Invasive fungal infection in immunocompetent trauma patients – A case series

Loganathan, Sivakkanan; Ajay, G; Thyagarajan, U.; Gokul, Raj.D

doi:10.1016/j.jcot.2017.10.005

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…We previously described the performance characteristics of a panfungal assay for the diagnosis of trauma-related IFIs [ 15 ], and here, we extend those observations by evaluating 3 seminested assays designed to detect fungi of the order Mucorales and genera Aspergillus and Fusarium . Selection of fungal targets for the seminested assays were predicated on a review of published literature, conventional culture results, and our prior panfungal work [ 3 , 5–7 , 15 , 26 , 27 ]. As observed in the civilian setting, using seminested assays, fungi of the order Mucorales dominated; however, fungi of the genera Aspergillus and Fusarium were also isolated from combat injuries sustained in Afghanistan [ 3 , 5 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

A Seminested PCR Method for the Diagnosis of Invasive Fungal Infections in Combat Injured

Ellis,

Shaikh,

Carson

et al. 2024

Open Forum Infectious Diseases

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Background Among combat injured, invasive fungal infections (IFIs) result in significant morbidity. Cultures and histopathology are the primary diagnostic methods for IFIs, but they have limitations. We previously evaluated a panfungal polymerase chain reaction assay, which was 83% sensitive and 99% specific for angioinvasive IFIs. Herein, we evaluated three less resource-intensive semi-nested assays targeting clinically-relevant fungi in the order Mucorales and genera Aspergillus and Fusarium. Methods Formalin-fixed paraffin-embedded tissue (FFPE) specimens from a multicenter trauma IFI cohort (2009-2014) were used. Cases were U.S. military personnel injured in Afghanistan with histopathologic IFI evidence. Controls were patients with similar injury patterns and no laboratory IFI evidence (negative culture and histopathology). Semi-nested assays specific to Mucorales (V4/V5 regions of 18S rDNA), Aspergillus (mitochondrial tRNA), and Fusarium (internal transcribed spacer [ITS]/28A regions of DNA) were compared to a panfungal assay amplifying the ITS2 region of rDNA and to histopathology. Results Specimens from 92 injury sites (62 subjects) were compared to control specimens from 117 injuries (101 subjects). We observed substantial agreement between the semi-nested and panfungal assays overall, especially for the order Mucorales. Moderate agreement was observed at the genus-level for Aspergillus and Fusarium. When compared with histopathology, sensitivity and specificity of semi-nested assays were 67.4% and 96.6% respectively (sensitivity increased to 91.7% when restricted to sites with angioinvasion). Conclusion Prior studies of semi-nested molecular diagnostics have focused on culture-negative samples from immunocompromised patients. Our findings underscore the utility of the semi-nested approach in diagnosing soft-tissue IFIs using FFPE samples, especially with angioinvasion.

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Section: Discussionmentioning

confidence: 99%

A Seminested PCR Method for the Diagnosis of Invasive Fungal Infections in Combat Injured

Ellis,

Shaikh,

Carson

et al. 2024

Open Forum Infectious Diseases

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“…The IFI cases associated with traumatic injury often present with soilcontaminated wounds, in both rural and urban areas. [74][75][76][77][78] In military personnel with IFIs, the predominant fungi found were Mucorales and Aspergillus spp., in addition to other environmental moulds such as Fusarium spp. 27,76,79,80 The most common fungal species within the broader taxonomic order of Mucorales are Rhizopus, Absidia and Rhizomucor.…”

Section: Reg Ional Environmental and S E A Sonal Variations Of Fung ...mentioning

confidence: 99%

Invasive fungal infections in wars, following explosives and natural disasters: A narrative review

El Eid,

Chowdhary,

El Zakhem

et al. 2024

Mycoses

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Infections are well‐known complications in patients following traumatic injuries, frequently leading to high morbidity and mortality. In particular, trauma occurring in disaster settings, both natural and man‐made, such as armed conflicts and explosives detonation, results in challenging medical conditions that impede the best management practices. The incidence of invasive fungal infections (IFI) is increasing in trauma patients who lack the typical risk factors like an immune compromised state or others. This narrative review will focus on IFI as a direct complication after natural disasters, wars, and man‐made mass destruction with a summary of the available evidence about the epidemiology, clinical manifestations, risk factors, microbiology, and proper management. In this setting, the clinical manifestations of IFI may include skin and soft tissue infections, osteomyelitis, visceral infections, and pneumonia. IFI should be considered in the war inflicted patients who are exposed to unsterile environments or have wounds contaminated with soil and decaying organic matter.

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“…The Plafond fracture accounts for less than 1% of lower limb injuries and 3-10% of tibial fractures. 1 Treatment of plafond fractures mainly depends on the Fracture pattern and degree of injury. Mechanism of injury is mainly axial compression which causes impaction of articular surface proximally into the metaphysis and also associated with comminution of metaphysis.…”

Section: Introductionmentioning

confidence: 99%

“…A thorough understanding of the mechanism of injury is most important when first assessing a pilon fracture. 1 The amount of soft-tissue injury and the degree of complexity vary widely from low to high-energy injuries. Because of the severity of the soft tissue injury and the disastrous results of deep wound complications felt to be attributed to extensive surgical exposures and bulky internal fixation devices, external fixation emerged as a successful technique for decreasing significant septic complications that had been previously attributed to open surgical management.…”

Section: Introductionmentioning

confidence: 99%

Mucormycosis in compound grade IIIa tibial plafond with medial malleolus fracture: A case report

Yadav¹,

C²

2023

IJOS

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Tibial plafond fracture is defined by intra articular involvement of the distal tibia with metaphyseal extension. The plafond fracture accounts for less than 1% of lower limb injuries and 3–10% of tibial fractures. The rate of deep infection in open ankle fractures is approximately 5%. Pilon fractures are frequently associated with severe soft- tissue injuries that alter the management plan. Here we describe the case of 35year old man brought to ER after sustaining machinery injury to right ankle. On local examination a Laceration of 7x2x2 cms present over left ankle anteriorly extending from Medial Malleolus to Lateral Malleolus and cut ends of tendons of extensor digitorum longus, extensor hallucis longus and Tibialis anterior were identified. X-ray left ankle Ap and Lateral views were taken. X-ray showed Left Distal Tibia fracture. Thorough Wound wash given. Under spinal anesthesia debridement of wound was done and K-wire fixation done for distal tibia fracture. Tendon repair for extensor digitorum longus, extensor hallucis longus and tibialis anterior done using Ethibond suture material using Modified Kessler Technique. On 2 Post operative day a swab from the wound site sent for culture and sensitivity which revealed fungal growth of zygomycetes species. In view of angioinvasive properties of Zygomycetes, after checking Renal parameters patient was started on Inj Amphotericin B 1mg/kg for 4 days and later converted to Tablet Posaconazole 600mg BD. Patient was kept on posaconazole tablet for 6weeks. Regular dressings were done. On regular follow ups and regular dressings wound healed well.

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Invasive fungal infection in immunocompetent trauma patients – A case series

Cited by 5 publications

References 9 publications

A Seminested PCR Method for the Diagnosis of Invasive Fungal Infections in Combat Injured

A Seminested PCR Method for the Diagnosis of Invasive Fungal Infections in Combat Injured

Invasive fungal infections in wars, following explosives and natural disasters: A narrative review

Mucormycosis in compound grade IIIa tibial plafond with medial malleolus fracture: A case report

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