Farooqi, Joveria

Zahid, Mohammad Faizan

English

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eCommons@AKUDepartment of Pathology and Laboratory Medicine Medical College, PakistanJuly 2015Aspergillus fumigatus spinal abscess in animmunocompetent childMohammad Faizan ZahidJoveria FarooqiAga Khan University, joveria.farooqi@aku.eduFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiolPart of the Microbiology Commons, and the Pathology CommonsRecommended CitationZahid, M., Farooqi, J. (2015). Aspergillus fumigatus spinal abscess in an immunocompetent child. JCPSP: Journal of the College ofPhysicians and Surgeons Pakistan, 25(7), 555-556.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiol/466Sir,Aspergillus species are ubiquitous fungi in theenvironment and are the most common cause ofinvasive mould infections in immunocompromisedpatients.1 Invasive Aspergillosis (IA) is a life-threateninginfection that predominantly affects individuals with acompromised immune system. Other risk factors, suchas but not limited to prolonged corticosteroid use, humanimmunodeficiency virus infection, cancers and chronicgranulomatous disease have also been identified.1However, IA is rarely encountered in individuals with ahealthy and fully functional immune system.2A 10-year boy presented with a 3-month history ofprogressively worsening lower backache associatedwith high grade fever. There were no neurologicalsymptoms associated with his complaints. There was nohistory of trauma which the parents could recall. Adetailed history was negative for any concerns about thechild's growth or recurrent infections that would suggestimmunodeficiency. White blood cell counts in the pastwere normal, and were raised in accordance with theinfection at this time. Past medical history revealedthat he had undergone ultrasound of the spine whichshowed a collection of pus in the vertebral spaces fromL3-L5. He was initially treated with antibiotics, with anti-staphylococcal coverage, and then later with Anti-tuberculous Therapy (ATT) with suspicion of tuber-culosis of the spine, however, he showed no improve-ment. Thus, CT-guided drainage was performed and thethick pus obtained was sent for Gram stain, Acid-FastBacilli (AFB) smear and culture.Gram stain, under low magnification (x100), showed asheet of pus cells with branching aggregations of crystalviolet stain (Figure 1A). However, at higher magnification(x1000), there was clustering of neutrophils around wellseptate hyphae (Figure 1B) and ghost hyphae (Figure 1Cand 1D) which were not seen at low magnification. The10%-KOH smear confirmed presence of hyphae andculture grew Aspergillus fumigatus. The patient wasstarted on intravenous (I.V.) amphotericin B for oneweek, after which he was switched to oral itraconazolewith close out-patient follow-up. At the end of 3 monthsthe child was doing well, with no complaints of feveror back pain, however, he was lost to follow-upthereafter.IA predominantly affects immunocompromised patients,especially those with prolonged neutropenia.1-4 IA initself is an extremely rare occurrence in immuno-competent hosts.1,2 Spinal involvement is an infrequentfinding in immunocompromised patients, and even rarerin immunocompetent subjects. Tew et al. and Vaishya etal. reported cases of a 50-year man and a   35-year-oldwoman, respectively, suffering from Aspergillus spinalabscess.3,4 Both these individuals had no evidence ofimmunodeficiency from history of laboratory investi-gations. Though neurological involvement with eventualparaplegia and fecal and urinary incontinence werepresent in both these cases, this patient presented withno neurological complaints other than back pain.Vertebral involvement with Aspergillosis is a rarephenomenon and is associated with high mortality.1,3,5Though surgical drainage and debridement wereemployed in the management of the above mentionedcases,1,3 they developed a fulminant postoperativecourse with a fatal outcome. This patient however,responded well to conservative management with I.V.and then oral antifungal agents at a maximum follow-upof 3 months.REFERENCES1. Cornet M, Mallat H, Somme D, Guerot E, Kac G, Mainardi J,et al. Fulminant invasive pulmonary Aspergillosis in immuno-competent patients: a two case report. Clin Microbiol Infec2003; 9:1224-7.2. Karam GH, Griffin FM. Invasive pulmonary Aspergillosis innon-immunocompromised, non-neutropenic hosts. Rev InfectDis 1986; 8:357-63.3. Tew C, Han F, Jureen R, Tey B. Aspergillus vertebralosteomyelitis and epidural abscess. Singapore Med J 2009;50:e151-4.Journal of the College of Physicians and Surgeons Pakistan 2015, Vol. 25 (7): 555-556 555LETTER TO THE EDITORAspergillus fumigatus SpinalAbscess in an ImmunocompetentChildFigure 1: (A) Photomicrograph of gram stain showing sheets of pus cellswith branching aggregations suggesting crystal violet artifacts (x100), (B)Clustering of neutrophils around hyphal forms seen on oil-immersion (x1000),(C and D) “Ghost hyphae” seen on other areas of the smear (x1000), notpreviously visible at low magnification.4. Vaishya S, Sharma MS. Spinal Aspergillus vertebralosteomyelitis with extradural abscess: case report and reviewof literature. Surg Neurol 2004; 61:551-5.5. Vinas FC, King PK, Diaz FG. Spinal Aspergillus osteomyelitis.Clin Infect Dis 1999; 28:1223-9.Letter to the editor556 Journal of the College of Physicians and Surgeons Pakistan 2015, Vol. 25 (7): 555-556Mohammad Faizan Zahid1 and Joveria Farooqi21 Medical Graduate, The Aga Khan University, Karachi.2 Department of Pathology and Microbiology, The Aga KhanUniversity Hospital, Karachi.Correspondence: Dr. Mohammad Faizan Zahid, House No. 54/1,Sector E, Phase 1, Defence Housing Authority, Lahore.E-mail: faizanzahid91@hotmail.comReceived: October 23, 2014;   Accepted: February 25, 2015.

Aspergillus fumigatus spinal abscess in an immunocompetent child

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Aspergillus fumigatus spinal abscess in an immunocompetent child

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