Post-operative Abdominal Wall Mucormycosis—a Case Series

Abstract

Mucormycosis is caused by saprophtytic fungi which cause acute invasive zygomycosis. It clinically presents with necrosis, and on histopathology, acute and chronic infiltrates are seen. It rarely infects a healthy host, but is devastating in an immunocompromised host. We studied five cases with post-operative abdominal wall mucormycosis, three females and two males. Three patients were post-operative while the other two had mucormycosis following trauma and infection was found in sutured wound. All were initially diagnosed as cases of necrotizing fasciitis. Two patients eventually survived after intensive medical therapy and extensive debridements.

Post operative abdominal wall mucormycosis infection after laparotomy for bowel perforation

“…This can occur with contaminated surgical instruments, sutures, or dressings during surgical procedure [13] . Environmental source, including the hospital environment such as hospital linen have been identified as potential source of nosocomial infections and outbreaks related to mucormycosis [13] , [14] , [15] , [16] . In our case, thorough microbiological investigation over the preceding 12 months revealed no other cases of interest, so further environmental investigation was not undertaken.…”

Pulmonary embolism and gastric bleed with disseminated mucormycosis - treading dangerous waters

“…Among immunocompetent individuals, most cases reported have localized disease involving skin/ subcutaneous tissue in trauma and burn patients with disseminated disease in few [12]. Surgery is another major cause of disseminated mucormycosis in immunocompetent adults with possible contamination in the peri-or post-operative period [13]. Once diagnosed, treatment should be initiated at the earliest possible.…”

Mucormicosis periostomal posoperatoria, a propósito de un caso

“…Dada su clínica, se suele diagnosticar, inicialmente, como pioderma gangrenoso 14 o una fasceitis necrotizante 3 , pero puede diferenciarse de esta última por la ausencia del intenso olor expelido 8 . El diagnóstico se confirma con cultivos o análisis histológico con la presencia de hifas gruesas (5-20 µm), de paredes delgadas en forma de cinta, con pocos o ningún septo y con ramificaciones en ángulo recto.…”

“…Se han descrito cuadros larvados 14 , pero también otros fulminantes 3,4 , por lo que es de suma importancia su diagnóstico expedito, pues la instauración pronta de un manejo quirúrgico agresivo con resección de los tejidos infectados 15 asociado a tratamiento antifúngico sistémico, puede marcar el pronóstico de esta seria enfermedad. Para esto último, de elección es la Anfotericina B 9,15,16 , con monitorización de función renal dada su nefrotoxicidad.…”

“…Las manifestaciones clínicas más frecuentes son la rinocerebral, pulmonar, cutánea, gastrointestinal y diseminado. Otras infrecuentes son endocarditis, osteomielitis y renal 1,2 En cuanto a la mucormicosis cutánea, por lo general existe el antecedente de trauma o cirugía [2][3][4][5] que permite una puerta de entrada, aunque también se han descrito casos secundarios a mordeduras de arañas 6 , sitios de inyección de medicamentos 7 e incluso espontáneo 8 .…”