Bisifusarium Delphinoides, an Emerging Opportunistic Pathogen in a Burn Patient with Diabetes Mellitus

Abstract

An 82-year-old man with diabetes was admitted to the emergency department with a third-degree burn on his left leg. The deep swab specimen from his left leg was cultured on Sabouraud dextrose agar without cycloheximide and incubated at 25 °C for 5 days. On the basis of morphological characteristics and multigene phylogenetic analyses of the internal transcribed spacer region of ribosomal DNA and partial fragments of beta-tubulin and translation elongation factor 1-alpha, the causal agent of fungal skin infection was identified as Bisifusarium delphinoides, which was newly introduced by accommodating a Fusarium dimerum species complex. Thus, we describe here the first case of skin infection caused by B. delphinoides on a burn patient with diabetes mellitus based on morphological observation and molecular analysis.

Fungal Infection in Burn Patents

“…Among them, 28 case series and 15 irrelevant studies were excluded. Finally, 36 case reports encompassing 44 burn patients were included for the final analysis 10–45 …”

“…In 36 of the 44 cases, fungal infections were initially suspected and identified from the burn wound samples 10–27,31–33,35–37,39–45 . In the remaining 8 cases, presentations of fungal wound infection were not observed, whereas invasive fungal infections were found in other sites such as blood, arterial thrombosis, teeth, feces, urine, sputum, and tracheal fluid 28–30,34,38 …”

“…Finally, 36 case reports encompassing 44 burn patients were included for the final analysis. Of the 44 cases, 18 cases originated from the United States 10,12,13,16,18,22,23,30,31,[33][34][35]38,39,43,45 ; 18 cases originated from 5 Asian countries, including China, 17,20,29 Korea, 15 India, 36,[40][41][42] Iran, 26,39 and Vietnam 11,32 ; and the remaining 8 cases originated from France, 14 Australia, 19 Poland, 21 Jamaica, 24 German, 27 Switzerland, 25 Portugal, 28 and the Czech Republic, 44 respectively. The cases consisted of 31 males, 11 females, and 2 nonspecific sex identities.…”

“…In 36 of the 44 cases, fungal infections were initially suspected and identified from the burn wound samples. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][31][32][33][35][36][37][39][40][41][42][43][44][45] In the remaining 8 cases, presentations of fungal wound infection were not observed, whereas invasive fungal infections were found in other sites such as blood, arterial thrombosis, teeth, feces, urine, sputum, and tracheal fluid. [28][29][30]34,38 The most frequent fungal pathogens were Zygomycetes, which were found in 13 cases.…”

“…12,[17][18][19]33,[35][36][37]39,40,42,43,45 Non-albicans Candida was found in 12 cases, 20,[27][28][29][30]32,37 Aspergillus spp in 8 cases, 10,[12][13][14]25,32,34 C. albicans in 5 cases, 19,26,29,30,38 and Fusarium spp in 5 cases. 11,12,15,16,31 Besides, several unusual fungal species, including Fonsecaea monophora, 21 Pythium aphanidermatum, 22 Trichosporon asahii, 24 Exophiala jeanselmei, 41 Geotrichum candidum, 23 and Westerdykella dispersa 44 were identified in 6 cases. Note that 1 case might be infected with 1 or more fungal pathogens.…”