Cutaneous and Wound Aspergillosis

Abstract

Aspergillus infections of skin and wound have been increasingly reported in recent years. These diseases can range from non-invasive colonisation of wounds to invasive lesions that may serve as the aspergillosis portal of entry in immunosuppressed patients. Cutaneous aspergillosis can be broadly divided into: primary infections (starting from skin) and secondary infections (extending to skin from deeper tissues either contiguously or haematogenously). There has been marked increase in number of primary cutaneous aspergillosis cases in conjugation with prematurity, burn, HIV infection, organ transplantation, and malignancy. Wound aspergillosis affects mainly solid organ transplant recipients and those submitted to open-heart surgery. Small outbreaks of primary cutaneous aspergillosis have been reported in neonatal and surgical wards, and intensive care units in association with a contaminated environment. Simultaneous breach of skin and neutropenia predisposes a patient for cutaneous aspergillosis, though rare infection in healthy hosts has been reported. Demonstration of septate hyphae in tissue and isolation of Aspergilli help in diagnosis. Early diagnosis depends on increased awareness. These diseases can be of considerable morbidity and mortality if the patients are not managed aggressively. Combined surgery and antifungal therapy prevents the progression to disseminated aspergillosis, though surgery may be difficult in neonates and in HIV-infected patients.