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Traumatic mucormycosis caused by Apophysomyces species - A case series
Vithiya G1, Rajendran T1, Ramesh A1
1Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, India.
Background:
Apophysomyces species are emerging as the second most common agent of mucormycosis in India. It is worrisome as it affects predominantly immunocompetent host unlike other Mucorales. Unfortunately, the most common presentation is necrotising fasciitis which can be overlooked as bacterial infection.
Results:
Seven cases of mucormycosis due to Apophysomyces species were detected in our hospital between January 2019 and September 2022. Mean age was 55 years and all were males. Six patients presented with necrotising soft tissue infection following accidental or iatrogenic trauma. In four cases, multiple fractures over the body were observed. Median days between admission to laboratory diagnosis was 9 days. All isolates were phenotypically identified as Apophysomyces variabilis. Multiple wound debridements, on an average two, was performed in all the cases and amputation performed in two patients. Three patients recovered, two could not be treated due to financial constraints and lost to followup and two patients died.
Conclusion:
Through this series, we anticipate to upheave awareness among the orthopedician community about this emerging infection and contemplate it in appropriate case settings. All patients with necrotising soft tissue infection following trauma and significant degree of wound contamination with soil should be suspected for traumatic mucormycosis at the time of wound assessment.
Insights
Apophysomyces species cause mucormycosis in India, often affecting immunocompetent individuals with necrotizing fasciitis. Early suspicion in trauma cases is crucial for timely diagnosis and treatment of this emerging fungal infection.
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.
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