Abstract
ABSTRACT: Aspergillus species are ubiquitous in the environment. Premature neonates are particularly vulnerable to these fungal infections because their immune systems and integument are underdeveloped. Fungal invasion through breaks in the epidermis can lead to the development of primary cutaneous aspergillosis (PCA), a skin infection that is locally destructive and causes tissue necrosis. If left untreated, the fungus can disseminate into deeper tissues, causing significant morbidity and mortality. Treatment options are primarily pharmaceutical with rare indications for surgical debridement. However, concomitant wound care protocols may be beneficial.
Herein, the authors report the successful management and wound care of PCA with extensive necrosis in a premature neonate. A 6-day-old boy born prematurely at 23 weeks and 6 days presented with widespread white plaques along the midline of the back. Biopsy and culture of the area returned positive for both Aspergillus flavus and Aspergillus niger. Appropriate antibiotic and antifungal treatment was initiated. Loose necrotic tissue was removed weekly with warm 0.9% saline on a cotton-tipped applicator. Fresh silver-impregnated dressings were applied daily and secured with swaddling wraps. Pharmacotherapy and wound care were discontinued on day of life (DOL) 85 and DOL 108, respectively. By DOL 40, all wounds were red, moist, and granulating. By DOL 108, the wound reached complete resolution, and the patient was discharged from the wound care service with a well-healed scar. This case highlights the importance of rapid medical management coupled with daily wound care for the successful treatment of PCA with extensive necrosis.