Invasive Pulmonary Aspergillosis in Children: A Case Report and Literature Review.

BACKGROUND Invasive pulmonary aspergillosis (IPA) is the major cause of mortality and morbidity in immunocompromised patients with prolonged neutropenia and is associated with poor prognosis. Multiple factors are associated with an increased risk of invasive aspergillosis, including persistent neutropenia, impaired lymphocyte engraftment following bone marrow transplantation, cytomegalovirus disease, respiratory virus infection, cytotoxic chemotherapy, and Aspergillus colonization. Unfortunately, attempts at fungal isolation are often unsuccessful. CASE REPORT We describe a 15-year-old girl with a known case of acute myeloid leukemia (AML) with unusual cause of chest infection accompanied with a persistent radiological finding that worsened with time despite multiple levels of intervention. The optimal treatment was unclear, given that all cultures were negatives and the condition did not improve. Very interesting radiological findings will be elaborated in this case. Despite the typical radiological findings, we struggled to confirm the underlying cause of lung infection, which was demonstrated to be Aspergillus fumigatus by thoracoscopy and lavage. Eventually, when the patient started to improve, catastrophic bleeding occurred, confirming the angio-invasive nature of this organism. CONCLUSIONS IPA is still associated with very high morbidity and mortality. A high index of suspicion is needed for such cases. We recommend lavage on the third or fourth day of febrile neutropenia illness in patients who did not show clear improvement with the standard neutropenia protocol, and we suggest considering combined antifungal therapies at an earlier time point. IPA is angio-invasive and can lead to catastrophic bleeding. Earlier surgical intervention might be considered, especially in refractory localized Aspergillus.

Prevalence of fall injuries and risk factors for fall among hospitalized children in a specialized childrens hospital in Saudi Arabia.

BACKGROUND: Fall injuries among children during hospital stay is a major patient safety issue. Inpatient pediatric falls can lead to numerous negative consequences. In contrast to adults, there is a paucity of information on the prevalence and risk factors associated with children's falls during hospitalization. OBJECTIVES: Identify the prevalence of fall injuries among hospital.ized children and describe the demographic and environmental factors that could predict a higher risk of severe outcomes of fall. DESIGN: Descriptive, cross-sectional prevalence study. SETTING: Specialized children's hospital. PATIENTS AND METHODS: Data was obtained through the electronic Safety Reporting System (SRS). All reported fall events during hospitalization in children less than or equal 14 years of age for the period from 1 April 2015 to 30 April 2016 were included. Fall events that occurred in the day care unit and the outpatient clinic were excluded. MAIN OUTCOME MEASURES: Prevalence and possible risk factors for fall events. SAMPLE SIZE: 48. RESULTS: The prevalence of falls among the 4860 admitted children was 9.9 (95% CI=7.5, 13.1) per 1000 patients (48/4860). A majority of the falls were among boys (n=26, 54%), in the age group from 1-5 years old (n=22, 46%), in children at high risk of falling (n=35, 73%), with normal mobility status (n=21, 44%), and with no history of previ.ous falls (n=33, 69%). Severe injuries accounted for 25% of falls (n=12). However, falls among the moderate risk category (n=9, 69%) were more often severe than falls among the high risk category of children (n=12, 34%) (P=.03). CONCLUSION: Risk factor identification is required to prevent falls and their severe outcomes. LIMITATIONS: Underreporting and single-centered study. CONFLICT OF INTEREST: None.