Cutaneous Aspergillosis Among Extremely Preterm Neonates in Neonatal Intensive Care Units — Michigan and New York, 2023–2024

Abstract

Cutaneous aspergillosis is a rare, life-threatening fungal infection in neonates, particularly those born extremely preterm (gestational age <28 weeks); outbreaks have been linked to environmental sources of Aspergillus species. The Michigan Department of Health and Human Services and the New York State Department of Health investigated two clusters of cutaneous aspergillosis in neonatal intensive care units during 2023–2024. In Michigan, two extremely preterm neonates (gestational age <24 weeks) received a diagnosis of cutaneous aspergillosis. Samples cultured from both infants were positive for Aspergillus fumigatus; both received antifungal treatment, and one infant died. In New York, three neonates (two born at gestational age 24–25 weeks and one at <24 weeks) received a diagnosis of cutaneous aspergillosis. Isolates from skin lesions were identified as A. fumigatus (one isolate) and closely related Aspergillus quadrilineatus (two isolates); all infants received antifungal treatment, and all three survived. In Michigan, A. fumigatus was isolated from an air sample collected near linen-transport areas; environmental sampling was not performed in New York. No definitive environmental source was identified for either cluster. Both investigations led to targeted infection control interventions, including revised linen handling, optimized airflow and air-handling systems, and enhanced skin assessment and infection prevention practices. These clusters underscore the susceptibility of extremely preterm neonates to invasive mold infections and the importance of early recognition, thorough environmental assessment and multidisciplinary collaboration, to prevent further exposures.