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Cutaneous Invasive Fungal Infections with Saksenaea Species in Immunocompetent Patients in Europe: A Systematic
Andrea Planegger1, Semra Uyulmaz1, Audrius Poskevicius2
1Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
Abstract:
Invasive fungal infections from Saksenaea, a fungus belonging to the Mucorales, have been rarely reported in central European climate zones. This study aims to raise awareness of invasive cutaneous infections with Saksenaea species. The first case of a cutaneous infection was diagnosed in Switzerland in an immunocompetent 79-year-old patient. A minor skin trauma of her left lower leg led to a fulminant infection causing necrosis and extensive loss of tissue. The combination of surgical debridement and administration of antifungal agents averted a prolonged course with a possible worse outcome. A pedicled hemisoleus muscle flap was used to reconstruct the defect and treatment was continued for 63 days.
Methods:
A systematic review in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines was conducted to identify all European cases of infection with Saksenaea species in immunocompetent hosts. The epidemiology, clinical presentation, microbiological diagnosis, and management of cases reported in Europe were summarized and analyzed.
Conclusions:
The prognosis of soft tissue infections with Saksenaea species. depends on early diagnosis and appropriate antifungal and surgical treatment. Reconstruction can be successful under ongoing antifungal treatment.
Insights
Invasive fungal infections caused by Saksenaea are rare in Europe. Early diagnosis and treatment of these mucormycosis infections are crucial for a good prognosis in immunocompetent patients.
Area of Science:
- Mycology
- Infectious Diseases
- Dermatology
Background:
- Invasive fungal infections caused by Saksenaea species, a type of mucormycosis, are infrequently reported in central European climates.
- Cutaneous infections with Saksenaea are particularly rare, with limited data available on their presentation and management in immunocompetent individuals.
Purpose of the Study:
- To enhance awareness of invasive cutaneous Saksenaea infections.
- To systematically review and analyze European cases of Saksenaea infections in immunocompetent hosts.
- To summarize epidemiology, clinical presentation, diagnosis, and management strategies.
Main Methods:
- Systematic review adhering to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.
- Identification and analysis of all reported European cases of Saksenaea infection in immunocompetent individuals.
- Summarization of epidemiological, clinical, microbiological, and management data.
Main Results:
- The study identified the first case of invasive cutaneous Saksenaea infection in an immunocompetent 79-year-old patient in Switzerland.
- The infection, originating from minor skin trauma, led to fulminant necrosis and significant tissue loss.
- Combined surgical debridement and antifungal therapy, followed by muscle flap reconstruction, successfully managed the infection over 63 days.
Conclusions:
- Early diagnosis and prompt, appropriate antifungal and surgical treatment are critical for favorable outcomes in Saksenaea soft tissue infections.
- Successful tissue reconstruction is achievable even with ongoing antifungal therapy.
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