Invasive pulmonary aspergillosis in a premature neonate

Abstract

The incidence of opportunistic invasive infections has risen dramatically in the last years and morbidity and mortality remains high. Invasive aspergillosis has been described in immunocompromised patients (bone marrow transplant, haematological malignancies, solid transplant organ recipients). Neonates and in particular those born prematurely, are at especial risk of infection due to the immaturity of their immune system and the use of corticoids and antibiotics in neonatal intensive care units. Aspergillus species are ubiquitous, being present in the soil and dust. The usual port of entry is the respiratory tract. However, most neonatal invasive aspergillosis described are complication of cutaneous aspergillosis, where the port of entry are venous arm boards, tape used to secure catheters, etc. Most infections reported are due to Aspergillus fumigatus followed by A. flavus and occasional cases of A. niger . The current case is a premature monochorionic monoamniotic twin born at 25 + 4 weeks gestation. The placenta showed chorioamnionitis without fetal response to the infection. He developed a large subcapsular hepatic hematoma and died with multiorgan failure at 27 + 3 weeks gestation. There were no cutaneous lesions. At autopsy there was invasive pulmonary aspergillosis and disseminated intravascular coagulopathy. The organism responsible was Aspergillus flavus .