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Pulmonary Mycosis Caused by Aspiration of Polluted Water after
Near-Drowning: Case Reports and Literature Review

L. Wang MD, Y.-L. Cui MD, J.-Y. Liu MD, Z.-F. Lin MD, D.-C. Chen MD

Department of Emergency Medicine,Chang Zheng Hospital, Shanghai Military Medical University, 415 Feng Yang Road,
Shanghai, China

Abstract

Pulmonary mycosis can be seen in previously healthy individuals after submersion or near-drowning. We present
two cases of the disease confirmed with histological examination in immuno-competent patients after near-drowning
incidents. The submersion event in contaminated water likely increases the risk of pulmonary mycosis .Monitoring in the
intensive care unit, along with the use of corticosteroids and antibiotics could have rendered our patients more vulnerable
to mycosis. The definite diagnosis relies on etiological identification by fungal culture and histopathological evidence,and
it may be difficult because of the lack of etiological identification. Therefore, clinical diagnosis relies on the association of a
host factor, clinical course, radiological findings and microbiological findings. While optimal treatment remains undefined,
the empirical early use of voriconazole has been proposed in cases of suspected scedosporiosis after near-drowning or
even prophylactically in all near-drowning patients. Application of broad spectrum antifungal drugs and close monitoring
for side effects are the most important contributors to favorable outcome.

Corresponding Author: D.-C. Chen, E-mail: 18918520002@189.cn

Introduction eral sources of mycosis for patients in intensive care. Pa-
tients may acquire the infection in the community before
Pulmonary mycosis (PM) is a common type of invasive admission to the hospital with the infection colonizing the
fungal infection which is often severe and difficult to treat upper or lower respiratory tract, or they may acquire the
and has a high mortality rate. Post-transplant complica- infection from contaminated food, soil and water [5].
tions, prolonged neutropenia, immunosuppressive regi-
mens, prolonged use of corticosteroids and antibiotic use In this study, we retrospectively review cases of pul-
are all independent risk factors for PM [1]. The incidence monary mycosis in immuno-competent patients in the
of mycosis can be different depending on the underlying intensive care unit of our center, and present two cases of
condition: in immunosuppressive therapy or immuno-com- the disease confirmed with histological examination after
promised patients, pulmonary mycosis is a severe com- near-drowning incidents.
plication which can reach a 100% mortality rate when no
treatment is administered. In cases of bone marrow trans- Case report
plant, the incidence of invasive pulmonary aspergillosis is
about 5% with a mortality rate which can attain 82% even Case 1
when antifungal treatment is provided [2]. However, it is
also occasionally seen in patients with uncompromised im- A previously healthy 31-year-old man inhaled poison-
munological function and without underlying diseases. [3,4] ous gas when working in sewage drains, following which
Recent data suggest that the incidence of invasive aspergil- he lost consciousness and was later found lying face down
losis is increasing in non-immuno-suppressed patients in in a ditch of stagnant water. After he was taken to a nearby
intensive care units (ICU). Candida still is the major patho- hospital, he was treated and was fully conscious after 5
gen of invasive fungal infection (IFI) in ICU, accounting for hours. Then he started complaining of persistent fever and
91.4% of all infections. The incidence of mold infection has blurred vision in the left eye. Computed Tomography (CT)
risen to 5.9% in the intensive care setting. There are sev- scans of the chest revealed the presence of cavities and
nodules in both lungs. Antimycotic therapy was initiated
with liposomal amphotericin B (Ben Venue Laboratories

Laboratory and Clinical CInavseestRigeaptoiortn 461 FAM 2014 Nov/Dec Vol.21 Issue 6
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