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System for Focal, Closed-System Central Nervous System Injury
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Invasive mold infections following combat-related injuries.

Tyler Warkentien1, Carlos Rodriguez, Bradley Lloyd

  • 1Walter Reed National Military Medical Center, Bethesda, Maryland, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
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Invasive fungal wound infections (IFIs) are an emerging threat in combat trauma, characterized by blast injuries and amputations. Early diagnosis and aggressive treatment are crucial to reduce high morbidity and mortality rates.

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Area of Science:

  • Medical microbiology
  • Trauma surgery
  • Infectious diseases

Background:

  • Advances in combat casualty care increase survival rates for complex extremity trauma.
  • Invasive fungal wound infections (IFIs) are an emerging complication in trauma patients.
  • Understanding risk factors and clinical findings for IFIs is critical to reduce morbidity.

Purpose of the Study:

  • To identify risk factors and clinical findings associated with invasive fungal wound infections (IFIs) in combat casualties.
  • To characterize the epidemiology and outcomes of IFIs in a US military population.
  • To inform early identification and treatment strategies for IFIs.

Main Methods:

  • Retrospective case series of US military personnel injured between June 2009 and December 2010.
  • Case definition included wound necrosis with histopathological or microbiological evidence of IFI (excluding Candida spp.).
  • Data collected via trauma registry, medical records, and pathology review.

Main Results:

  • 37 cases of IFI identified, with 20 proven (angioinvasion) and 13 possible.
  • Commonly associated with blast injuries (100%), foot patrol (92%), southern Afghanistan (94%), lower extremity amputation (80%), and blood transfusion (97.2%).
  • Mold isolates (Mucorales, Aspergillus, Fusarium) recovered in 83% of cases; outcomes included 8.1% mortality, frequent debridements, and amputations.

Conclusions:

  • IFIs represent a significant, emerging trauma-related infection.
  • Early identification based on injury profile and tissue diagnosis is essential.
  • Aggressive surgical and antifungal therapy (liposomal amphotericin B, broad-spectrum triazole) is recommended for suspicious wounds.