Zygomycetic Gangrenous Cellulitis

Zygomycetes in Human Disease

“…The first reported human case occurred in a previously healthy 19-year-old individual who suffered soil contaminated cranial and facial wounds in an automobile accident (9,112). Soil contamination was likewise the probable source of infection in additional patients who sustained various crush or open injuries (9,75,173,350,366,453). One patient developed necrotizing fasciitis after being gored by a bull (77).…”

“…The predisposing features to infection included some combination of trauma with open wounds (9,75,77,112,173,272,332,453,464), needle stick trauma (357,361), insect or spider bites (33,77,203), immune system compromise due to steroid treatment (9,112,332,464), antibiotic therapy (9,33,112,195,332,464) or the presence of an indwelling catheter (332). Immune system compromise due to underlying disease also is thought to be a risk factor.…”

“…Most cases of S. vasiformis infection described in the literature involve cutaneous sites, the exception being two cases of primary sinusitis (173,229,350). Cutaneous lesions with S. vasiformis may present as painful red blisters (332,373), peeling skin with purulent eschar (453), black necrotic ulcers (75,248,464) indurated granulomatous ulcerative lesions (357) or raised red to purple lesions (33,272). Often, the lesions demonstrate seropurulent drainage (9,112,361).…”

Mucormycosis Caused by Unusual Mucormycetes, Non-Rhizopus, -Mucor, and -Lichtheimia Species

“…Necrotizing fasciitis or cellulitis (29,37,51,58,64,107,162,171,185,230,241,253,319,366) extending rapidly to neighboring tissues (29,37,51,58,64,107,162,185,253,319,366) is the most common characteristic of soft tissue S. vasiformis infection. Abscess formation with fat necrosis has also been described (266,326,366), with histological evidence of satellite lesions in one of these cases (366).…”

“…In most of the reported cases, the infection was localized and responded favorably to aggressive debridement and antifungal therapy (Tables 3 and 4) (29,37,58,171,185,253,266,319,326,343,366). However, amputation (51,240,366) and fatal progression despite treatment (with AmB alone or L-AmB and posaconazole) and extensive daily surgical debridement (162) have been described, occasionally associated with superim-posed bacterial infections (64). Only three cases of S. vasiformis infections restricted to soft tissues have been reported in previously relatively immunocompromised patients, specifically, two individuals with diabetes mellitus (29,58) and one who had thalassemia and underwent splenectomy (326).…”