Infectious Diseases
Abstract & Commentary

Invasive Mold Infections Following Trauma

June 20, 2016
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By Dean L. Winslow, MD, FACP, FIDSA, Chairman, Department of Medicine, Santa Clara Valley, Medical Center; Clinical Professor, Stanford University School of Medicine, is Associate Editor for Infectious Disease Alert.

Synopsis: Thirty-seven patients developed invasive mold infections after injuries endured in combat between mid-2009 and late 2010. Three fungal species dominated the results in this series of tests. A second report details 13 patients who contracted necrotizing fungal infections following their injuries sustained in a 2011 Joplin, MO, hurricane.

Sources: Warkentien T, et al. Invasive mold infections following combat-related injuries. CIin Infect Dis 2012; 55:1441-9.

Fanfair, RN, et al. Necrotizing cutaneous mucormycosis after a tornado in Joplin, Missouri, in 2011. New Engl Jrl Med 2012; 367:2214-25.

In Afghanistan between June 2009 and December 2010, 37 cases of invasive fungal infection were diagnosed among US military personnel injured during combat. After biopsy, 13 had no evidence of fungal tissue invasion despite positive fungal cultures, four demonstrated non-vascular tissue invasion and 20 displayed fungal invasion into the blood vessels. In the final quarter of 2010, rates of invasive fungal infections approached 4% of all trauma-care admissions. Each infection was predicated by blast injury, 92% occurred during foot patrols, and all but 6% occurred in southern Afghanistan. Of the patients, four in five underwent lower-extremity amputations and nearly all required large-volume blood transfusion. 83% of the cases yielded mold samples, including fungus of the order Mucorales, Aspergillus species, and Fusarium species. 3 of the patients died as a result of the infection, while over half of the patients required amputation revisions.

Similarly, following a 2011 hurricane that struck Joplin, MO, 13 instances of invasive Mucorales infections were reported. Five of the infected patients died. Testing afterwards confirmed in all 13 patients that the infection was caused by apophysomyces trapeziformis, a fungus often found in decaying matter.