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Absidia Corymbifera in an immune competent accident victim with multiple abdominal injuries: case report
Rita Belfiori1, Adelmo Terenzi, Laura Marchesini
1Intensive Care Unit, Perugia General Hospital, Monteluce, Perugia, Italy. contipg@libero.it <contipg@libero.it>
Background:
We report a case of mucormycosis in a healthy 17-year-old accident victim with multiple abdominal injuries which was caused by infection with Absidia Corymbifera, a ubiquitous saphrophyte in the ground.
Case Presentation:
The patient was admitted to hospital with massive abdominal trauma. During an 8-hour emergency operation he received transfusions of compacted red blood cells, plasma, platelets and hemagel. He developed a crush syndrome with acute renal failure, resolved with extra-corporeal dialysis and had to undergo splenectomy because of spleen hematoma. As wound secretion and central venous catheter (CVC) blood cultures and drainage fluid were positive for Enterococcus Faecium, Providentia Rettgeri, Hafnia Alvei and Candida Albicans, tecoplanin, metronidazole, imipenem, and flucanozole were administered. Although the CVC was changed high fever persisted and discharge continued from the large abdominal wound. Repeated tampons in different sections and wound secretion smears were positive for A. corymbifera. Flucanozole was stopped and liposomal amphotericin (Ambisome; 5 mg/Kg i.v.) given for over 3 months. The patient improved; fever gradually disappeared. After 8 days, tampons and wound secretion smears were negative for A. corymbifera. No other fungal infections developed. Drainage fluid was later positive for tecoplanin-resistant E. faecium and Pseudomonas Aeroginosa responding only to meropenem and ciprofloxacin. Abdominal computerized tomography visualized fluid accumulation around the iliac-femoral bypass. Abcess was ruled out when scintigraphy showed no tracer uptake. The lesion was drained. Drainage fluid cultures were negative for bacteria and fungi. Fluid accumulation gradually disappeared with prolonged antibiotic and antifungal therapy. One year after the accident the patient is in good health, with normal quality of life.
Conclusion:
Successful outcome was due to early, specific antifungal therapy, at sufficiently high dosage which was prolonged for an adequate period of time. Early diagnosis of mucormycosis is essential for efficacious anti-fungal treatment and prevention of irreversible spread of mucormycosis to vital organs. It presupposes awareness that A. corymbifera infection can develop in healthy individuals who are stressed and traumatized through skin-ground contact in accidents.
Insights
A healthy teenager with severe abdominal trauma developed mucormycosis caused by Absidia Corymbifera. Prompt, high-dose antifungal treatment led to a full recovery, highlighting the importance of early diagnosis in trauma patients.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Trauma Surgery
Background:
- Mucormycosis is a rare but serious fungal infection.
- Absidia Corymbifera, a common soil saprophyte, can cause mucormycosis.
- Trauma and stress can predispose individuals to opportunistic infections.
Observation:
- A 17-year-old healthy individual sustained severe abdominal trauma and underwent multiple surgeries.
- The patient developed a complex clinical picture including crush syndrome, acute renal failure, and secondary infections.
- Absidia Corymbifera was identified as the causative agent of mucormycosis from wound cultures.
Findings:
- Aggressive, broad-spectrum antibiotic and antifungal therapy was initiated.
- Liposomal amphotericin B was administered for over 3 months at a high dosage.
- The patient showed gradual clinical improvement with resolution of fever and negative fungal cultures.
Implications:
- Early and specific antifungal therapy is crucial for successful mucormycosis treatment.
- Awareness of mucormycosis risk in trauma patients with ground exposure is essential.
- Prompt diagnosis and treatment can prevent dissemination and improve outcomes in healthy individuals.
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