Primary cutaneous aspergillosis B44.9

Primary cutaneous aspergillosis is a relatively rare infectious disease that remains poorly characterized by its rarity. Previous reports have described cutaneous aspergillosis as either primary (Allo MD et al. 1987) or secondary to systemic aspergillosis (Van Burik JAH 1998).

Apparently, (in immunocompromised patients) the use of adhesive strips on the skin is a risk factor for local Aspergillus infections. Intermittent peeling of the tape from the skin causes mechanical trauma during dressing changes, predisposing patients to this infection. It is also possible that entrapment of Aspergillus spores under the adhesive dressing plays a role.

The clinical findings are uncharacteristic. Nodules, possibly pustules, molluscum-like papules, plaques and ulcers appear (Hui AN et al. 1984). .

In non-HIV-infected, immunocompromised patients with cutaneous aspergillosis, five major risk groups for primary cutaneous Aspergillus infection emerge:

• Burn victims
• Neonates
• Immunocompromised tumor patients
• Bone marrow transplant recipients
• Recipients of organ transplants.

Clinical manifestations vary depending on the underlying risk.

A lesional skin biopsy is necessary to confirm the diagnosis. A culture should also be performed to confirm the microscopic findings. If an Aspergillus infection is diagnosed, it must be clarified whether a systemic manifestation (e.g., aspergillosis of the lung) is present.

For localized primary aspergillosis, itraconazole is the first-line therapy. Patients receiving itraconazole should be monitored closely. Therapy should be switched to intravenous amphotericin B if lesions worsen or if there are other signs of clinical failure.

Itraconazole is not recommended as first-line therapy for the treatment of cutaneous aspergillosis infections occurring at vascular catheter exit sites or tunnel infections, secondary cutaneous aspergillosis, or extensive primary cutaneous disease such as in burn victims. These infections require treatment with intravenous amphotericin B, along with surgical therapy when clinically indicated (Van Burik JAH 1998).

1. Allo MD et al (1987) Primary cutaneous aspergillosis associated with Hickman intravenous catheters.N. Engl. J. Med 31719871105-1108.
2. Bretagne S et al. (1997) Fatal primary cutaneous aspergillosis in a bone marrow transplant recipient: nosocomial acquisition in a laminar-air flow room. J Hosp Infec.36: 235-239.
3. Bruck HM et al (1971) Opportunistic fungal infection of the burn wound with phycomycetes and Aspergillus. A clinical-pathologic review. Arch Surg 102: 476-482
4. Hui AN et al (1984) Necropsy findings in acquired immunodeficiency syndrome: a comparison of premortem diagnoses with postmortem findings. Hum Patho.15: 670-676
5. Langlois RP et al (1980) D.Cutaneous aspergillosis with fatal dissemination in a renal transplant recipient.Can Med Assoc J 122: 673-676.
6. McCarty JM ET AL: (!98&) Outbreak of primary cutaneous aspergillosis related to intravenous arm boards.J. Pediat.108: 8721-724
7. Van Burik JAH (1998) Cutaneous aspergillosis Journal of Clinical Microbiology 36: 3115-3121.