BONE MARROW INVASION BY ASPERGILLUS SPECIE IN A SICKLE CELL TRAIT PATIENT WITH INVASIVE ASPERGILLOSIS: A FATAL CASE IN ASSOCIATION WITH DISSEMINATED INTRAVASCULAR COAGULATION
Background: Invasive aspergillosis has been predominantly associated with pulmonary infection, particularly amongst immunocompromised individuals. Extrapulmonary infections with Aspergillus specie have been reported rarely irrespective of immune status. Risk factors for invasive aspergillosis includ...
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| Autores principales: | , , , , |
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| Formato: | article |
| Lenguaje: | EN |
| Publicado: |
Ntec Specialist
2020
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| Acceso en línea: | https://doaj.org/article/3b658f5a85634678978213cb51daa7e7 |
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| Sumario: | Background: Invasive aspergillosis has been predominantly associated with pulmonary
infection, particularly amongst immunocompromised individuals. Extrapulmonary infections
with Aspergillus specie have been reported rarely irrespective of immune status. Risk factors for
invasive aspergillosis include prolonged and severe neutropenia, haematopoietic stem cell and
solid organ transplantation, advanced AIDS, and chronic granulomatous disease. The most
frequently involved specie is Aspergillus fumigatus that constitutes over 90% of cases, followed
by Aspergillus flavus, usually associated with a primary skin infection. Haematogenous spread
to the bone causing osteomyelitis is the commonest form of disseminated aspergillosis and a
surprisingly high proportion of these patients have no immunosuppression. We present a rare
case of bone marrow invasion by Aspergillusspp. in a 3-year-old patient with sickle cell trait and
chronic Aspergillosis. Case report: A 3-year-old patient with sickle cell trait was brought to the
paediatric unit with recurrent diarrhoea, abdominal distention, weight loss and persistent cough.
The child was severely wasted with generalised peripheral lymphadenopathy. She had marked
respiratory distress and hepatosplenomegaly but no demonstrable ascites. Haematologic
examination revealed leukaemoid reaction (leukocyte count of 44.0 x 109/L) with monocytosis
(10%) and thrombocytopenia (platelet count of 97,000/mm3); no blast cells were seen on blood
film. The bone marrow was hypercellular with a myeloid/erythroid ratio of 20:1, consistent with
infection. Bone Marrow culture yielded Aspergillus spp. and other results of sepsis work up were
negative. Conclusion: Cases of extrapulmonary invasive aspergillosis have been reported rarely
in both immunocompetent and immunocompromised patients. Haematogenous spread to the
bone is the commonest form of disseminated disease |
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