Mucormycosis in Burns: A Review

Abstract

Mucormycosis is a rare fungal infection with a high mortality rate. It presents with scattered black/necrotic ulcers, white fungal elements, and progression of wounds despite seemingly adequate debridement. Diagnosis is confirmed on wound histology, however this is often delayed. There is currently no comprehensive review of burn related mucormycosis within the literature, making this the first paper to provide evidence-based treatment guidance. We performed a review of publications from 1946 - present. There were 151 cases of mucormycosis complicating burns. The mortality rate was 54.5%, and there was a significant increase in mortality with axial body site involvement compared with isolated peripheral involvement. The standard treatment was prompt and radical debridement. Utilisation of frozen section to guide debridement aided in clinical decision making. No systemic treatment reached statistical significance, however amphotericin B trended towards significance. Although there is no strong evidence for topical amphotericin B or hyperbaric oxygen, there may be benefit in some cases. This study recommends early radical debridement in conjunction with the European Confederation of Medical Mycology guidelines of IV liposomal/lipid complex amphotericin B >5mg/kg/day, with posaconazole 800mg daily in divided doses as a salvage or oral step-down 1.

Mucormycosis: update on clinical presentation, diagnosis, and treatment

“…Attempts are being made to avoid exenteration in patients with rhino-orbital MCR, opting for more cosmetically conservative procedures, such as eyelid-sparing debridement, endoscopic orbital clearance, and medial orbital wall decompression [81]. Treatment of burn patients with superinfection includes aggressive debridement guided by frozen section in association with antifungal therapy [52]. Flap reconstruction following debridement and treatment with systemic antifungal therapy has been used with success [82].…”

“…Finally, other adjuncts, such as hyperbaric oxygen [91] or topical potassium iodide [92], are sometimes used, although there are few data to support doing so [52].…”

Cutaneous zygomycosis: a poor prognostic indicator in burns patients

“…5 There is a significant increase in mortality with axial disease (32%) as opposed to peripheral disease (15.5%), where only the extremities are involved. 6 Peripheral disease often requires amputation as a life-saving procedure. 3,6 In patients with systemic disease, palliation may need to be considered.…”

“…6 Peripheral disease often requires amputation as a life-saving procedure. 3,6 In patients with systemic disease, palliation may need to be considered. 6 In both our cases, cutaneous zygomycosis presented as patches of necrosis, which could easily be mistaken for dried blood.…”

“…3,6 In patients with systemic disease, palliation may need to be considered. 6 In both our cases, cutaneous zygomycosis presented as patches of necrosis, which could easily be mistaken for dried blood. Hallmark features include: (1) the presence of well-circumscribed black lesions coupled with a white filamentous growth often in multiple different sites, and (2) time course: both patients' burns had initially healed, and later developed areas of progressive necrosis.…”