<div>ASPERGILLUS MEDIASTINITIS IN AN IMMUNOCOMPETENT CHILD</div><div>AUTHORS</div><div>Vidur Bansal<sup>1</sup>, Anand Kumar Mishra<sup>1</sup>,
Parakritii Gupta<sup>2</sup>, Gradlin Roy<sup>1</sup>,
Vikram Halder<sup>1</sup></div><ol><li>Department of Cardiothoracic and Vascular Surgery(CTVS), Advanced
cardiac Centre(ACC), PGIMER, Chandigarh, India</li><li>Department of Medical Microbiology, PGIMER, Chandigarh, India</li></ol><div>CORRESPONDING AUTHOR</div><div>Dr. Vidur Bansal, Department of CTVS, ACC, PGIMER, Chandigarh, India</div><div>RUNNING HEAD – Aspergillus mediastinitis</div><div>KEYWORDS – Aspergillus; immunocompetent; antifungal</div><div>ABSTRACT</div><div>Mediastinitis is a serious complication after cardiac surgery. While
bacteria are the more common pathogens, fungal infections are
rare. Post-operative Aspergillus mediastinitis is considered to be a
catastrophic infection, affecting patients with specific predisposing
factors undergoing cardiothoracic surgery. The patient outcome after
aspergillus mediastinitis is extremely poor despite antifungal therapy
and surgery. The diagnosis is usually delayed and relies on direct
visualization and culture. Clinical features of post-operative
Aspergillus mediastinitis could be minimal, underlining the necessity
for a low index of suspicion in cases of culture-negative mediastinitis.
Antifungal therapy including amphotericin B or voriconazole along with
surgical debridement forms the mainstay of treatment.</div><div>TEXT</div><div>Post-operative Aspergillus mediastinitis is regarded to be a devastating
infection, usually affecting patients undergoing cardiothoracic surgery
with specific predisposing factors.<sup>1</sup> We describe the
case of an immunocompetent 2-month-old child with obstructed
Supracardiac Total Anomalous Pulmonary Venous Circulation(TAPVC) and
severe Pulmonary Artery Hypertension(PAH), who underwent TAPVC repair
via median sternotomy. Primary closure of the sternum was not possible
due to significant myocardial oedema, necessitating a
polyvinylchloride(PVC) patch to be sutured to the skin. The child was
put on broad spectrum antibiotics from the outset and liposomal
amphotericin B was started on POD 8. But the child died as a result of
septic shock and multiple organ failure on POD-19. Pericardial and
sternal tissues were positive for hyphae under direct visualization,
compatible with Aspergillus species. Cultures were positive for several
colonies of Aspergillus flavus, no bacteria were isolated. A
comprehensive search for possible environmental contamination did not
reveal any source in the operating room or in the ICU. In this patient,
the maintenance of chest opening for over 7 days appeared to be the most
probable entry site of infection.</div><div>Post-surgical mediastinitis is defined as an infection involving the
structures between the sternum and the esophagus, occurring mainly after
cardiothoracic surgery.<sup>2</sup> Optimal treatment relies on
surgical debridement and antifungal therapy Antifungal treatment should
include amphotericin B or voriconazole.<sup>3</sup></div>