Postoperative aspergillosis

A.C. Pasqualotto1 and D.W. Denning2

Author address: 

1School of Medicine, University of Manchester, Manchester, UK and 2Wythenshawe Hospital, Manchester, UK


Introduction: While invasive aspergillosis typically occurs in immunocompromised patients, cases of troublesome surgical site infections have been reported in immunocompetent patients. The purpose of this article is to describe 3 cases of post-operative aspergillosis, followed by literature review. Cases: The first case was a 70-year-old patient who underwent elective aortic valve replacement and died because of Aspergillus endocarditis. The diagnosis was not suspected premortem. The second case was a 16-year-old girl submitted to elective neurosurgery for Chiari I malformation who died despite medical and surgical therapy. The third case was a 43-year-old woman who recovered from cerebral aspergillosis following treatment with voriconazole. Methods: Medline search and review of references in articles and in our own files for cases meeting the definition of aspergillosis occurring in the postoperative setting, not related to primary lung infection. Cases of primary cutaneous aspergillosis were not considered for this review, as well as infection associated with intravascular devices. Results: Postoperative aspergillosis is usually an indolent infection. After the publication of the first case in 1933, many additional patients with this condition were reported. More than 100 welldocumented cases of endocarditis and aortitis have been reported to date. These cases were characterized by a low rate of antemortem diagnosis (Aspergillus is rarely isolated from blood cultures) and an extremely high mortality. Preautopsy diagnosis was usually associated with the examination of the valve or emboli to large peripheral arteries. Most of the reports have associated the infection with contaminated grafts, contaminated sutures or intraoperative shedding of spores. More than 30 cases of wound aspergillosis were reported; different from patients with endocarditis, the interval between surgery and infection was measured in days, not months. Wound aspergillosis can progress to profound or disseminated infection, so all patients need to be aggressively treated with combined medical and surgical therapy. A. flavus is more common than A. fumigatus in many of these wound infections. Other presentations of postoperative aspergillosis, including mediastinitis, bronchial infections, aspergillosis following breast surgery, abdominal surgery, orthopedic surgery, neurosurgery, ophthalmological surgery, and surgical dental procedures are reviewed. The optimal treatment of Aspergillus surgical infections has not been specifically studied. Survival seems to depend on the excision of the infected tissue. Concomitant use of a systemic antifungal agent is also crucial. Prophylaxis of these infections should include special care with the ventilation system in the operating room. Conclusions: Postoperative aspergillosis is relatively common compared with many other manifestations of disease and rarely affects the lungs. Mortality is high in non-cutaneous infections.

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Full conference title: 

2nd Trends in Medical Mycology
    • TIMM 2nd (2010)