Mucormycosis: emerging prominence of cutaneous infections

Twenty-five patients with mucormycosis were seen at two university-affiliated hospitals from 1979 to 1993. These cases included 10 cutaneous, 9 rhinocerebral, and 3 disseminated infections, as well as one case each of pulmonary, renal, and peritoneal dialysis catheter-related infection. Eleven of the patients were diabetic and seven had ketoacidosis, including four who became acidotic after admission to the hospital. The mortality rates associated with rhinocerebral, disseminated, and pulmonary infections were 78%-100%, while those associated with cutaneous and miscellaneous forms were zero. In view of the prominence of cutaneous infections, the 10 cases of cutaneous mucormycosis (in addition to a case from a community hospital) are reported in detail. Systemic diseases were present in four of the 11 patients. Local factors leading to infection were identified in nine of the cases and included motor vehicle accident-related and other trauma, surgery, a spider bite, and an intravenous infusion catheter. The cases of cutaneous mucormycosis reported in the literature have been analyzed for identification of predisposing factors, treatment, and outcome. Aggressive surgical debridement is the most important component of therapy, and administration of amphotericin B is a useful adjunct. Skin grafting is useful as a method of repairing defects left by extensive debridement.