Saksenaea erythrospora Infection following Combat Trauma

Abstract

Saksenaea erythrospora is a newly described species of the order Mucorales which has not previously been reported as a cause of human infection. We report a fatal case of S. erythrospora invasive burn wound infection in a 26-year-old male injured during combat operations in Iraq. CASE REPORTA 26-year-old male sustained 56% total body surface area burns following an improvised explosive device blast in Iraq in November 2005. Injuries were significant for deep, fullthickness facial burns and partial-thickness and full-thickness burns affecting his head, arms, and legs. No evidence of significant smoke inhalation injury was noted on fiber-optic bronchoscopy. At a combat support hospital in Iraq, he was resuscitated and taken to the operating room for bilateral canthotomies, four extremity escharotomies, and four extremity fasciotomies. After initial stabilization, he was evacuated to Germany, where he was found to be in persistent circulatory shock and taken back to the operating room. He was found to have nonviable muscle in the right anterior tibialis compartment, and muscle debridement was performed. He was subsequently stabilized and transferred to the U.S. Army Institute of Surgical Research burn center approximately 4 days postburn. On postburn day 5, the patient underwent tangential excision of his extremity burn wounds and split-thickness skin graft placement. On postburn day 14, the patient was found to have proptosis of his left eye on a routine physical evaluation and underwent a head computed tomography (CT) scan. The CT scan revealed displacement of his left orbit in the inferior lateral direction due to swelling in the orbital fossa. He was rushed to the operating room, where he underwent enucleation of the left eye and debridement of nonviable-appearing tissue in the orbital fossa. Histopathology of the surgical specimen revealed mucormycosis (Fig. 1). Broad-width, aseptate hyphae consistent with Mucorales infection (mucormycosis) were noted on histopathologic examination of tissue from his head and neck multiple times during subsequent serial wound debridements over the course of his hospitalization (days 19, 20, 21, 52, and 85). Multiple cultures were obtained over the course of this management, including mycologic cultures. Most of the fungal cultures were overgrown with bacteria, but they occasionally revealed broad, ribbonlike hyphae on Calcofluor staining. A single culture recovered Saksenaea erythrospora during the course of his hospitalization. The mold was recovered from scalp wound fluid placed into blood culture (aerobic) medium on day 19 postinjury.In addition to radical debridement, flap coverage of the left side of his face was attempted on two separate occasions during the course of his hospitalization. Both of these attempts were unsuccessful. His course was also complicated by recurrent bacterial infections and sepsis, in addition to this inability to control his facial mucormycosis, and 100 days following his initial injury, he expired. At autopsy, invasive fungal infection of the l...

DNA barcoding in <I>Mucorales</I>: an inventory of biodiversity

“…stolonifer , Rhizomucor miehei , Rm. pusillus , Saksenaea vasiformis , S. erythrospora (Hospenthal et al 2011) and Syncephalastrum racemosum. …”

Saksenaea infection masquerading as a brain tumor in an immunocompetent child

“…Disseminated disease is rare but has been reported in both immunocompetent and immunocompromised patients and is associated with a high mortality rate . Although there have only been a few cases of human S. erythrospora infections reported to date, it is likely they have long been the cause of mucormycosis before the discovery of additional Saksenaea species . As with S. vasiformis , the majority have also presented as cutaneous or soft tissue infections associated with trauma or procedures, likely from contamination with soil or water .…”

“…Although there have only been a few cases of human S. erythrospora infections reported to date, it is likely they have long been the cause of mucormycosis before the discovery of additional Saksenaea species . As with S. vasiformis , the majority have also presented as cutaneous or soft tissue infections associated with trauma or procedures, likely from contamination with soil or water . S. erythrospora infections have been described following combat trauma, a river sailing accident in Argentina, breast augmentation surgery in Venezuela and in a series of five cases associated with intramuscular injections and medicated bandage application in India …”

A New European Species of The Opportunistic Pathogenic GenusSaksenaea–S. dorisiaeSp. Nov.

“…Most likely, the fungus originated from surrounding soil resulting in pollution of ground water in the well. In fact, soil is supposed to be the primary habitat of the fungus and a known source for infection typically seen after skin rupture and subsequent contact with contaminated soil (3, 26) or contaminated water (2, 4). Although, the presence of the Saksenaea fungi (as S. vasiformis ) associated with soil environments has been rarely reported, the fungus has been found in different parts of the world, suggesting a wide distribution (27).…”