galactomannan and Pneumonia--Aspiration

Invasive aspergillosis is extremely rare in immunocompetent children. Here we describe the clinical, radiologic, and laboratory course of fatal invasive pulmonary and central nervous system aspergillosis in a previously healthy child after a near-drowning incident with submersion in a pond. Findings were compared with data from the literature, which is reviewed. Serum Aspergillus galactomannan levels were determined retrospectively and were compared with the results of routine microbiological and radiologic examinations, showing a significant diagnostic and therapeutic delay of the routine diagnostic approach in comparison with the use of the Aspergillus galactomannan assay. This delay may have contributed to the fatal course. Serial determination of serum Aspergillus galactomannan may be helpful in diagnosing invasive aspergillosis early in case of pulmonary disease after near-drowning and may contribute to an early appropriate treatment. Currently voriconazole, eventually in combination with caspofungin, should be considered as the drug of choice in the management of invasive aspergillosis after near-drowning.

Topics: Aspergillosis; Aspergillus fumigatus; Disease Susceptibility; Early Diagnosis; Epilepsy; Fatal Outcome; Female; Fresh Water; Galactose; Gram-Negative Bacterial Infections; Humans; Infant; Lung Diseases, Fungal; Mannans; Near Drowning; Neuroaspergillosis; Paraplegia; Pneumonia, Aspiration; Pneumonia, Bacterial; Respiratory Distress Syndrome; Respiratory Insufficiency; Stenotrophomonas maltophilia; Water Microbiology

Both 1,3-beta-D-glucan (BDG) and galactomannan (GM) are polysaccharide components of the fungal cell wall. Although elevated levels of serum BDG and Aspergillus GM suggest invasive fungal infection or Pneumocystis pneumonia and aspergillosis, respectively, it is also necessary to consider the possibility of false-positives. We herein report a 68-year-old man with marked elevation in serum BDG and GM levels accompanied by Mendelson's syndrome after rice aspiration. With the improvement of Mendelson's syndrome, his serum BDG and GM levels decreased. The false-positive serum BDG and GM findings may have been due to his aspiration of food containing them. It is important to take a detailed history of aspiration in addition to making a conventional differential diagnosis in patients with pneumonia with elevated serum BDG and GM levels.

Topics: Aged; Aspergillus; beta-Glucans; Galactose; Glucans; Humans; Male; Mannans; Oryza; Pneumonia, Aspiration; Pneumonia, Pneumocystis; Sensitivity and Specificity

Topics: Aged, 80 and over; Aspergillosis; Aspergillus; Enzyme-Linked Immunosorbent Assay; False Positive Reactions; Female; Galactose; Humans; Incidence; Japan; Male; Mannans; Pneumonia, Aspiration; Retrospective Studies