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Superficial abdominal surgical site infection caused by Aspergillus welwitschiae: a case report

Summary

An elderly woman developed a rare fungal infection in her abdominal surgical wound after surgery for a perforated colon. The infection was caused by Aspergillus welwitschiae, a mold that was initially thought to be a more common species. Doctors treated the infection by surgically removing the infected tissue and giving the patient an antifungal medication called voriconazole. This is the first reported case of this particular mold causing this type of surgical infection.

Background

Aspergillus species are rare causes of surgical site infections (SSIs). Aspergillus welwitschiae, belonging to Aspergillus section Nigri, has not previously been reported as a cause of abdominal SSIs. Species in this section are known to have low antifungal drug susceptibility, particularly to azoles.

Objective

To report the first documented case of superficial abdominal SSI caused by Aspergillus welwitschiae in an elderly patient with multiple comorbidities and steroid use who developed the infection following open Hartmann surgery for sigmoid colon perforation.

Results

Aspergillus welwitschiae was identified via calmodulin gene analysis with MIC values showing voriconazole (VRCZ) MIC of 2 mg/L. Surgical removal of infected tissue combined with VRCZ administration (400 mg twice on day 1, then 200 mg twice daily for 40 days) was effective in treating the infection. Serum Aspergillus antigen and beta-D-glucan levels elevated during treatment but normalized by day 38.

Conclusion

This is the first reported case of noninvasive postsurgical aspergillosis caused by A. welwitschiae. Identification and drug susceptibility testing of Aspergillus section Nigri species are crucial due to their low susceptibility to azoles, which may influence antifungal agent selection. Many cryptic species within the A. niger complex may have been previously misidentified based on microscopic findings alone.
  • Published in:BMC Infectious Diseases,
  • Study Type:Case Report,
  • Source: PMID: 39289609, DOI: 10.1186/s12879-024-09919-4
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