Cunninghamella bertholletiae wound infection of probable nosocomial origin

After closed reduction and casting of a tibial fracture in a 69-year-old diabetic man, a gangrenous lesion developed under the cast. Cultures of debrided tissue revealed multiple bacteria, including Bacillus sp, plus two fungi, Fusarium sp and a zygomycete identified as Cunninghamella bertholletiae. Large nonseptate hyphae in thrombosed blood vessels suggested that C bertholletiae played a major role in the development of the infection. Recovery of organisms from our patient's wound and from the cast padding suggests that the wound infection was acquired from nonsterile dressings.