Öz

Objective: Invasive pulmonary aspergillosis (IPA) is a life-threatening fungal infection that predominantly affects immunocompromised individuals. Environmental exposure to large amounts of construction dust following natural disasters may also increase the risk of invasive fungal infections. We aimed to present a fatal case of IPA that developed in an earthquake survivor rescued from prolonged entrapment under collapsed buildings.

Methods: A female earthquake victim with no known chronic disease or history of immunosuppressive therapy was admitted to the intensive care unit (ICU) after prolonged entrapment under rubble, cardiac arrest, and severe crush-related complications. Clinical findings, microbiological results, imaging studies, treatment course, and outcome were retrospectively reviewed.

Results: The patient developed septic shock, acute kidney injury requiring renal replacement therapy, and persistent respiratory failure. Despite broad-spectrum antimicrobial therapy, fever and hypoxemia persisted. Thoracic computed tomography revealed multiple pulmonary nodular lesions and consolidations suggestive of invasive fungal infection. Aspergillus fumigatus was isolated from endotracheal aspirate cultures on the 17th day of ICU admission. Voriconazole therapy was initiated; however, the patient died on the 35th day of ICU hospitalization.

Conclusion: IPA should be considered in critically ill survivors of natural disasters, even in the absence of classical host-related risk factors. Early recognition of invasive fungal infections in patients exposed to substantial environmental dust and debris may facilitate timely antifungal treatment and potentially improve outcomes.

Anahtar Kelimeler: aspergillosis, earthquake, invasive fungal infection, mortality

Referanslar

  1. Spagnolo AM. Aspergillus contamination in healthcare facilities: an ever-present issue-prevention and control measures. Hygiene. 2025;5:1-13. https://doi.org/10.3390/hygiene5010003
  2. Chakrabarti A, Chatterjee SS, Das A, Shivaprakash MR. Invasive aspergillosis in developing countries. Med Mycol. 2011;49(Suppl 1):35-47. https://doi.org/10.3109/13693786.2010.505206
  3. Ledoux MP, Herbrecht R. Invasive pulmonary aspergillosis. J Fungi (Basel). 2023;9:131. https://doi.org/10.3390/jof9020131
  4. Patterson TF. Aspergillus species. In: Mandell GL, Bennett JE, Dolin R (eds). Mandell, Douglas and Bennett’s principles and practice of infectious diseases. 7th ed. Philadelphia: Churchill Livingstone; 2009:3241-55. https://doi.org/10.1016/B978-0-443-06839-3.00258-7
  5. De Pauw BE. Increasing fungal infections in the intensive care unit. Surg Infect (Larchmt). 2006;7(Suppl 2):93-6. https://doi.org/10.1089/sur.2006.7.s2-93
  6. Azim A, Ahmed A. Diagnosis and management of invasive fungal diseases in non-neutropenic ICU patients, with focus on candidiasis and aspergillosis: a comprehensive review. Front Cell Infect Microbiol. 2024;14:1256158. https://doi.org/10.3389/fcimb.2024.1256158
  7. Blot SI, Taccone FS, Van den Abeele AM, et al. A clinical algorithm to diagnose invasive pulmonary aspergillosis in critically ill patients. Am J Respir Crit Care Med. 2012;186:56-64. https://doi.org/10.1164/rccm.201111-1978OC
  8. Blot S, Rello J, Koulenti D. Diagnosing invasive pulmonary aspergillosis in ICU patients: putting the puzzle together. Curr Opin Crit Care. 2019;25:430-7. https://doi.org/10.1097/MCC.0000000000000637
  9. Verweij PE, Rijnders BJ, Brüggemann RJ, et al. Review of influenza-associated pulmonary aspergillosis in ICU patients and proposal for a case definition: an expert opinion. Intensive Care Med. 2020;46:1524-35. https://doi.org/10.1007/s00134-020-06091-6
  10. White PL, Dhillon R, Cordey A, et al. A national strategy to diagnose coronavirus disease 2019-associated invasive fungal disease in the intensive care unit. Clin Infect Dis. 2021;73:e1634-44. https://doi.org/10.1093/cid/ciaa1298
  11. Koehler P, Bassetti M, Chakrabarti A, et al. Defining and managing COVID-19-associated pulmonary aspergillosis: the 2020 ECMM/ISHAM consensus criteria for research and clinical guidance. Lancet Infect Dis. 2021;21:e149-62. https://doi.org/10.1016/S1473-3099(20)30847-1
  12. Ullmann AJ, Aguado JM, Arikan-Akdagli S, et al. Diagnosis and management of aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect. 2018;24(Suppl 1):e1-e38. https://doi.org/10.1016/j.cmi.2018.01.002
  13. Perbet S, Mongardon N, Dumas F, et al. Early-onset pneumonia after cardiac arrest: characteristics, risk factors and influence on prognosis. Am J Respir Crit Care Med. 2011;184:1048-54. https://doi.org/10.1164/rccm.201102-0331OC
  14. Sipsas NV, Kontoyiannis DP. Occupation, lifestyle, diet, and invasive fungal infections. Infection. 2008;36:515-25. https://doi.org/10.1007/s15010-008-8129-5
  15. Kawakami Y, Tagami T, Kusakabe T, et al. Disseminated aspergillosis associated with tsunami lung. Respir Care. 2012;57:1674-8. https://doi.org/10.4187/respcare.01701

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Nasıl atıf yapılır?

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Kalın BS, Yanatma S, Düzgün A, Sert Aİ. A case of invasive pulmonary aspergillosis seen in a earthquake victim impacted by the disaster in Türkiye. Turk J Intensive Care. 2026;24(2):147-151. https://doi.org/10.63729/TJIC.2026.698