Abdominal Aspergillosis – an Underdiagnosed Disease? Three Cases of Abdominal Aspergillosis in Severely Immunocompromised Infants

Introduction

Immunosuppressed and immunocompromised patients are at high risk of infectious complications. Among those are rare but sometimes lethal invasive fungal infections/disease (IFD). Especially immunosuppression caused by intense polychemotherapy, corticosteroids, prolonged, severe neutropenia or surrounding organ transplantation seems to cause susceptibility towards opportunistic mycosis [Pacholczyk, M., et al., Ann Transplant, 2011. 16(3): p. 14-16; Ceylan, B., et al., Infez Med, 2019. 27(1): p. 85-92; Fischer, J., et al., Eur J Pediatr Surg, 2018. 28(6): p. 477-483; Avcu, G., et al., Med Mycol Case Rep, 2016. 11: p. 1-4; Decembrino, N., et al., New Microbiol, 2016. 39(1): p. 65-9; Marr, K.A., et al., Clin Infect Dis, 2002. 34(7): p. 909-917; Otto, W.R. and A.M. Green, Br J Haematol, 2020. 189(4): p. 607-624]. In children, the most common causative species are Candida spp., Aspergillus spp., and the Mucorales molds [Otto, W.R. and A.M. Green, Br J Haematol, 2020. 189(4): p. 607-624]. Invasive aspergillosis usually presents as a pulmonary infection and can disseminate to other tissues in the body via vascular invasion [Barnes, P.D. and K.A. Marr, Infect Dis Clin North Am, 2006. 20(3): p. 545-561]. Cases of gastrointestinal/abdominal aspergillosis (PGA/PAA) without primary pulmonary involvement constitute a rarity. In the pediatric setting only a handful of case reports are published to date. Yet, due to insufficient specific diagnostic measures and drug therapies with only limited efficiency once the infection has established itself, PGA/PAA has a high case lethality rate, varying between 10-60% depending on the pathogen, age, immunocompetence of the patient and extent of infection [Ceylan, B., et al., Infez Med, 2019. 27(1): p. 85-92; Groll, A.H., et al., Lancet Oncol, 2021. 22(6): p. e254-e269]. Here we report on three infants with primary invasive abdominal aspergillosis, caused by Aspergillus fumigatus. Patient #1 was an infant diagnosed with acute myeloid leukemia receiving induction chemotherapy, while patients #2 and #3 both suffered from biliary atresia and were treated with liver transplantation. Some details have been omitted for the sake of clarity.

Publication History

Article published online:
30 January 2024