Klin Padiatr 2024; 236(03): 189-192
DOI: 10.1055/a-2233-1021
Pictorial Essay

Abdominal Aspergillosis – an Underdiagnosed Disease? Three Cases of Abdominal Aspergillosis in Severely Immunocompromised Infants

Abdominelle Aspergillose – eine unterdiagnostizierte Erkrankung? Drei Fälle abdomineller Aspergillose in immunkompromittierten Säuglingen
1   Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
2   Research Institute Children's Cancer Center, Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Germany
,
Martin Jankofsky
3   Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Stefan Klohs
4   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Uta Herden
5   Department of Transplant Surgery, University Medical Center Hamburg- Eppendorf, Hamburg, Germany
,
Martin Blohm
3   Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
Beate Winkler
1   Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
› Author Affiliations

Introduction

Immunosuppressed and immunocompromised patients are at high risk of infectious complications. Among those are rare but sometimes lethal invasive fungal infections/disease (IFD). Especially immunosuppression caused by intense polychemotherapy, corticosteroids, prolonged, severe neutropenia or surrounding organ transplantation seems to cause susceptibility towards opportunistic mycosis [Pacholczyk, M., et al., Ann Transplant, 2011. 16(3): p. 14-16; Ceylan, B., et al., Infez Med, 2019. 27(1): p. 85-92; Fischer, J., et al., Eur J Pediatr Surg, 2018. 28(6): p. 477-483; Avcu, G., et al., Med Mycol Case Rep, 2016. 11: p. 1-4; Decembrino, N., et al., New Microbiol, 2016. 39(1): p. 65-9; Marr, K.A., et al., Clin Infect Dis, 2002. 34(7): p. 909-917; Otto, W.R. and A.M. Green, Br J Haematol, 2020. 189(4): p. 607-624]. In children, the most common causative species are Candida spp., Aspergillus spp., and the Mucorales molds [Otto, W.R. and A.M. Green, Br J Haematol, 2020. 189(4): p. 607-624]. Invasive aspergillosis usually presents as a pulmonary infection and can disseminate to other tissues in the body via vascular invasion [Barnes, P.D. and K.A. Marr, Infect Dis Clin North Am, 2006. 20(3): p. 545-561]. Cases of gastrointestinal/abdominal aspergillosis (PGA/PAA) without primary pulmonary involvement constitute a rarity. In the pediatric setting only a handful of case reports are published to date. Yet, due to insufficient specific diagnostic measures and drug therapies with only limited efficiency once the infection has established itself, PGA/PAA has a high case lethality rate, varying between 10-60% depending on the pathogen, age, immunocompetence of the patient and extent of infection [Ceylan, B., et al., Infez Med, 2019. 27(1): p. 85-92; Groll, A.H., et al., Lancet Oncol, 2021. 22(6): p. e254-e269]. Here we report on three infants with primary invasive abdominal aspergillosis, caused by Aspergillus fumigatus. Patient #1 was an infant diagnosed with acute myeloid leukemia receiving induction chemotherapy, while patients #2 and #3 both suffered from biliary atresia and were treated with liver transplantation. Some details have been omitted for the sake of clarity.



Publication History

Article published online:
30 January 2024

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