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Published on: November 8, 2024
Invasive mycoses following trauma
S Hajdu1, Alexandra Obradovic, Elisabeth Presterl
1Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Wien, Austria. s.hajdu@aon.at
Abstract:
Invasive fungal infection may afflict people with trauma in two ways: either by entry into tissue via penetrating trauma or by haematogenous spread in critically ill people with polytrauma. Penetrating injury allows the advance of ubiquitously present fungi into the human body. Miniscule foreign material fosters the establishment and growth of fungi within the traumatically changed tissue. The seriousness of the infection depends upon the type of injury, the body area and the person's general condition. Usually, the infection is confined to the cutis and subcutis; the fascia, muscles and bones are rarely affected. In the presence of immunocompromise, however, the fungus may spread rapidly and cause systemic disease. The following overview will focus on fungal infection associated with open wounds and fractures, particularly eye injury and with near-drowning, tropical mycetoma and nosocomial conditions. Post-traumatic invasive fungal infections are rare, but the surgeon should be alert to this possibility in cases with chronic inflammation and deferred healing of injuries, with or without systemic inflammatory response.
Insights
Invasive fungal infections can occur after trauma through direct injury or spread in critically ill patients. Surgeons should suspect fungal infection in non-healing wounds, especially in immunocompromised individuals.
Area of Science:
- Medical Mycology
- Trauma Surgery
- Infectious Diseases
Background:
- Invasive fungal infections (IFIs) complicate trauma care through direct inoculation or hematogenous spread.
- Foreign material in penetrating trauma can facilitate fungal establishment and growth.
- Severity of IFIs depends on injury type, location, and patient's immune status.
Purpose of the Study:
- To provide an overview of invasive fungal infections associated with various traumatic conditions.
- To highlight the importance of considering IFIs in non-healing post-traumatic wounds.
Main Methods:
- Literature review focusing on fungal infections in open wounds, fractures, eye injuries, near-drowning, mycetoma, and nosocomial settings.
- Analysis of factors influencing fungal infection development and spread in trauma patients.
Main Results:
- IFIs in trauma are typically superficial but can become systemic, particularly in immunocompromised patients.
- Specific scenarios include eye injuries, near-drowning, tropical mycetoma, and nosocomial infections.
- Chronic inflammation and delayed healing in traumatic injuries may indicate underlying fungal infection.
Conclusions:
- Post-traumatic IFIs are rare but pose a significant risk, especially in immunocompromised individuals.
- Surgeons must maintain a high index of suspicion for IFIs in patients with persistent wound inflammation and delayed healing.
- Early recognition and appropriate management are crucial to prevent severe outcomes from invasive fungal infections.
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