Invasive Mold Infections Following Combat-related Injuries

Warkentien, Tyler; Rodríguez, Carlos J.; Lloyd, Bradley A.; Wells, Justin; Weintrob, Amy; Dunne, James R.; Ganesan, Anuradha; Li, Ping; Bradley, William P.; Gaskins, Lakisha J.; Seillier-Moiseiwitsch, Françoise; Murray, Clinton K.; Millar, Eugene V.; Keenan, Bryan; Paolino, Kristopher; Fleming, Mark E.; Hospenthal, Duane R.; Wortmann, Glenn; Landrum, Michael L.; Kortepeter, Mark G.; Tribble, David R.

doi:10.1093/cid/cis749

Cited by 168 publications

(167 citation statements)

References 41 publications

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“…The IFI cases were identified based on the finding of recurrent tissue necrosis following at least two operative debridements subsequent to the initial procedure, in addition to histopathological evidence (i.e., tissue containing fungal hyphae angioinvasion or observed fungal elements) and/or mold growth from tissue cultures (2,8). The histopathology specimens were assessed by two surgical pathologists.…”

Section: Methodsmentioning

confidence: 99%

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Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections

et al. 2015

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Section: Methodsmentioning

confidence: 99%

“…Since recognition of this emergent infection, combat-related IFIs have been described in case investigations, including development of a trauma-related IFI classification scheme (2,8). Further analyses have examined risk factors, clinical outcomes, and the effect of an early IFI diagnosis practice guidance (10,11).…”

mentioning

confidence: 99%

Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections

et al. 2015

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“…Zygomycosis affects immuno-compromised patients with neutropenia, diabetes mellitus with ketoacidosis, solid organ transplantation, trauma, and dialysis patients using iron chelators (deferoxamine) [164,[171][172][173][174][175][176]. Moreover, the use of voriconazole as a prophylaxis or for treatment of aspergillosis represents a risk factor for zygomycosis, because Zygomycetes are intrinsically resistant to this antifungal drug [177][178][179].…”

Section: Cryptococcosismentioning

confidence: 99%

Update on Fungal Disease: From Establish Infection to Clinical Manifestation

Melo¹,

Scorzoni²,

Rossi³

et al. 2017

J Biotechnol Biomater

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Fungal diseases have emerged as an important cause of morbidity and mortality, especially among immunocompromised patients. Pathogenic fungi have evolved an array of virulence factors to survive within the host and to outwit immune defenses. Fungi may cause a wide range of diseases in humans that range in extent from superficial to disseminated infections. Generally, the site of infections classifies the type of fungal disease, which can be divided into superficial, cutaneous, subcutaneous and systemic. In addition, the fungal virulence factors determine whether the infection will become established in the host. A primary pathogen may infect an immunologically normal host, whereas, an opportunistic pathogen requires some compromise of the host immune defenses in order for the infection to become established. This article covers the main fungi that are responsible for the increase of the fungal infections.Keywords: Fungal infections; Virulence; Yeast; Opportunistic infections; Endemic mycosis Fungal InfectionsFungal diseases have changed constantly in the last years. The virulence of these microorganisms has been adapted according to the human host, promoting a range of clinical manifestation. Several are the ways by which fungi promote a disease depending on human body part involved by the microorganism and the immunologic system of the host [1].In this review, we discuss the main fungal pathogens responsible for causing several diseases, highlighting on their virulence associate to clinical manifestation and the difficulty to accomplish the treatment. Superficial and cutaneous fungal diseasesSuperficial and cutaneous fungal infections are very common and occur worldwide affecting millions of people, especially immunocompromised patients. The most common types of these infections are dermatophytosis (tinea or ringworm), pityriasis versicolor (formerly tinea versicolor) and candidiasis (moniliasis). These occur by fungal invasion into the skin, keratinized tissues and mucous membranes [2]. Trichosporon and Fusarium species also cause superficial fungal infection, but also may be considered an invasive pathogen that may cause a systemic infection [3,4].Dermatophytosis: Dermatophytes are fungi that invade keratinized structures of humans and animals producing a condition called dermatophytosis or, more commonly, tinea [5,6]. These fungi belong to three main genera Trichophyton, Microsporum and Epidermophyton, of these T. rubrum is the most prevalent species worldwide [7,8]. The mechanisms of pathogenicity of these fungi are not yet well understood. There are several studies focusing on keratinolytic proteases (keratinases) produced by dermatophytes, but it is not known how these fungi regulate the use of these proteases to obtain nutrients from the stratum corneum substrate they invade, and whether there are additional roles of these proteins in adhesion and immunomodulation [9].To establish the infection, the contact of arthroconidia or hyphal fragmens with the host skin is essential. The fungi express spe...

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“…During the recent combat operations in Afghanistan, IFIs have emerged as a significant cause of morbidity and mortality among U.S. military personnel (10)(11)(12). Blast injuries from IEDs have the potential for severe disruption of skin and bone and contamination of wounds with organic material such as soil and plant matter (13).…”

mentioning

confidence: 99%

“…Blast injuries from IEDs have the potential for severe disruption of skin and bone and contamination of wounds with organic material such as soil and plant matter (13). Risk factors associated with IFIs include dismounted injuries while on foot patrol and large-volume blood transfusions (11,14).…”

mentioning

confidence: 99%

Combat-Related Pythium aphanidermatum Invasive Wound Infection: Case Report and Discussion of Utility of Molecular Diagnostics

et al. 2015

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hWe describe a 22-year-old soldier with 19% total body surface area burns, polytrauma, and sequence-and culture-confirmed Pythium aphanidermatum wound infection. Antemortem histopathology suggested disseminated Pythium infection, including brain involvement; however, postmortem PCR revealed Cunninghamella elegans, Lichtheimia corymbifera, and Saksenaea vasiformis coinfection. The utility of molecular diagnostics in invasive fungal infections is discussed. CASE REPORT In August 2013, a 22-year-old U.S. soldier was injured by an improvised explosive device (IED) while on foot patrol in Bamyan Province, central Afghanistan, which propelled him into a nearby stream. He sustained 19% total body surface area (TBSA) partial-and full-thickness burns, including superficial burns to the penis and multiple skin and soft tissue injuries. These injuries extended from the distal right medial thigh to the right midcalf and from the left gluteus to the left thigh, involving portions of the scrotum. Open fractures of the right tibia/fibula and left proximal femur were noted in addition to comminuted, minimally displaced fractures of the left pelvic girdle complicated by intra-and retroperitoneal hematomas. Soft tissue wounds from IED fragments without bony injury were observed in the left posterior upper arm. He was evacuated to Craig Joint Theater Hospital (CJTH) in Bagram in north-central Afghanistan.Upon arrival at CJTH, he received a massive transfusion of packed red blood cells (PRBC; 18 units within the first 24 h from injury), fresh frozen plasma (20 units), platelets (3 units apheresis platelets), and cryoprecipitate (20 units) and underwent irrigation and debridement of all soft tissue wounds with external fixation of the right tibia/fibula and left femoral fractures. The minimally displaced fractures of the left pelvic girdle were treated nonoperatively. The patient was medically evacuated to Landstuhl Regional Medical Center (LRMC) in Germany. Despite serial irrigation and debridement of each of these injuries (except the pelvic girdle injuries) over the next 48 h, progressive wound infection in the proximal open left femur fracture necessitated a left hip disarticulation on day 4 after injury (PDOI 4). Intraoperative cultures of the left lower extremity (the site was not further specified) revealed 2 isolates of multidrug-resistant (MDR) Escherichia coli. A prior fungal culture from the left lower extremity (PDOI 2) grew three separate molds (Aspergillus species, Geotrichum species, and Alternaria species) and an unspecified yeast, whereas a fungal culture from this site on PDOI 4 became overgrown with bacteria and could not be further evaluated. No additional operative cultures were obtained at LRMC. To minimize fecal contamination of the left hip wound, an open laparotomy was performed, with placement of a diverting colostomy and evacuation of a retroperitoneal hematoma.On PDOI 12, the patient was transferred to the Burn Intensive Care Unit at San Antonio Military Medical Center (SAMMC) for continued treatment. He ...

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Invasive Mold Infections Following Combat-related Injuries

Cited by 168 publications

References 41 publications

Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections

Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections

Update on Fungal Disease: From Establish Infection to Clinical Manifestation

Combat-Related Pythium aphanidermatum Invasive Wound Infection: Case Report and Discussion of Utility of Molecular Diagnostics

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