Successful treatment of an invasive Aspergillus flavus infection in a premature infant with liposomal amphotericin B and caspofungin

Abstract

Aspergillosis is an uncommon diagnosis in neonates, especially if caused by Aspergillus flavus. Although amphotericin B remains the drug of choice for treatment of invasive aspergillosis, Aspergillus flavus has been reported as being resistant to amphotericin B. We present here a case of a 24-week gestational age preterm infant who developed skin and invasive intestinal Aspergillus flavus infection after laparotomy for necrotizing enterocolitis. Aspergillus flavus was first isolated from the smear of the umbilical stump at the third postoperative day. The initial response to antimycotic treatment with amphotericin B and caspofungin was not sufficient. Because of continued disseminated infection and multiple intra-abdominal abscesses with necrotic areas of the liver, a second surgical intervention was performed on the 24th day of life. Antimycotic therapy was continued for approximately 43 days so as to ensure clinical remission. No adverse events were observed. This case supports the importance of the combination of surgery and newer antimycotic drugs for the outcome of premature infants with invasive aspergillosis.

Keywords

Aspergillus flavus - preterm newborn - amphotericin B - caspofungin