Diagnostic and therapeutic challenges of treating opportunistic fungal cellulitis: a case series

Abstract

Background Cellulitis is an infection most commonly caused by bacteria and successfully treated with antibiotics. However, certain patient populations, especially the immunocompromised, are at risk for fungal cellulitis, which can be misidentified as bacterial cellulitis and contribute to significant morbidity and mortality. Case presentations We describe three cases of opportunistic fungal cellulitis in immunosuppressed patients that were initially mistaken for bacterial infections refractory to antibiotic therapy. However, atypical features of cellulitis ultimately prompted further diagnostics to identify fungal cellulitis and allow initiation of appropriate antifungals. We discuss: (1) a 52-year-old male immunosuppressed hematopoietic cell transplant recipient with Fusarium solani cellulitis on his right lower extremity that was treated with amphotericin B and voriconazole with full resolution of the cellulitis; (2) a 70-year-old male lung transplant recipient with Fusarium solani cellulitis on his left lower extremity that ultimately progressed despite antifungals; and (3) a 68-year-old male with a history of kidney transplantation with suspected Purpureocillium lilacinum cellulitis on his left lower extremity ultimately treated with posaconazole with resolution of the skin lesions. Conclusions Fusarium solani and Purpureocillium lilacinum are important pathogens causing opportunistic fungal cellulitis. These cases remind providers to be vigilant for fungal cellulitis when skin and soft tissue infection does not adequately respond to antibiotics and atypical features of cellulitis are present.

Best practices for managing malodorous and infected wounds in advanced cervical cancer

“…The research's emphasis on wound attributes, including dimensions, duration, categories of infections and intensity of odour, corresponds to the more comprehensive comprehension of wound profiles among patients with advanced cervical cancer. Consistent with previous research, acute lesions and fungal infections are prevalent 17–19 …”

“…The prevailing degree of odour intensity was moderate. The insights gained from these findings are of great value in elucidating the particular wound [17][18][19] The study's principal discovery pertained to the divergent effectiveness of wound management approaches. Negative Pressure Wound Therapy demonstrated superior efficacy, as evidenced by its minimal mean healing duration, maximal reduction in odour and high levels of patient satisfaction.…”

Cutaneous Hyalohyphomycosis and Its Atypical Clinical Presentations in Immunosuppressed Patients

“…Hyalohyphomycosis is an emerging infection among immunosuppressed individuals, ranging from cutaneous forms to severe systemic and disseminated infections. Almost all of the fungi from this group are widely distributed in the environment and can enter the human body via inhalation or inoculation in a site of skin or mucosal breakdown [11][12][13]. Altogether, skin is the most frequently affected organ, either as the site of primary infection or as affected tissue in the disseminated disease, with variable clinical presentations [9,[14][15][16].…”

“…The most frequent infection sites are the skin, subcutaneous tissue, and eyes, although it can spread through the bloodstream, causing infections in various organs, such as the lungs, sinuses, and CNS [9]. Infection commonly occurs via the inhalation of the fungus and its consequent dissemination to the skin and other sites or directly, through inoculation at a site of skin or mucosal breakdown [11]. There have been reports of hospital-acquired P. lilacinum infections due to contaminated medical supplies, including lotions and catheters, or even tattoo-related infections, due to the contamination of the tattoo needle or ink [23].…”

“…Most skin infections are not accompanied by general symptoms, such as a fever or malaise [41]. The latest reports point out that P. lilacinum infections of the lower limbs in immunocompromised patient can be easily mistaken for typical bacterial cellulitis, caused by Streptococcus and Staphylococcus, and P. lilacinum is usually suspected only after the patient is unresponsive to antibiotic therapy [11]. A distinctive feature of P. lilacinum infections is the complete lack of a spontaneous resolution and a tendency towards recurrent infections [40], which is why they need to be properly diagnosed, taken seriously, and treated accordingly.…”