tailieunhanh - Báo cáo y học: "Invasive pulmonary and central nervous system aspergillosis following slops aspiration in a trauma patient"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Invasive pulmonary and central nervous system aspergillosis following slops aspiration in a trauma patient. | Zhang et al. Critical Care 2010 14 442 http content 14 5 442 CRITICAL CARE LETTER L_ Invasive pulmonary and central nervous system aspergillosis following slops aspiration in a trauma patient Mao Zhang1 Guang-Ju Zhou1 Xuan-Ding Wang2 Lian Wang1 Jian-Xin Gan1 and Shao-Wen Xu1 Cerebral aspergillosis is a rare complication of multiple trauma. In this report we present a remarkable case of multiple lung and brain lesions caused by aspergillosis after a falling incident. A 54-year-old male was admitted with multiple trauma brain contusion aspiration pneumonitis with pulmonary contusion right humerus fracture and right scapular fracture due to a 6-m fall and aspiration of slops. In view of aspiration pneumonitis Figure 1 day 1 intravenous antibiotic treatment tazocin moxifloxacin hydrochloride and metronidazole was started. Brain computerized tomography CT on day 12 indicated a focus of encephalomalacia in the left frontal lobe which was thought to be the progress of brain contusion Figure 1 day 12 . On the same day chest CT showed a pulmonary halo sign on the left upper lung Figure 1 day 12 and voriconazole therapy was used because of high suspicion of invasive pulmonary fungal infection. Voriconazole treatment had to be stopped however due to severe rash 5 days later. Anti-fungus therapy was continued with caspofungin. On day 19 the brain CT showed signs of fungus infection Figure 1 day 19 . Twenty-two days after injury the central venous catheter culture grew aspergillus species and established the diagnosis of invasive aspergillosis in this patient liposomal amphotericin B was then also added to the patient s treatment. On day 34 enhanced CT imaging of the brain showed progression of multiple lesions of fungus infection Figure 1 day 34 . Unfortunately the patient died 40 days after injury. We have described invasive aspergillosis with a rapidly progressive and fatal pulmonary and cerebral course in a previously healthy man. Neuroaspergillosis is an