Invasive Mucormycosis and Aspergillosis in a Healthy 22-Year-Old Battle Casualty: Case Report

Radowsky, Jason S.; Strawn, Alan A.; Sherwood, Jeffrey E.; Braden, Adam; Liston, W. A.

doi:10.1089/sur.2010.065

Cited by 32 publications

(18 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…f One unit of packed red blood cells or fresh frozen plasma is approximately 250-300 mL. observed in earlier case investigations of combat casualties who ultimately developed IFI [9][10][11][12][14][15][16]. Trauma-associated IFI cases within civilian populations are associated primarily with traffic or agricultural accidents and natural disasters [2,3,[6][7][8] and are characterized generally by penetrating wounds contaminated with environmental debris.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, combat trauma-associated IFI has emerged as a serious military health concern [9][10][11][12]. Prior to 2009, the rate of IFI diagnosed among wounded United States (U.S.) service members was negligible ( < 0.1%) [9]; however, by the fourth quarter of 2010, IFI rates increased substantially to 3.5% of U.S. combat casualties admitted to Landstuhl Regional Medical Center (LRMC) in Germany [10].…”

mentioning

confidence: 99%

“…Prior evaluations have suggested that combat casualties at highest risk for IFI are those injured in southern Afghanistan while on foot patrol. Additionally, patients sustaining a traumatic amputation (often with perineal involvement), and those requiring massive packed red blood cell transfusions ( > 25 U) within the first 24 h have been observed with IFI development [9][10][11][12][14][15][16].…”

mentioning

confidence: 99%

See 2 more Smart Citations

Risk Factors Associated with Invasive Fungal Infections in Combat Trauma

RodriguezCarlos

WeintrobAmy²,

ShahJinesh³

et al. 2014

Surgical Infections

View full text Add to dashboard Cite

Background: In recent years, invasive fungal infections (IFI) have complicated the clinical course of patients with combat-related injuries. Commonalities in injury patterns and characteristics among patients with IFI led to the development of a Joint Trauma System ( JTS) clinical practice guideline (CPG) for IFI management. We performed a case-control study to confirm and further delineate risk factors associated with IFI development in combat casualties with the objective of generating data to refine the CPG and promote timelier initiation of treatment. Methods: Data were collected retrospectively for United States (U.S.) military personnel injured during deployment in Afghanistan from June 2009 through August 2011. Cases were identified as IFI based upon wound cultures with fungal growth and/or fungal elements seen on histology, in addition to the presence of recurrent wound necrosis. Controls were matched using date of injury ( -3 mo) and injury severity score ( -10). Risk factor parameters analyzed included injury circumstances, blood transfusion requirements, amputations after first operative intervention, and associated injuries. Data are expressed as multivariate odds ratios (OR; 95% confidence interval [CI]). Results: Seventy-six IFI cases were identified from 1,133 U.S. military personnel wounded in Afghanistan and matched to 150 controls. Parameters associated significantly with the development of IFI multivariate analysis were blast injuries (OR: 5.7; CI: 1.1-29.6), dismounted at time of injury (OR: 8.5; CI: 1.2-59.8); above the knee amputations (OR: 4.1; CI: 1.3-12.7), and large-volume packed red blood cell (PRBC; > 20 U) transfusions within first 24 h (OR: 7.0; CI: 2.5-19.7). Conclusions: Our analysis indicates that dismounted blast injuries, resulting in above the knee amputations, and requirement of large volume PRBC transfusions are independent predictors of IFI development. These data confirm all the preliminary risk factors, except for genitalia/perineal injuries, utilized by JTS in their IFI CPG. Model validation is necessary for further risk factor specification.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors Associated with Invasive Fungal Infections in Combat Trauma

RodriguezCarlos

WeintrobAmy²,

ShahJinesh³

et al. 2014

Surgical Infections

View full text Add to dashboard Cite

show abstract

“…This presumption of innocence avoids antibiotic prescription, sparing their intestinal flora, skin flora, nasal and dental flora, and so on. It also prevents the increased occurrence of invasive fungal infections (Radowsky et al 2011, Warkentien et al 2012 and antibiotic resistance later in patient care, something predicted by theory, measured in experiment, and observed in clinical practice. From a research perspective, the development of advanced diagnostics should certainly be a priority (Ehrlich and Post 2013).…”

Section: Hasty Actionmentioning

confidence: 92%

Counterinsurgency Doctrine Applied to Infectious Disease

Kirkup

2014

Preprint

View full text Add to dashboard Cite

Recent scientific discoveries lead inexorably to the conclusion that the 'total human' incorporates a necessary body of numerous microbes, including bacteria. These bacteria play a very important role in immunity by actively resisting infections by outside bacteria; however, under certain conditions they can degrade their community. They can arrogate to themselves resources that normally flow through other metabolic pathways and form persistent biological structures. In this situation, these bacteria constitute an insurgency, with strategic ramifications.PeerJ PrePrints | http://dx.doi.org/10.7287/peerj.preprints.236v1 | CC-BY 4.0

show abstract

“…Given the rapid systemic progression and contiguous spread of IFI [54], aggressive surgical debridement and systemic antifungal therapy are immediately started once the infection is clinically suspected, even before histopathological proof is obtained [37•, 55, 56••]. …”

Section: Ifi Patient Managementmentioning

confidence: 99%

Combat-Related Invasive Fungal Wound Infections

Tribble

Rodríguez

2014

Curr Fungal Infect Rep

View full text Add to dashboard Cite

Combat-related invasive fungal (mold) wound infections (IFIs) have emerged as an important and morbid complication following explosive blast injuries among military personnel. Similar to trauma-associated IFI cases among civilian populations, as in agricultural accidents and natural disasters, these infections occur in the setting of penetrating wounds contaminated by environmental debris. Specific risk factors for combat-related IFI include dismounted (patrolling on foot) blast injuries occurring mostly in southern Afghanistan, resulting in above knee amputations requiring resuscitation with large-volume blood transfusions. Diagnosis of IFI is based upon early identification of a recurrently necrotic wound following serial debridement and tissue-based histopathology examination with special stains to detect invasive disease. Fungal culture of affected tissue also provides supportive information. Aggressive surgical debridement of affected tissue is the primary therapy. Empiric antifungal therapy should be considered when there is a strong suspicion for IFI. Both liposomal amphotericin B and voriconazole should be considered initially for treatment since many of the cases involve not only Mucorales species but also Aspergillus or Fusarium spp., with narrowing of regimen based upon clinical mycology findings.

show abstract

Invasive Mucormycosis and Aspergillosis in a Healthy 22-Year-Old Battle Casualty: Case Report

Abstract: The suspicion of invasive fungal infections must be tested early if intervention is to be curative.

Cited by 32 publications

References 13 publications

Risk Factors Associated with Invasive Fungal Infections in Combat Trauma

Risk Factors Associated with Invasive Fungal Infections in Combat Trauma

Counterinsurgency Doctrine Applied to Infectious Disease

Combat-Related Invasive Fungal Wound Infections

Contact Info

Product

Resources

About