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Invasive fungal wound infection in an otherwise healthy trauma patient (Mucor Trauma).
Trauma Case Rep 2019; 24:100251TC

Abstract

Background

Mucor fungi are found ubiquitously in the environment and rarely cause infections in humans. Mucormycosis is typically seen in immunocompromised patients, but has been increasingly documented in previously healthy trauma patients. Mortality due to these infections can be high due to delayed diagnosis from a subtle clinical presentation and spread of infection by angioinvasion. Early recognition and prompt treatment is critical for survival. We describe a case of invasive mucormycosis in a previously healthy trauma patient treated at a Level 1 trauma center.

Case report

A 22-year-old male presented to the hospital after being involved in a motor vehicle accident. He sustained multiple traumatic injuries and developed multi-system organ failure within 48 hours of admission. He developed invasive, soft tissue mucormycosis (Rhizopus sp) at the laparotomy site, requiring multiple surgical debridements and prompt antifungal therapy. The fungus was also cultured from respiratory secretions and likely associated with his abdominal infection. We suspect the patient was predisposed to an invasive fungal infection in the setting of multi-system organ failure and multiple blood transfusions. The patient ultimately did well and continued to improve on follow up in the outpatient setting.

Conclusions

Mucormycosis is a rare infection that has been increasingly documented in trauma patients. Early recognition together with prompt debridement and antifungal therapy is key to successful management. Understanding risk factors for post-traumatic mucormycosis should raise our index of suspicion and prompt early diagnosis and initiation of treatment. Aggressive debridement is a critical component of appropriate management due to the angioinvasive spread of the mucor fungi. This means frequent debridement beyond the demarcation of gangrenous tissue. The management of our patient demonstrates the importance of early recognition of the clinical presentation, prompt initiation of antifungal therapy, and aggressive debridement of the wound.

Authors+Show Affiliations

Department of General Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA.Department of Trauma Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA.Department of Trauma Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA.Department of Trauma Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA.Department of Trauma Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

31788530

Citation

Wilson, Whitney, et al. "Invasive Fungal Wound Infection in an Otherwise Healthy Trauma Patient (Mucor Trauma)." Trauma Case Reports, vol. 24, 2019, p. 100251.
Wilson W, Ali-Osman F, Sucher J, et al. Invasive fungal wound infection in an otherwise healthy trauma patient (Mucor Trauma). Trauma Case Rep. 2019;24:100251.
Wilson, W., Ali-Osman, F., Sucher, J., Shirah, G., & Mangram, A. (2019). Invasive fungal wound infection in an otherwise healthy trauma patient (Mucor Trauma). Trauma Case Reports, 24, p. 100251. doi:10.1016/j.tcr.2019.100251.
Wilson W, et al. Invasive Fungal Wound Infection in an Otherwise Healthy Trauma Patient (Mucor Trauma). Trauma Case Rep. 2019;24:100251. PubMed PMID: 31788530.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Invasive fungal wound infection in an otherwise healthy trauma patient (Mucor Trauma). AU - Wilson,Whitney, AU - Ali-Osman,Francis, AU - Sucher,Joseph, AU - Shirah,Gina, AU - Mangram,Alicia, Y1 - 2019/11/20/ PY - 2019/05/23/received PY - 2019/09/04/revised PY - 2019/09/19/accepted PY - 2019/12/3/entrez PY - 2019/12/4/pubmed PY - 2019/12/4/medline KW - Healthy KW - Invasive KW - Mucormycosis KW - Rhizopus KW - Trauma SP - 100251 EP - 100251 JF - Trauma case reports JO - Trauma Case Rep VL - 24 N2 - Background: Mucor fungi are found ubiquitously in the environment and rarely cause infections in humans. Mucormycosis is typically seen in immunocompromised patients, but has been increasingly documented in previously healthy trauma patients. Mortality due to these infections can be high due to delayed diagnosis from a subtle clinical presentation and spread of infection by angioinvasion. Early recognition and prompt treatment is critical for survival. We describe a case of invasive mucormycosis in a previously healthy trauma patient treated at a Level 1 trauma center. Case report: A 22-year-old male presented to the hospital after being involved in a motor vehicle accident. He sustained multiple traumatic injuries and developed multi-system organ failure within 48 hours of admission. He developed invasive, soft tissue mucormycosis (Rhizopus sp) at the laparotomy site, requiring multiple surgical debridements and prompt antifungal therapy. The fungus was also cultured from respiratory secretions and likely associated with his abdominal infection. We suspect the patient was predisposed to an invasive fungal infection in the setting of multi-system organ failure and multiple blood transfusions. The patient ultimately did well and continued to improve on follow up in the outpatient setting. Conclusions: Mucormycosis is a rare infection that has been increasingly documented in trauma patients. Early recognition together with prompt debridement and antifungal therapy is key to successful management. Understanding risk factors for post-traumatic mucormycosis should raise our index of suspicion and prompt early diagnosis and initiation of treatment. Aggressive debridement is a critical component of appropriate management due to the angioinvasive spread of the mucor fungi. This means frequent debridement beyond the demarcation of gangrenous tissue. The management of our patient demonstrates the importance of early recognition of the clinical presentation, prompt initiation of antifungal therapy, and aggressive debridement of the wound. SN - 2352-6440 UR - https://www.unboundmedicine.com/medline/citation/31788530/Invasive_fungal_wound_infection_in_an_otherwise_healthy_trauma_patient_(Mucor_Trauma) L2 - https://linkinghub.elsevier.com/retrieve/pii/S2352-6440(19)30085-8 DB - PRIME DP - Unbound Medicine ER -