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Abstract
An 8-year-old boy, with fibular agenesis, tibial campomelia, and oligosyndactyly (FATCO syndrome), had been operated on for reconstruction 3 weeks prior at another hospital. He was admitted to our hospital because of right leg pain and purulent exudates from the surgical wound site for one week. Physical examination revealed purulent material at the surgical wound on the right leg. Radiological examination confirmed the clinical diagnosis as osteomyelitis. Clinical findings did not improve with empirical antibacterial therapy. A microbiological examination yielded a filamentous fungus from three different specimens that was identified as Aspergillus flavus. The patient was treated successfully with oral itraconazole for 6 weeks. In conclusion, invasive Aspergillus infections can affect immunocompetent adults and children. Trauma and surgical intervention can also be a risk factor for immunocompetent individuals. In addition to surgery, itraconazole can be a good choice in the treatment of Aspergillus osteomyelitis, especially in children.
(J Pediatr Inf 2012; 6: 163-6)
Key words: Aspergillus flavus, osteomyelitis, immunocompetent, itraconazole
Özet
Fibula yoklugu, tibiada kampomeli ve oligosindaktilisi olan (FATCO sendromu) 8 yasindaki bir erkek çocuk, üç hafta önce baska bir hastanede rekonstrüksiyon amaciyla opere olmustu. Bir haftadir devam eden sag bacak agrisi ve cerrahi yara bölgesinden pürülan akinti sikayeti ile hastanemize basvurdu. Fizik muayenede sag bacaktaki cerrahi yarada pürülan materyal gözlendi. Radyolojik incelemeler klinik osteomyelit tanisi ile uyumlu bulundu. Ampirik olarak baslanan antibakteriyel tedavi klinik bulgularda iyilesme saglamadi. Mikrobiyolojik incelemelerde üç farkli klinik örnekten filamantöz bir mantar izole edildi ve bu mantar Aspergillus flavus olarak tanimlandi. Hastaya oral itrakonazol ile 6 haftalik basarili bir tedavi uygulandi. Sonuç olarak, invaziv Aspergillus enfeksiyonlari immünsaglikli eriskin ve çocuklari etkileyebilir. Travma ve cerrahi müdahaleler immünsaglikli bireyler için risk faktörü olarak ortaya çikabilir. Cerrahiye ilave olarak itrakonazol, özellikle çocuklardaki Aspergillus osteomyelitinin tedavisinde iyi bir seçenek olabilir.
(J Pediatr Inf 2012; 6: 163-6)
Anahtar kelimeler: Aspergillus flavus, osteomyelit, immünsaglikli, itrakonazol
Introduction
Invasive aspergillosis usually affects the lungs, and osteomyelitis due to Aspergillus spp. is a rare manifestation of invasive aspergillosis. Generally, there are underlying immunosuppressive conditions such as prolonged granulocytopenia, immunosuppressive therapy, and chronic granulomatous disease. Although amphotericin B is one of the most preferred agents for invasive aspergillosis management, its poor bone penetration and renal toxicity limit its use for the treatment of osteomyelitis, especially in pediatric ages.