Pulmonary aspergillosis in a burn patient

A. Silva*, G. Mota, F. Xambre, L. Krebs

Author address: 

Lisbon, PT)

Abstract: 

Introduction: In acute phase of burn injury, thermal damage to the human skin barrier and local and systemic immune dysfunction predisposes patients to potentially serious fungal infections. The nature of burns injuries often result in complex intensive care and exposure to multiple risk factors for fungal infection. Aspergillus spp. is a fungus acquired by inhalation of airborne spores and may cause various clinical conditions. Pulmonary disease caused by Aspergillus, mainly A. fumigatus, can result in Invasive Pulmonary Aspergillosis (IPA), especially in immunocompromised patients, and has become the most important airborne pathogen in developed countries. Case report: A 56 years old man was admitted with electrical burns to 23.5% total body surface area involving his neck, back and bilateral upper extremities. There was no evidence of inhalation injury and the patient had no other pathological condition. Resuscitation was started immediately, using the Parkland formula and the patient was ventilated and treated with piperacillin/tazobactan. Patient was taken several times to the operating room for amputation of upper extremity, escharectomy and skin grafting. Ten days after admission in burn unit, the patient developed high fever, expectoration and leukocytosis. A fiberoptic bronchoscopy with bronchoalveolar lavage was performed and 11 days later revealed aspergillus fumigatus. A therapy with amphotericin B was initiated and continued for 29 days, and he has discharged free from symptoms and signs. On 37 day did another fiberoptic bronchoscopy. On 50 day bronchoalveolar lavage culture and galactomannan detection were negative. After 39 day the patient was extubated and clinically he had no signs of infection. Conclusion: Infections remain a primary cause of morbidity and mortality in burned patients, with fungal infections being among the main pathogens. Advancements in burn care therapy have extended survival of seriously burned patients, exposing them to increased risk of infectious complications, notably fungal infections. Invasive Aspergillosis must be considered as an emerging and devastating infectious disease in intensive care unit (ICU) patients, even in the absence of an apparent predisposing immunodeficiency. Total body surface area (TBSA) burn and length of stay (survival after burn) were identified as
2012

abstract No: 

P793

Full conference title: 

22nd European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 22nd (2012)