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Parashar A, Singh C. Angioinvasive mucormycosis in burn intensive care units: A case report and review of literature. World J Crit Care Med 2024; 13:86866. [PMID: 38633476 PMCID: PMC11019633 DOI: 10.5492/wjccm.v13.i1.86866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/25/2023] [Accepted: 12/01/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Mucormycosis is a rare, rapidly progressive and often fatal fungal infection. The rarity of the condition lends itself to unfamiliarity, delayed treatment, and poor outcomes. Diagnosis of fungal infections early enough to enable appropriate treatment occurs in less than half of affected patients. CASE SUMMARY An 11-year-old girl with a history of 15% total body surface area scald burns involving both lower limbs progressed to develop angioinvasive mucormycosis. This further led to a thrombosis of the right external iliac artery and vein and rapidly progressive necrosis of surrounding soft tissues. She also had dextrocardia and patent foramen ovale. A right hip disarticulation and serial aggressive debridements were performed but she went on to develop systemic sepsis with multisystem involvement and succumbed to the infection. Pathology revealed mucor species with extensive vascular invasion. CONCLUSION This case highlights the importance of maintaining vigilance for mycotic infections and acting appropriately when there are signs of fulminant wound infection.
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Affiliation(s)
- Atul Parashar
- Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Chandra Singh
- Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Herbst I, Helleberg M, Overgaard-Steensen C, Holmgaard R. Mucorales-disseminated infection in burn wound. BMJ Case Rep 2023; 16:e253879. [PMID: 37914163 PMCID: PMC10626915 DOI: 10.1136/bcr-2022-253879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
A previously fit and well man in his 50s was rescued from a burning apartment with Glasgow Coma Scale 3 and admitted to the burn intensive care unit with 18% mixed dermal and full thickness burns and inhalation injury. He received standardised acute burn treatment according to the Emergency Management of Severe Burn guidelines and was found to have acute kidney injury requiring dialysis and cerebral watershed infarcts. The burns were deep especially on the left leg that was deemed unsalvageable and on day 8, he underwent a mid-femoral amputation.A wound swab on day 8 grew mould and with progression of skin necrosis, Mucorales infection was clinically suspected. Microbiological assessment of the swab confirmed Mucorales infection-an invasive fungus with the ability to invade blood vessels leading to vessel thrombosis and tissue necrosis and associated with high mortality. Recommended radical debridement with free cutaneous margins was not possible due to the widespread disease, and the patient was treated conservatively with antifungal therapy and survived.
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Affiliation(s)
- Isabella Herbst
- Department of Plastic Surgery and Burns Treatment, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Rikke Holmgaard
- Department of Plastic Surgery and Burns Treatment, University of Copenhagen, Copenhagen, Denmark
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Bishay J, Yeap I, Wijewardana A, Darbar A, Soliman B, Gillies R, Vandervord J. Cutaneous zygomycosis: a poor prognostic indicator in burns patients. ANZ J Surg 2023; 93:2527-2528. [PMID: 37128665 DOI: 10.1111/ans.18500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 04/18/2023] [Accepted: 04/26/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Jeremy Bishay
- Severe Burns Injury Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Isobel Yeap
- Severe Burns Injury Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Aruna Wijewardana
- Severe Burns Injury Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Archie Darbar
- Department of Microbiology and Infectious Diseases, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Bishoy Soliman
- Severe Burns Injury Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Rowan Gillies
- Severe Burns Injury Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - John Vandervord
- Severe Burns Injury Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Pham D, Howard-Jones AR, Sparks R, Stefani M, Sivalingam V, Halliday CL, Beardsley J, Chen SCA. Epidemiology, Modern Diagnostics, and the Management of Mucorales Infections. J Fungi (Basel) 2023; 9:659. [PMID: 37367595 DOI: 10.3390/jof9060659] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023] Open
Abstract
Mucormycosis is an uncommon, yet deadly invasive fungal infection caused by the Mucorales moulds. These pathogens are a WHO-assigned high-priority pathogen group, as mucormycosis incidence is increasing, and there is unacceptably high mortality with current antifungal therapies. Current diagnostic methods have inadequate sensitivity and specificity and may have issues with accessibility or turnaround time. Patients with diabetes mellitus and immune compromise are predisposed to infection with these environmental fungi, but COVID-19 has established itself as a new risk factor. Mucorales also cause healthcare-associated outbreaks, and clusters associated with natural disasters have also been identified. Robust epidemiological surveillance into burden of disease, at-risk populations, and emerging pathogens is required. Emerging serological and molecular techniques may offer a faster route to diagnosis, while newly developed antifungal agents show promise in preliminary studies. Equitable access to these emerging diagnostic techniques and antifungal therapies will be key in identifying and treating mucormycosis, as delayed initiation of therapy is associated with higher mortality.
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Affiliation(s)
- David Pham
- Centre for Infectious Diseases & Microbiology, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Annaleise R Howard-Jones
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
- Faculty of Medicine & Health, University of Sydney, Camperdown, NSW 2006, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW 2006, Australia
| | - Rebecca Sparks
- Douglass Hanly Moir Pathology, Sydney, NSW 2113, Australia
| | - Maurizio Stefani
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Varsha Sivalingam
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Catriona L Halliday
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
| | - Justin Beardsley
- Centre for Infectious Diseases & Microbiology, Westmead Hospital, Westmead, NSW 2170, Australia
- Faculty of Medicine & Health, University of Sydney, Camperdown, NSW 2006, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW 2006, Australia
- Westmead Institute for Medical Research, Sydney, NSW 2145, Australia
| | - Sharon C-A Chen
- Centre for Infectious Diseases & Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology & Medical Research, Westmead Hospital, Westmead, NSW 2170, Australia
- Faculty of Medicine & Health, University of Sydney, Camperdown, NSW 2006, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW 2006, Australia
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Successful treatment of Mucor circinelloides in a Burn patient. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Welch G, Sabour A, Patel K, Leuthner K, Saquib SF, Medina-Garcia L. Invasive cutaneous mucormycosis: A case report on a deadly complication of a severe burn. IDCases 2022; 30:e01613. [PMID: 36131803 PMCID: PMC9483795 DOI: 10.1016/j.idcr.2022.e01613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/31/2022] [Accepted: 09/03/2022] [Indexed: 11/04/2022] Open
Abstract
A 38 year old woman presented with burns totaling 45 % total body surface area, following an explosion resulting from manufacturing cannabis wax. Initial debridement, was delayed to hospital day 7 due to hemodynamic instability. Over the course of her, hospitalization, she required multiple debridements and grafting to her lower, extremities; grafted tissue never survived longer than 72 h. Her bilateral lower, extremities began to exhibit visible mold growth. She underwent repeated, debridements down to vitalized tissue only for recurrent necrosis and mold growth to, occur. She underwent serial amputations eventually reaching the level of her midthigh, At this point her clinical condition deteriorated further resulting in multiorgan failure., Ultimately family made the decision to remove her from life support, and she expired, within a few hours. Postmortem analysis identified Rhizopus spp, Fusarium spp, and, Geotrichum candidum. Mucormycosis species are a frequent infector of Cannabis, sativa, which our patient was working with in the inciting explosion. Cutaneous, mucormycosis is a documented but rare manifestation. We propose that the patient's, relatively young age, severity of burns, and exposure to cannabis plants resulted in this, unusual presentation
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Parra Fariñas R, Alonso-Sardón M, Velasco-Tirado V, Galindo Pérez I, Carbonell C, Álvarez Artero E, Romero-Alegría Á, Pardo-Lledías J, Belhassen-García M. "Increasing Incidence of Mucormycosis in Spanish inpatients from 1997-2018". Mycoses 2021; 65:344-353. [PMID: 34951054 DOI: 10.1111/myc.13418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/07/2021] [Accepted: 12/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mucormycosis is a worldwide angio-invasive fungal infection that is associated with high morbidity and mortality. A few European studies have focused on the epidemiology. METHODOLOGY A retrospective longitudinal descriptive study was performed with inpatients diagnosed with mucormycosis (ICD-9-CM, code 117.7, cases 1997-2015; and ICD-10, code B46, cases 2016-2018; along with length of hospital stay) in Spanish public hospitals between 1 January 1997 and 31 December 2018. Data were obtained from the Minimum Basic Data Set (CMBD in Spanish). PRINCIPAL FINDINGS A total of 962 patients were recorded; 665 were men. The mean age (±SD) was 55±18.8 years. The annual incidence rate increased from 0.74 to 1.24 cases per million person-years. The lethality rate was 31.3%. Renal failure (41.6%) and hematological malignancy (36.3%) were the main factors involved. CONCLUSIONS Mucormycosis is a rare infectious disease in Spain, but it has had a significantly increased incidence in the last two decades. Being an adult male and having diabetes, neoplasm or renal failure are the main factors associated. High mortality is usually associated mainly with hematological malignancy and renal failure. CMBD studies could be an efficient tool for assessing changes in the epidemiology of mucormycosis.
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Affiliation(s)
- Raúl Parra Fariñas
- Servicio de Medicina Interna, Hospital Marques de Valdecilla, Universidad de Cantabria, Spain
| | - Montserrat Alonso-Sardón
- Area of Preventive Medicine and Public Health, University of Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Salamanca, Spain
| | - Virginia Velasco-Tirado
- Servicio de Dermatología, Complejo Asistencial Universitario de Salamanca (CAUSA), CIETUS, IBSAL, Salamanca, Spain
| | | | | | - Elisa Álvarez Artero
- Servicio de Medicina Interna. Hospital Rio Carrión. Complejo Asistencial de Palencia (CAUPA), Avenida Donantes de Sangre S/N, 34005, Palencia, España
| | | | - Javier Pardo-Lledías
- Servicio de Medicina Interna, Hospital Marques de Vadecilla, Universidad de Cantabria, Instituto de Investigación Valdecilla (IDIVAL), Spain
| | - Moncef Belhassen-García
- Internal Medicine, Infectious Diseases Section, CAUSA, IBSAL, CIETUS, University of Salamanca, Paseo San Vicente 58-182, 37007, Salamanca, Spain
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Keri VC, Kumar A, Singh G, Mandal A, Ali H, Ranjan P, Wig N. Pilot study on burden of fungal contamination in face masks: need for better mask hygiene in the COVID-19 era. LE INFEZIONI IN MEDICINA 2021; 29:557-561. [PMID: 35146364 PMCID: PMC8805480 DOI: 10.53854/liim-2904-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/20/2021] [Indexed: 06/14/2023]
Abstract
Risk factors which led to the outbreak of COVID-19 associated Mucormycosis still remains elusive. Face masks can become contaminated by fungal spores that are present ubiquitously in the environment. However the exact burden of such contamination is not known. Fifty masks of patients who attended the Employees Health Scheme COVID-19 facility of a tertiary healthcare centre in India were sampled by direct impression smears on Sabouraud Dextrose Agar. Agar plates were screened for any growth within five days after incubation. Growth was identified by microscopy on the Lactophenol Cotton Blue mount. Mask hygiene practices of participants was assessed using a pre-designed proforma. Out of 50 masks, fungal contamination was seen in 35/50 (70%) masks, with Aspergillus sp. being isolated from 26/50 (52%) masks and Mucorales being isolated from 9/50 (18%) of the masks. Aspergillus niger, Rhizopus a rrhizus and Syncephalastrum sp. were the most common species isolated. Same mask was worn for a median duration of 8 days (2-30 days) at a stretch with or without washing. Thirty one patients washed and re-wore their masks, with median time duration since last wash being 12 hours (4-72 hours). None of the factors assessed for mask hygiene were associated with fungal contamination. High rates of fungal contamination observed in our study emphasizes the need for better mask hygiene in the COVID-19 era.
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Affiliation(s)
- Vishakh C Keri
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Kumar
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayan Mandal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Haider Ali
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
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Giacobbe DR, Cortegiani A, Karaiskos I, Mercier T, Tejada S, Peghin M, Grecchi C, Rebuffi C, Asperges E, Zuccaro V, Scudeller L, Bassetti M. Performance of Existing Definitions and Tests for the Diagnosis of Invasive Fungal Diseases other than Invasive Candidiasis and Invasive Aspergillosis in Critically Ill, Adult Patients: A Systematic Review with Qualitative Evidence Synthesis. J Fungi (Basel) 2021; 7:jof7030176. [PMID: 33670864 PMCID: PMC7997529 DOI: 10.3390/jof7030176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 12/19/2022] Open
Abstract
The Fungal Infections Definitions in Intensive Care Unit (ICU) patients (FUNDICU) project aims to provide standard sets of definitions for invasive fungal diseases (IFDs) in critically ill, adult patients, including invasive aspergillosis (IA), invasive candidiasis (IC), Pneumocystis jirovecii pneumonia (PJP), and other non-IA, non-IC IFDs. The first step of the project was the conduction of separated systematic reviews of the characteristics and applicability to critically ill, adult patients outside classical populations at risk (hematology patients, solid organ transplant recipients) of available definitions and diagnostic tests for IFDs. We report here the results of two systematic reviews exploring the performance of available definitions and tests, for PJP and for other non-IA, non-IC IFDs. Starting from 2585 and 4584 records for PJP and other IFDs, respectively, 89 and 61 studies were deemed as eligible for full-text evaluation. However, only two studies for PJP and no studies for other IFDs met the FUNDICU protocol criteria for inclusion in qualitative synthesis. Currently, there is no sufficient solid data for directly evaluating the performance of existing definitions and laboratory tests for the diagnosis of PJP and other non-IA, non-IC IFDs in critically ill adult patients outside classical populations at risk.
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Affiliation(s)
- Daniele R. Giacobbe
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy;
- Clinica Malattie Infettive, Ospedale Policlinico San Martino–IRCCS, 16132 Genoa, Italy
- Correspondence: ; Tel.: +39-01-0555-4652
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, 90127 Palermo, Italy;
- Department of Anaesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, 90127 Palermo, Italy
| | | | - Toine Mercier
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium;
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Sofia Tejada
- Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d’Hebron Institute of Research (VHIR), 08035 Barcelona, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - Maddalena Peghin
- Infectious Diseases Division, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, 33100 Udine, Italy;
| | - Cecilia Grecchi
- Infectious Diseases Unit, IRCCS San Matteo, 27100 Pavia, Italy; (C.G.); (E.A.); (V.Z.)
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Chiara Rebuffi
- Scientific Direction, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Erika Asperges
- Infectious Diseases Unit, IRCCS San Matteo, 27100 Pavia, Italy; (C.G.); (E.A.); (V.Z.)
| | - Valentina Zuccaro
- Infectious Diseases Unit, IRCCS San Matteo, 27100 Pavia, Italy; (C.G.); (E.A.); (V.Z.)
| | - Luigia Scudeller
- Scientific Direction, Clinical Epidemiology and Biostatistics IRCCS, Ca’ Granda Ospedale Maggiore Policlinico di Milano Foundation, 20122 Milan, Italy;
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, 16132 Genoa, Italy;
- Clinica Malattie Infettive, Ospedale Policlinico San Martino–IRCCS, 16132 Genoa, Italy
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Bonifaz A, Tirado-Sánchez A, Hernández-Medel ML, Kassack JJ, Araiza J, González GM. Mucormycosis with cutaneous involvement. A retrospective study of 115 cases at a tertiary care hospital in Mexico. Australas J Dermatol 2020; 62:162-167. [PMID: 33222179 DOI: 10.1111/ajd.13508] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/07/2020] [Accepted: 10/11/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVES Cutaneous mucormycosis is an emerging opportunistic mycosis caused by Mucorales. It can be divided into primary caused by trauma and secondary by extension of rhino-cerebral and disseminated cases. The objective is to present a retrospective study of cases of mucormycosis with cutaneous involvement. METHODS A retrospective and descriptive study was carried out. Mucormycosis patients were included and divided into two groups: a) Primary Cutaneous and b) Secondary Cutaneous. Mycological tests were performed; the agents were identified by morphology and molecular studies (PCR and sequencing); some cases underwent histopathology. Clinical data and response to treatment were collected. RESULTS 115 cases were included, 18 of primary, and 97 of secondary cutaneous mucormycosis. Primary cutaneous mucormycosis was most associated with adhesive bands (44.4%) and trauma from traffic accidents (33.3%). The principal clinical form was extensive and deep necrotic ulcers. Secondary cutaneous mucormycosis cases were rhino-cerebral with uncontrolled diabetes (81.4%) The most frequent clinical presentation was necrosis of the eyelid and the nose (65.9%). In both groups, the principal agent was Rhizopus arrhizus, 38.8% and 74.2% respectively. The most effective treatment was the combination of amphotericin B with surgical debridement. The clinical and mycological cure was achieved in 31.0% of primary cases, and 44.4% for secondary cases. CONCLUSION Primary cutaneous mucormycosis is caused by implantation of the Mucorales due to trauma or rupture of the cutaneous barrier-breach, and secondary cutaneous mucormycosis develops as part of the rhino-cerebral process. The response to treatment depends on the extension and depth, as well as the predisposing factors.
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Affiliation(s)
- Alexandro Bonifaz
- Dermatology Service & Mycology department, Hospital General de México, "Dr Eduardo Liceaga", Mexico City, Mexico
| | - Andrés Tirado-Sánchez
- Dermatology Service & Mycology department, Hospital General de México, "Dr Eduardo Liceaga", Mexico City, Mexico
| | - María L Hernández-Medel
- Infectology Service, Hospital General de México, "Dr Eduardo Liceaga", Ciudad de Mexico, Mexico
| | - Juan J Kassack
- Hematology Service, Hospital General de México, "Dr Eduardo Liceaga", Ciudad de Mexico, Mexico
| | - Javier Araiza
- Dermatology Service & Mycology department, Hospital General de México, "Dr Eduardo Liceaga", Mexico City, Mexico
| | - Gloria M González
- Facultad de Medicina, Microbiology Department, Universidad Autónoma de Nuevo León, San Nicolas de los Garza, Mexico
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Chandorkar A, Simkins J. Emerging Fungal Cutaneous Infections in Immunocompromised Patients. CURRENT FUNGAL INFECTION REPORTS 2020. [DOI: 10.1007/s12281-020-00395-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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13
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Giacobbe DR, Riccardi N, Vena A, Bassetti M. Mould Infections of Traumatic Wounds: A Brief Narrative Review. Infect Dis Ther 2020; 9:1-15. [PMID: 32072492 PMCID: PMC7054562 DOI: 10.1007/s40121-020-00284-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Indexed: 01/06/2023] Open
Abstract
Mould infections may follow traumatic injuries, with direct fungal inoculum in the site of injury and subsequent angioinvasion, possibly resulting in tissue necrosis and systemic dissemination. The pathogenesis of mould infections following trauma injuries presents unique features compared with classical mould infections occurring in neutropenic or diabetic patients, because a large fraction of post-traumatic mould infections is observed in previously healthy individuals. Most of the published clinical experience and research on mould infections following traumatic injuries regards soldiers and infections after natural disasters. However, following trauma and soil contamination (e.g., agricultural or automotive injuries) other immunocompetent individuals may develop mould infections. In these cases, delays in correct diagnosis and treatment may occur if pertinent signs such as necrosis and absent or reduced response to antibacterial therapy are not promptly recognized. Awareness of mould infections in at-risk populations is needed to rapidly start adequate laboratory workflow and early antifungal therapy in rapidly evolving cases to improve treatment success and reduce mortality.
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Affiliation(s)
- Daniele Roberto Giacobbe
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy. .,Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy.
| | - Niccolò Riccardi
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Antonio Vena
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino, IRCCS, Genoa, Italy
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Special Issue: Mucorales and Mucormycosis. J Fungi (Basel) 2019; 6:jof6010006. [PMID: 31877973 PMCID: PMC7151165 DOI: 10.3390/jof6010006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/16/2022] Open
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Outbreaks of Mucorales and the Species Involved. Mycopathologia 2019; 185:765-781. [PMID: 31734800 DOI: 10.1007/s11046-019-00403-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/22/2019] [Indexed: 01/27/2023]
Abstract
The order Mucorales is an ancient group of fungi classified in the subphylum Mucoromycotina. Mucorales are mainly fast-growing saprotrophs that belong to the first colonizers of diverse organic materials and represent a permanent part of the human environment. Several species are able to cause human infections (mucormycoses) predominantly in patients with impaired immune system, diabetes, or deep trauma. In this review, we compiled 32 reports on community- and hospital-acquired outbreaks caused by Mucorales. The most common source of mucoralean outbreaks was contaminated medical devices that are responsible for 40.7% of the outbreaks followed by contaminated air (31.3%), traumatic inoculation of soil or foreign bodies (9.4%), and the contact (6.2%) or the ingestion (6.2%) of contaminated plant material. The most prevalent species were Rhizopus arrhizus and R. microsporus causing 57% of the outbreaks. The genus Rhizomucor was dominating in outbreaks related to contaminated air while outbreaks of Lichtheimia species and Mucor circinelloides were transmitted by direct contact. Outbreaks with the involvement of several species are reported. Subtyping of strains revealed clonality in two outbreaks and no close relation in two other outbreaks. Based on the existing data, outbreaks of Mucorales can be caused by heterogeneous sources consisting of different strains or different species. Person-to-person transmission cannot be excluded because Mucorales can sporulate on wounds. For a better understanding and prevention of outbreaks, we need to increase our knowledge on the physiology, ecology, and population structure of outbreak causing species and more subtyping data.
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Walsh TJ, Hospenthal DR, Petraitis V, Kontoyiannis DP. Necrotizing Mucormycosis of Wounds Following Combat Injuries, Natural Disasters, Burns, and Other Trauma. J Fungi (Basel) 2019; 5:jof5030057. [PMID: 31277364 PMCID: PMC6787580 DOI: 10.3390/jof5030057] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/28/2019] [Accepted: 07/01/2019] [Indexed: 01/30/2023] Open
Abstract
Necrotizing mucormycosis is a devastating complication of wounds incurred in the setting of military (combat) injuries, natural disasters, burns, or other civilian trauma. Apophysomyces species, Saksenaea species and Lichtheimia (formerly Absidia) species, although uncommon as causes of sinopulmonary mucormycosis, are relatively frequent agents of trauma-related mucormycosis. The pathogenesis of these infections likely involves a complex interaction among organism, impaired innate host defenses, and biofilms related to traumatically implanted foreign materials. Effective management depends upon timely diagnosis, thorough surgical debridement, and early initiation of antifungal therapy.
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Affiliation(s)
- Thomas J Walsh
- Departments of Medicine, Pediatrics, and Microbiology & Immunology; Weill Cornell Medicine of Cornell University and New York Presbyterian Hospital, New York, NY 10065, USA.
| | - Duane R Hospenthal
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Vidmantas Petraitis
- Departments of Medicine, Weill Cornell Medicine of Cornell University, New York, NY 10065, USA
| | - Dimitrios P Kontoyiannis
- Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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