Mucormycosis in Burn Patients

Abstract

Patients with extensive burns are an important group at risk for cutaneous mucormycosis. This study aimed to perform a systematic review of all reported mucormycosis cases in burn patients from 1990 onward. A Medline search yielded identification of 7 case series, 3 outbreaks, and 25 individual cases reports. The prevalence reached 0.04%–0.6%. The median age was 42–48 in the case series and outbreaks, except for the studies from military centers (23.5–32.5) and in individual reports (29.5). The median total body surface area reached 42.5%–65%. Various skin lesions were described, none being pathognomonic: the diagnosis was mainly reached because of extensive necrotic lesions sometimes associated with sepsis. Most patients were treated with systemic amphotericin B or liposomal amphotericin B, and all underwent debridement and/or amputation. Mortality reached 33%–100% in the case series, 29%–62% during outbreaks, and 40% in individual cases. Most patients were diagnosed using histopathology and/or culture. Mucorales qPCR showed detection of circulating DNA 2–24 days before the standard diagnosis. Species included the main clinically relevant mucorales (i.e., Mucor, Rhizopus, Absidia/Lichtheimia, Rhizomucor) but also more uncommon mucorales such as Saksenaea or Apophysomyces. Contact with soil was reported in most individual cases. Bandages were identified as the source of contamination in two nosocomial outbreaks.

Necrotizing Mucormycosis of Wounds Following Combat Injuries, Natural Disasters, Burns, and Other Trauma

“…Mucormycosis of burn wounds has been known for more than one-half century to be associated with a high mortality and severe morbidity. Devauchelle et al recently reviewed the epidemiology of mucormycosis in burn patients [5]. They identified 7 case series, 3 outbreaks and 25 case reports containing infected patients.…”

“…Fungi of the order Mucorales are increasingly recognized as important causes of necrotizing wound infections in the setting of military (combat) injuries, burns, natural disaster-related, and other civilian trauma [1,2,3,4,5,6,7]. As the literature on these infections is widely distributed into journals across various disciplines, as well as lay press publications, we summarize herein the microbiology, pathogenesis, epidemiology, diagnosis, and treatment of wound-associated mucormycosis.…”

Mould Infections of Traumatic Wounds: A Brief Narrative Review

“…Of note, local health structures unable to guarantee sterile irrigation of wounds and rapid care for patients with injuries may be another predisposing factor to post-traumatic mould infections during natural disasters [26,27]. Finally, patients with burn injuries are also at increased risk of developing post-traumatic mould infections [6,34,35]. Overall, the general picture stemming from these epidemiological data is that wound mould infections can be observed in previously healthy people who are affected by severe trauma [12,33,36].…”

“…NA, not available. Comprehensive summaries of management of post-traumatic mould wound injuries in previous decades and in burn patients are available elsewhere [13,34] *Some cases of burn or postoperative mould wound infections were also included (4/16) **Cohort overlapping with that of other studies investigating different aspects of combat-related injuries [10,21,24,50,63] ***Possible cross-transmission…”

Special Issue: Mucorales and Mucormycosis

“…The importance of cutaneous mucormycosis is highlighted in the paper of Devauchelle et al [12] who performed a systematic review of all cases of mucormycosis in burn patients reported in the international literature from 1990. The authors carefully described the prevalence, the epidemiological and clinical characteristics, as well as the diagnostic and therapeutic challenges of this clinical entity.…”