Invasive cutaneous fungal infections requiring radical resection in cancer patients undergoing chemotherapy

Abstract

Invasive fungal infections have emerged as a significant problem in patients with cancer with the development of better systemic therapies for malignancy and more effective antibacterial agents. The currently available world published medical literature was reviewed on invasive fungal infections in cancer patients with specific attention devoted to the multidisciplinary role of surgery in refractory cutaneous cases. Infections can develop on the forearm where peripheral intravenous catheters had been inserted in cancer patients undergoing cytotoxic chemotherapy. Curative intent begins with systemic contemporary anti-fungal therapy. Following resolution of neutropenia, patients may require radical surgical debridement with negative margins of resection for complete eradication of the fungal infection. Although invasive fungal infections refractory to antifungal systemic therapy in immunocompromised patients undergoing chemotherapy are a rare event, it is critical for surgeons and other multidisciplinary clinicians to recognize these potentially life-threatening infections that may necessitate radical surgical resection for cure.

Empirical antifungal therapy in selected patients with persistent febrile neutropenia

“…4 The application of EAT is indicated without delay in patients with severe sepsis or septic shock, or in those with signs of focal infection (pulmonary infiltrates, sinusitis, brain abscess, skin lesions and abdominal focus) in which IFI is an outstanding aetiology. [14][15][16][17][18][19][20][21] In those patients at high risk for fungal infection, when fever and neutropenia persists without an alternative diagnosis, EAT may be indicated through an individualized clinical decision. In the rest of the patients with asymptomatic fever who are clinically stable (which constituted the main clinical syndrome of PFN) with a low IFI incidence (null in our study), EAT would not be applied and further diagnostic evaluation, including high-resolution thorax scan, galactomannan and abdominal ultrasound, should be performed to establish the aetiology of the persistent fever.…”