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Invasive fungal infections following combat-related injury

Kristopher M Paolino1, James A Henry, Duane R Hospenthal

  • 1Department of Clinical Trials, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910, USA.

Military Medicine
|June 27, 2012
PubMed

Insights

Invasive mold infections are rare in combat wounds but are increasing. These fungal infections cause significant illness, requiring antifungal treatment and surgery, though no deaths occurred in this study.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Trauma Surgery

Background:

  • Invasive mold infections (IMIs) are uncommon complications of traumatic injuries.
  • Combat-related traumatic wounds present unique challenges for infection control.

Purpose of the Study:

  • To determine the incidence and outcomes of IMIs in U.S. soldiers with combat wounds.
  • To analyze trends and identify associated factors for IMIs in this population.

Main Methods:

  • Retrospective chart review of U.S. soldiers returning from Iraq and Afghanistan (March 2002-July 2008).
  • Confirmed IMI defined by pathogenic mold growth and histopathological fungal elements.
  • Analysis of patient demographics, injury types, clinical presentation, treatment, and outcomes.

Main Results:

  • Six cases of IMI identified, yielding an incidence of 0.4 cases/1,000 admissions.
  • Incidence increased significantly over time (p=0.008), peaking at 5.2 cases/1,000 admissions in 2007.
  • Commonly isolated molds included Aspergillus and Bipolaris. Patients presented with fever and leukocytosis; 3 required amputation revision. Average length of stay was 97 days; no deaths occurred.

Conclusions:

  • IMIs are a rare but serious complication of combat wounds.
  • The frequency of IMIs in combat casualties appears to be increasing.
  • Prompt diagnosis, antifungal therapy, and surgical management are crucial for improving outcomes.

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