Current research on fungi in chronic wounds

Abstract

The occurrence of chronic wounds is a major global health issue. These wounds are difficult to heal as a result of disordered healing mechanisms. The most common types of chronic wounds are diabetic ulcers, pressure ulcers, arterial/venous ulcers and nonhealing surgical wounds. Although bacteria are an important cause of chronic nonhealing wounds, fungi also play a substantial role in them. The fungal infection rate varies with different chronic wound types, but overall, the prevalence of fungi is extremely underestimated in the clinical treatment and management of chronic wounds. Wounds and ulcers can be colonized by host cutaneous, commensal or environmental fungi and evolve into local infections, causing fungemia as well as invasive fungal disease. Furthermore, the fungi involved in nonhealing wound-related infections help commensal bacteria resist antibiotics and the host immune response, forcing wounds to become reservoirs for multiresistant species, which are considered a potential key factor in the microbial bioburden of wounds and ulcers. Fungi can be recalcitrant to the healing process. Biofilm establishment is the predominant mechanism of fungal resistance or tolerance to antimicrobials in chronic nonhealing wounds. Candida albicans yeast and Trichophyton rubrum filamentous fungi are the main fungi involved in chronic wound infection. Fungal species diversity and drug resistance phenotypes in different chronic nonhealing wound types will be emphasized. In this review, we outline the latest research on fungi in chronic wounds and discuss challenges and future perspectives related to diagnosing and managing chronic wounds.

Bacterial Species Involved in Venous Leg Ulcer Infections and Their Sensitivity to Antibiotherapy—An Alarm Signal Regarding the Seriousness of Chronic Venous Insufficiency C6 Stage and Its Need for Prompt Treatment

“…Fungal infections are also associated with worsening and delaying the healing process for chronic wounds, commonly involving poor clinical outcomes. The most frequently isolated pathogenic fungi and opportunistic pathogenic fungi mainly include Candida species and filamentous fungi [ 29 ]. Further investigation into the underlying mechanisms of this difference could provide valuable insights into the pathophysiology of recurrent VLUs and potentially lead to more targeted therapeutic interventions.…”

Direct metagenomics investigation of non-surgical hard-to-heal wounds: a review

“…There are three main limitations of the studies. Fistly, fungal infections are a major contributor to delayed wound healing, involved in polymicrobial biofilm formation and helping commensal bacteria in resisting antibiotics and the host immune response [57,58]. However most studies (12/17) used 16 S rDNA metagenomics, which only detected bacteria, leaving wound viral, fungal and/ or parasites communities underestimated and specially fungal infections undocumented [27,39].…”

Chronic chest wound treated with antifungal

“…Fungi, of all microbes, are known to be opportunistic and studies indicate that their presence in chronic wounds prolong healing time and is often associated with poor outcomes 1 2. With antibiotics as the first-line of treatment in wound care, an ideal environment is created for fungal infections to thrive making wound healing difficult 1–3. For poorly healing wounds, fungal pathology may be considered as one of the causative factors 4.…”