for which the diagnosis of primary infection with cytomegalovirus is retained (HIV seroconverted, high viral load in the blood and lungs, no filtration of blood products in the country of origin). The Cymevan is introduced and preferred to Foscarnet because of renal disease; the occurrence of pancytopenia should be discontinued Cymevan, Foscarnet is administered in doses then adapted to the renal function. In this context failure gross lesions suggestive of aspergillosis appear and become widespread in 48 hours, aspergillosis antigenaemia passing this same period an index of 1 to 5. The change over is fatal with the increase 'multiorgan by septic shock and hemophagocytic syndrome.
In human pathology Neosartorya fischeri is considered keratitis agent; it was considered by both as responsible for endocarditis, finally it has been described as responsible for invasive aspergillosis in a marrow transplantation.In our patient a combination of factors is promoting the cause of the occurrence of Aspergillus infection and fatal worsening Clinque table. In practice the isolation of a mushroom before such a table should lead to a request for an expert from the National Reference Centre of mycoses. Currently accurate diagnosis is possible through molecular biology or by spectrometry. For such patients hospitalized in large burnt services it is imperative to appreciate the aspergillus risk by repeating antigenaemia along in Hematology.
Full conference title:
- RICAI 31st (2011)