Opportunistic fungal infection of the burn wound with Phycomycetes and Aspergillus

Viral infections and wounds

“…Viral burn wound infections have been reported to be very rare (11)(12)(13)(14)(15)(16)(17). As with surgical wounds, thermal injuries destroy the barrier function of skin, enabling the passage of viruses (18).…”

Cutaneous aspergillosis

“…The predisposition for burn victims to develop cutaneous aspergillosis likely involves physical cutaneous barrier disruption and depression of several host defense mechanisms, such as impaired or decreased phagocytosis, bacterial flora disturbances from the use of systemic antimicrobial agents, and hyperglycemia from hyperalimentation. Cutaneous aspergillosis usually involves those patients with burns that average 50 to 60% of the total body surface area and occurs 50 to 60 days after the burn, usually within 10 to 35 days (7,56,60). Importantly, the burned skin serves as a portal of entry for Aspergillus organisms (44).…”

“…For one patient without an implicated source of contamination, the patient had underlying diabetes in addition to the burn wounds (46). In the burn patient population, primary lesions may disseminate or cause a contiguous osteomyelitis by direct extension (7). A successful outcome in the burn patient involves treatment with intravenous and topical antifungal agents, surgical excision to the level of noninvaded viable tissue, and, in some instances, amputation of the affected limb (60).…”

“…Infections arising at the site of an intravenous catheter puncture typically begin with erythema and induration at the skin puncture site and progress to necrosis that extends radially from the initial focus (2). A patient with primary cutaneous aspergillosis arising in a wound generally presents with significant fever, a change in the character of the wound surface, swelling, induration, and tenderness (7,8,42,44,46,60). The pace of the infection varies from indolent to fulminant, and the mortality rate is approximately 30 to 75%.…”

“…For example, cutaneous aspergillosis in burn victims occurs as primary disease, treated principally with a surgical approach that may involve amputation (7,60). Conversely, the approach in premature neonates with cutaneous aspergillosis, who do not tolerate skin surgery well, is antifungal chemotherapy without surgery (55).…”