Gangrenous Necrotizing Cutaneous Mucormycosis in an Immunocompetent Neonate: A Case Report from Oman

Abstract

We describe a case of progressive cutaneous mucormycosis, which caused gangrenous necrotizing fasciitis, in an immunocompetent neonate from Oman. Extensive wound contamination and a favorable environment for the growth of Mucorales were the predisposing factors. Early aggressive management including frequent wound debridement, targeted pharmacotherapy with liposomal amphotericin B and supportive care is pivotal for improved outcomes.

Update on invasive fungal infections in the Middle Eastern and North African region

“…A retrospective analysis has reported rhino-cerebral mucormycosis as a cerebral venous thrombosis (CVT) [122]. Gangrenous necrotizing cutaneous mucormycosis in a female neonate who has had injuries on the scalp, abdomen, and back was reported in an ICU in Oman [123].…”

Estimated Burden of Fungal Infections in Oman

“…Globally there is insufficient data on mycology, and Oman is no different. All the available published local literature reporting fungal infection cases were reviewed [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. In other situations where there are no local data, a population at risk and their frequencies represented in prevalence or incidence rates were utilized to achieve a valid and precise estimation using the most authentic studies addressing frequencies in different populations at risk.…”

“…There is a total of 8 mucormycosis cases obtained from the local literature [ 11 , 12 , 13 , 14 , 15 ], including one case of an expatriate that developed pulmonary mucormycosis with chronic renal failure [ 16 ]. We have estimated an annual incidence of 2 per million [ 32 ].…”

“…Although low profile, its increasing incidence partly because of diabetes and trauma [ 50 , 51 ], may surpass immunocompromised patients. In Oman, the local literature has recorded eight cases [ 11 , 12 , 13 , 14 , 15 ], including one additional case in an expatriate [ 16 ].…”

“…The overall burden of fungal diseases in Oman is unknown and is difficult to quantify because these infections are likely substantially underdiagnosed, and no national public health surveillance exists for any fungal disease. A few studies have reported on the fungal disease in Oman, mostly case reports [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. However, excellent efforts were made by scientists from all over the world in collaboration with and led by the Global Action Fund for Fungal Infections (GAFFI) and the Leading International Fungal Education (LIFE) to systematically estimate the global burden of fungal infection.…”