Traumatic mucormycosis caused by Apophysomyces species - A case series.

Area of Science:

• Medical Mycology
• Infectious Diseases

Background:

• Apophysomyces species are the second most frequent cause of mucormycosis in India.
• This fungal infection predominantly affects immunocompetent hosts, unlike other Mucorales.
• A common presentation is necrotizing fasciitis, which can be misdiagnosed as a bacterial infection.

Purpose of the Study:

• To raise awareness among orthopedic surgeons regarding Apophysomyces-associated mucormycosis.
• To highlight the importance of considering traumatic mucormycosis in patients with soft tissue infections post-trauma.

Main Methods:

• Retrospective analysis of seven cases of Apophysomyces mucormycosis between January 2019 and September 2022.
• Phenotypic identification of fungal isolates as Apophysomyces variabilis.
• Review of clinical presentations, treatment, and outcomes.

Main Results:

• Seven male patients with a mean age of 55 years were diagnosed.
• Six patients presented with necrotizing soft tissue infections, often following trauma, with four having multiple fractures.
• Median time to diagnosis was 9 days; patients underwent surgical debridement and/or amputation, with a 43% mortality rate.

Conclusions:

• Apophysomyces mucormycosis is an emerging threat, particularly in immunocompetent individuals post-trauma.
• Early suspicion and diagnosis are vital, especially in cases of necrotizing soft tissue infections with soil contamination.
• Increased awareness among orthopedic specialists is necessary for prompt management.