Mucormycosis: Emerging Prominence of Cutaneous Infections

Abstract

Twenty-five patients with mucormycosis were seen at two university-affiliated hospitals from 1979 to 1993. These cases included 10 cutaneous, 9 rhinocerebral, and 3 disseminated infections, as well as one case each of pulmonary, renal, and peritoneal dialysis catheter-related infection. Eleven of the patients were diabetic and seven had ketoacidosis, including four who became acidotic after admission to the hospital. The mortality rates associated with rhinocerebral, disseminated, and pulmonary infections were 78%-100%, while those associated with cutaneous and miscellaneous forms were zero. In view of the prominence of cutaneous infections, the 10 cases of cutaneous mucormycosis (in addition to a case from a community hospital) are reported in detail. Systemic diseases were present in four of the 11 patients. Local factors leading to infection were identified in nine of the cases and included motor vehicle accident-related and other trauma, surgery, a spider bite, and an intravenous infusion catheter. The cases of cutaneous mucormycosis reported in the literature have been analyzed for identification of predisposing factors, treatment, and outcome. Aggressive surgical debridement is the most important component of therapy, and administration of amphotericin B is a useful adjunct. Skin grafting is useful as a method of repairing defects left by extensive debridement.

Mucormicosis cutánea primaria: a propósito de dos casos. Revisión de la literatura

“…Finalmente, debemos mencionar que la mucormicosis presenta una mortalidad cercana a 50-60%; en ocasiones, a pesar del precoz diagnóstico e instauración del tratamiento, su curso es fatal, mencionándose en la literatura médica, como factores asociados al pronóstico, la edad, enfermedad de base o condición predisponente para desarrollar la enfermedad, localización de la infección, oportuno diagnóstico e instauración de tratamiento farmacológico y/o quirúrgico que permitan controlar y/o eliminar el agente y los tejidos comprometidos 2,4,8,9,13,28,29 .…”

Aspects cliniques et radiologiques des mucormycoses

“…Dans ce contexte, les infections sont principalement pulmonaires ou rhino-orbito-cérébrales (Figure 1). Enfin, dans environ 20 % des cas, l'infection peut survenir chez un patient non diabétique, immunocompétent ou peu immunodéprimé [4,6,11]. La porte d'entrée du pathogène est alors une plaie ou une brûlure, et l'infection envahit les tissus cutanés et sous-cutanés.…”

“…Chez l'hôte immunocompétent, les spores sont détruites par les polynucléaires neutrophiles et les macrophages [9,10]. La contamination peut également se faire par voie cutanée suite à une plaie traumatique ou chirurgicale, une brûlure ou une peau fragilisée par un pansement ou par un topique corticoïde [11,12]. Ces infections peuvent rester locorégionales ou disséminer à distance, en particulier si elles surviennent sur un terrain de déficit immunitaire.…”

A 4-year-old child with leukemia and an enlarging arm lesion

“…1,2 These fungi have wide nonseptated hyphae that may branch at right angles. Infections generally occur in immunocompromised patients with conditions such as neutropenia, diabetes or hematologic malignant disease.…”