Aspergillus fumigatus wound infection in an immunocompetent child

Invasive aspergillosis is a well-documented opportunistic infection in the immunocompromised host. Infection may occasionally occur in association with tissue damage such as burns, surgery, or foreign body. However, Aspergillus spp. infection complicating post-traumatic soft tissue injury in immunocompetent children is very unusual and only 4 cases have been reported in the literature. Morbidity is high despite aggressive surgical and anti-fungal therapy. We describe a previously healthy 7-year-old female who was involved in a motor vehicle accident and suffered a severe degloving and crush injury to her right leg contaminated with soil and grass debris. Intravenous ampicillin, gentamicin, and clindamycin were administered and surgical exploration with debridement of nonviable tissue of her posterior right lower extremity was performed. The postoperative course was complicated by development of wound infection on day 8 post-injury, histologically and microbiologically confirmed to be caused by Aspergillus fumigatus necessitating treatment with intravenous amphotericin B (1mg/kg/day). Repeat wound cultures on day 7 of therapy yielded no growth. Prolonged therapy with amphotericin B (total cumulative dose of 31 mg/kg) and oral itraconazole therapy in association with repeated radical surgical debridement resulted in successful outcome. It is important for physicians to recognize that Aspergillus can cause severe soft tissue infection following extensive trauma with environmental contamination. Prompt identification facilitates the initiation of appropriate therapy, thus decreasing the morbidity associated with this infection.