Real-time polymerase chain reaction detection of Lichtheimia species in bandages associated with cutaneous mucormycosis in burn patients

Mucormycosis in Burn Patients

“…The median delay between burn and diagnosis was 13 days (3–150 days), and in 14 out of 21 patients (67%), mucormycosis manifested within the initial 2 weeks after admission. This short delay was consistent with the inoculation of the patient’s burn wounds with the fungi during the burn injury, whereas the 36 day median delay between admission and diagnosis (18–95 days) reported in one outbreak was more indicative of a nosocomial contamination [14].…”

“…A Medline search yielded seven case series from the USA ( n = 3), Australia ( n = 1), France ( n = 1), Greece ( n = 1), and across Europe ( n = 1) [6,7,8,9,10,11,12]. Three nosocomial outbreaks were reported: one in Belgium in 2005 and two in France in 2018 [13,14,15,16]. Lastly, 25 reports of individual cases were identified between 1990 and 2019, including publications from the USA ( n = 12, with three cases occurring in the Middle East (Afghanistan, Iraq) and one in Japan) [17,18,19,20,21,22,23,24,25,26,27,28], from Asia ( n = 6; two in China, three in India, one in Iran) [29,30,31,32,33,34], from Europe ( n = 3; in Czech Republic, Germany, and the U.K.) [35,36,37], from Australia ( n = 3) [3,38,39], and from Ecuador ( n = 1) [40].…”

“…The most common clinical forms of mucormycosis were cutaneous, but three patients presented rhinocerebral, cerebral, or retro-orbitary infection (12%) (Table 2). Pulmonary localization was reported in one patient during an outbreak [14], and chronic osteomyelitis of the lower limb was associated with sinus infection 5 months after a burn in one patient [33]. One study reported septic shock and uncontrollable disseminated intravascular coagulation causing fatal cerebrovascular stroke [35].…”

“…Local treatment with amphotericin B was used in three patients. Although posaconazole and isavuconazole can also be considered for the treatment of mucormycosis [42,43], only three reports of treatment with posaconazole and/or isavuconazole were identified in three patients, including two patients who underwent initial treatment with liposomal amphotericin B [14,33]. In the third patient, posaconazole was followed by isavuconazole and associated with local amphotericin B [27].…”

“…or Apophysomyces variabilis infection, including one patient who had coinfection with S. vasiformis , C. elegans , and Lichtheimia corymbifera (Table 2). Identification was also confirmed in two out of three outbreaks, yielding M. circinelloides or L. corymbifera [16] and L. ramosa or L. ornata [14], but no molecular identification was reported in the case series.…”