Outbreak of primary cutaneous aspergillosis related to intravenous arm boards

Concomitant <i>Mycobacterium tuberculosis</i>and <i>Aspergillus niger</i> Infection in a Patient with Acute Myeloid Leukemia

“…It has been mainly reported in patients with leukemia or lymphoma undergoing intensive cytotoxic chemotherapy or recipients of organ transplants and HIV-infected individuals. In this patient population, contaminated intravenous cannulas or Hickman catheters, minor trauma and abrasions associated with contaminated tapes, gauze wraps and arm boards as well as burns have been described as additional risk factors for cutaneous aspergillosis [1][2][3][4][5][6][7]. Disruption of the integrity of the epidermis by trauma or maceration appears to be a major risk factor for this infection.…”

“…The treatment of choice for primary cutaneous aspergillosis is amphotericin B, in conjunction with surgical debridement when indicated [2,6]. Despite aggressive therapy with amphotericin, primary cutaneous aspergillosis can lead to disseminated disease with fatal consequences, usually in association with ongoing immunosuppression or neutropenia [2,9].…”

Cutaneous aspergillosis

“…Although most of these patients had leukemia as the underlying oncologic diagnosis, reports have described other diseases, including aplastic anemia (2,51,66), astrocytoma (38), chronic granulomatous disease (14), and agranulocytosis treated with antithymocyte globulin (45). In greater than 85% of cancerrelated cases, primary cutaneous aspergillosis was associated with intravenous catheters, arm boards, or tape securing arm boards (2,9,11,17,22,25,37,38,51,68). Other associations have included breaks in the epithelium during insertion of a vaginal clotrimazole troche (53) and phlebotomy (34).…”

“…In contrast, among cases of cutaneous aspergillosis that did not involve HIV-infected or burn patients, the following organisms accounted for the indicated proportion of cases: Aspergillus flavus, 44%; A. fumigatus, 26%; Aspergillus spp. (the species of Aspergillus was not determined), 10%; Aspergillus terreus, 6% (13,38,45,61); Aspergillus niger, 6% (10, 25, 32, 38, 55); A. glaucus, 4% (15,66,68); Aspergillus chevalieri, 3% (42); and Aspergillus ustus, 1% (59). The proportions of species differed by at-risk populations: A. flavus accounted for approximately one-half of non-burnrelated primary infection, whereas A. flavus and A. fumigatus each accounted for approximately one-third of secondary or metastatic skin lesions.…”

“…Previous reports have described cutaneous aspergillosis as either primary (2,17,25,38) or secondary (15,19) infection. Primary cutaneous aspergillosis usually involves sites of skin injury, namely, at or near intravenous access catheter sites, at sites of traumatic inoculation, and at sites associated with occlusive dressings, burns, or surgery.…”