Case report

A 53-year-old woman without medical history sustained an accidental thermic burn injury in Gabon. The patient was initially resuscitated in Gabon, then transferred to the burn centre of Percy Military Teaching Hospital on post-burn day (PBD) 2.

Burn injury assessment at the admission found both partial and full thickness burns estimated to 60% total body surface area (45% full thickness). Fibreoptic bronchoscopy finds out smoke inhalation injury (grade 2). Wound swabs were collected as part of routine microbial colonisation assessment. The first surgical procedure with debridement, excision and autografting of the posterior trunk was performed on PBD 5.

At PBD 8, a burn wound infection (BWI) of the back was suspected because of a fever and a skin graft lysis. Swab cultures identified Enterobacter cloacae and Stenotrophomonas maltophilia leading to an intravenous antibiotherapy (piperacillin– tazobactam +amikacin) associated with topical antibiotics (mafenide acetate). At PBD 15, a new BWI occurred in the same anatomic region. Swab cultures and quantitative culture of skin biopsies showed an unidentified Aspergillus species. This fungal local infection was associated with the presence of galactomannan antigen (Platelia, BioRad, Hercules, California, USA) in blood samples: index=3 ng/mL (positive cut-off index ≥0.5 ng/mL). The first fungal species identification was Aspergillus flavus. However, first …