Mixed Fungal Infection (Aspergillus,Mucor, andCandida) of Severe Hand Injury

Abstract

Severe hand injuries are almost always heavily contaminated and hence wound infections in those patients are frequent. Fungal wound infections are rare in immunocompetent patients. A case of mixed fungal infection (Aspergillus, Mucor, and Candida) was documented in a young male patient, with a severe hand injury caused by a corn picker. The diagnosis of fungal infection was confirmed microbiologically and histopathologically. The treatment was conducted with repeated surgical necrectomy and administration of antifungal drugs according to the antimycogram. After ten weeks the patient was successfully cured. The aggressive nature of Mucor and Aspergillus skin infection was described. A high degree of suspicion and a multidisciplinary approach are necessary for an early diagnosis and the initiation of the adequate treatment. Early detection, surgical intervention, and appropriate antifungal therapy are essential in the treatment of this rare infection that could potentially lead to loss of limbs or even death.

Isavuconazole for treatment of invasive fungal diseases caused by more than one fungal species

“…Therefore, it might reasonably be expected that this would be reflected in worse treatment outcomes in patients with IFD caused by multiple fungal species. Consistent with this expectation, fatal outcomes were reported in more than half of the case reports we found in a search of the literature for patients with IFD involving multiple fungal species . This figure may be underestimated because case reports tend to favour positive outcomes.…”

“…1 Antifungal treatment options for most IFDs include amphotericin B formulations, echinocandins, and triazole antifungal agents, although each may be associated with limitations that include pathogen susceptibility and patient tolerability. 2 Despite that IFDs in clinical practice usually involve a single fungal pathogen, concurrent infections with more than one fungal species have been reported in case studies [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] and retrospective analyses. [18][19][20] A multiple-species IFD may pose a unique clinical challenge because of the potential for increased virulence and different susceptibility profiles of the pathogens.…”

Case Report: Facial mixed fungal infection in a poorly responding non-Hodgkin’s lymphoma patient with suspected immunodeficiency

“…In our case we found it difficult to take any tissue biopsy due to rapid deterioration of patient's general condition which is one of the limitations in our work. Mixed fungal infection is a rare condition, it was reported in 2014 in a case with severe hand injury after corrective surgery 6 . Other study reported only three mixed fungal infections from 178 immunocompromised pneumonia patients 7 .…”

Peyronellaea gardeniae fungus infection presenting as posttraumatic hemorrhagic bullae and desquamation

“… 5 Because wound cultures are positive in less than 30% of posttraumatic fungal infections, a high level of suspicion is necessary so surgical debridement and appropriate antifungal medications may be initiated in a timely manner. 6 …”