Invasive Pulmonary Aspergillosis After Near-drowning:Three Cases Report And Review Of The Literature

1. ObjectivesThe purpose of this study was to analyze the clinical presentations and disease courses of invasive pulmonary aspergillosis (IPA) in patients after near-drowning.2. MethodsThe clinical data of3cases of IPA after near-drowning from Jan.2010to March.2012in the First Affiliated Hospital of Medical School of Zhejiang University were retrospectively analyzed, and the related literature was reviewed.3. ResultsThere were1male and2female patients, aged from22to44years. All of them had been immunocompetent before drowning. One patient drowned due to traffic accident,1fell in sewage by accident, and1suffered from the injury. All of the3patients were intubated because of acute respiratory distress, and received therapies of both broad-spectrum antibiotic and glucocorticoid. Clinical symptoms were nonspecific. Fluctuations of body temperature seemed to be parallel to the deteriorations. Laboratory tests revealed hypersensitive c-reactive protein increased, and liver dysfunction, from which hypoproteinemia was remarkable. Cultures of the samples, such as sputum, transtracheal biopsy tissue, and bronchoalveolar lavage fluid, for aspergillus were negative in3patients. The condition of the3cases deteriorated5to11days after near-drowning. Thoracic CT findings presented dynamic changes, including multiple bilateral pulmonary nodules, lung consolidation and cavity formation.Meanwhile, using the terms "aspergillosis" and "near-drowning" a PubMed search yielded8articles, published between1984and2012. Using the terms "invasive pulmonary aspergillosis" and "near-drowning", searching Wangfang data and CHED data, encompass2articles with complete information. In all of the10articles, there are12cases:5final diagnosis cases,7clinical diagnosis cases. The different characteristic of these patients are summarized. We find condition deteriorated5to15days after near-drowning in most cases. Thoracic CT findings are typical.4. ConclusionsThe occurrence of IPA after near-drowning results from directly inhaling a large amount of aspergillus, and also from the pathogenic infection. The use of broad-spectrum antibiotics greatly increases the probabilities of this kind of infection. Comprehensive clinical diagnosis should be advocated in the early stage, despite the limitation of current detection methods. Characteristics in imaging are helpful both for the diagnosis and evaluation. Following the principles of evidence-based medicine, individual and combination treatments are encouraged to improve the prognosis of patients.