Invasive pulmonary aspergillosis (IPA) is uncommon in immunocompetent patients, but rare cases have been described after nonfatal drowning, particularly in contaminated water sources. Given subacute disease manifestations, diagnostic difficulties and the rapidly progressive nature of this organism, its mortality rate approaches 50%. Clinicians must rely on nonculture-based biomarkers and imaging to inform early diagnosis. There are currently no recommendations regarding diagnostics or empiric therapy for mold infections in near-drowning patients. We report a fatal case of IPA in a 4-year-old male following submersion in a manure pond. Early serum biomarkers and empiric voriconazole should be strongly considered in all patients after near-drowning in contaminated water sources.
Keywords: Aspergillus; antibiotics; antifungals; aspergillosis; contaminated water; invasive pulmonary aspergillosis; management; manure; treatment.
Children that survive drowning can suffer lung infections after inhaling water. The cause is usually bacteria (germs) that live in our nose, as well as the bacteria in the water itself. In dirty water, many different bacteria are present. Strong antibiotic medicines are usually given to treat or stop infections from happening after drowning. Molds (fungus germs) can also cause lung infections, but usually in people with weak infection-fighting ability. We report a case of a mold infection that spread from the lungs to the blood and brain which led to the death of a previously healthy boy after drowning in a pond of animal waste. These mold infections can be slow and then spread quickly, so testing and treating for it with antifungal medicine in addition to antibacterial medicine needs to be done as early as possible.