The first isolation of Westerdykella dispersa in a critically burned patient

Abstract

Patients with critical thermal trauma belong to one of the most high-risk groups for development of infectious complications. Fungal infections are not among frequent complications during therapy of patients with thermal trauma, yet their incidence dramatically aggravates the prognosis for patients with this disorder. In the case report, we present the case of a young man with a critical burn, where Westerdykella dispersa was isolated. Identification of the pathogen was provided with a combination of cultivation and molecular biological confirmation. In this case, the distinction between infection and colonization was very complicated. Histopathological examination for definitive diagnosis of infection was not performed because the material from unburned soft tissue sampling could further compromise the function of the hand. Repeated cultivation and molecular identification W. dispersa before and after the necrectomy is indicative of infection rather than colonization. It is the second documented case of positive cultivation with this pathogen in humans and the first such case in a non-neutropenic host.

Emerging mould infections: Get prepared to meet unexpected fungi in your patient

“…46 Two cases of human infections have been reported until now. 47,48 Sue et al reported the infection in a neutropenic patient with acute lymphoblastic leukemia. 48 Infectious complication around a peripherally inserted central catheter occurred.…”

“…The second case was isolated from a critically burned patient. 47 Three other isolates were recovered from lower extremity wounds or tissue in the United States identified as Westerdykella, one of them as W. dispersa and the other two as W. reniformis. 48 However, their virulence in these cases has not been acknowledged.…”

Fungal Infection in Burn Patents

“…Among them, 28 case series and 15 irrelevant studies were excluded. Finally, 36 case reports encompassing 44 burn patients were included for the final analysis 10–45 …”

“…In 36 of the 44 cases, fungal infections were initially suspected and identified from the burn wound samples 10–27,31–33,35–37,39–45 . In the remaining 8 cases, presentations of fungal wound infection were not observed, whereas invasive fungal infections were found in other sites such as blood, arterial thrombosis, teeth, feces, urine, sputum, and tracheal fluid 28–30,34,38 …”

“…Wound scrap of the case showed no fungal growth, and the final species identification was achieved by sequence analysis 21 . With a combination of mycological culture and molecular biological confirmation (sequence analysis), the second case of Westerdykella spp isolation recorded in literature was reported by Lipovy et al 44 in a critically burned patient.…”