Hazel C Dobinson1, Gregory Down1, Julia E Clark1,2. 1. Infection Management and Prevention Service, Queensland Children's Hospital, Brisbane, Queensland, Australia. 2. School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
Abstract
BACKGROUND: Exserohilum species are environmental moulds that can cause skin infection and sinusitis in both normal and immunosuppressed children. This study reviews paediatric cases of Exserohilum infection in Queensland, Australia, to identify the spectrum of disease and its clinical course. METHODS: All culture-positive samples of Exserohilum species in children <18 years of age were identified from the Queensland Health Laboratory database (April 2003-April 2018). Clinical information was recorded from medical records. RESULTS: Eleven children were identified, and all had isolated Exserohilum rostratum. The mean age was 7.4 years (range 2.3-17.8) and 64% female. Four immunocompetent children (36%) had a skin infection (2/4), chronic sinusitis (1/4) or otitis externa (1/4). Seven children (64%) had an underlying oncological diagnosis with E. rostratum causing local skin infection (2/7), invasive rhinosinus disease (3/7) or disseminated infection (2/7). All oncological patients were empirically started on liposomal amphotericin B with addition, or switch, to posaconazole or voriconazole. CONCLUSION: Exserohilum rostratum infection of the skin has a favourable course, whereas rhinosinus infection can be rapidly invasive in the immunocompromised child requiring prompt surgical intervention and antifungal therapy. Susceptibility data support empiric use of liposomal amphotericin and/or posaconazole.
BACKGROUND:Exserohilum species are environmental moulds that can cause skin infection and sinusitis in both normal and immunosuppressed children. This study reviews paediatric cases of Exserohiluminfection in Queensland, Australia, to identify the spectrum of disease and its clinical course. METHODS: All culture-positive samples of Exserohilum species in children <18 years of age were identified from the Queensland Health Laboratory database (April 2003-April 2018). Clinical information was recorded from medical records. RESULTS: Eleven children were identified, and all had isolated Exserohilum rostratum. The mean age was 7.4 years (range 2.3-17.8) and 64% female. Four immunocompetent children (36%) had a skin infection (2/4), chronic sinusitis (1/4) or otitis externa (1/4). Seven children (64%) had an underlying oncological diagnosis with E. rostratum causing local skin infection (2/7), invasive rhinosinus disease (3/7) or disseminated infection (2/7). All oncological patients were empirically started on liposomal amphotericin B with addition, or switch, to posaconazole or voriconazole. CONCLUSION:Exserohilum rostratuminfection of the skin has a favourable course, whereas rhinosinus infection can be rapidly invasive in the immunocompromised child requiring prompt surgical intervention and antifungal therapy. Susceptibility data support empiric use of liposomal amphotericin and/or posaconazole.