Primary cutaneous zygomycosis in a burns patient: a review

Abstract

Cutaneous zygomycosis is an uncommon but potentially fatal disease. An illustrative case is used to highlight the difficulties in managing these burns patients followed by a review of the literature with special emphasis on the surgical management and outcomes in these patients. English language articles were identified using the MEDLINE database from 1966 to 2006, using key words zygomycosis and mucormycosis. The set was limited to humans and cutaneous disease. All articles (n = 173) were reviewed with special consideration for articles (n = 28) post an extensive review of cutaneous zygomycosis in 1993 by Adam et al. Key clinical features, risk factors, microbiological diagnostics, medical and surgical treatment modalities, outcomes, and prognosis were extracted. In contrast to all overall zygomycosis, cutaneous zygomycosis is associated with immune competency in 50% of cases. Diagnosis remains difficult with extensive and sometimes multiple biopsies confirming the presence of a fungus. Although there are no randomized controlled trials on best care, documented treatment options providing survival benefits include antifungal therapy or surgical debridement. Multiple debridements are routine with amputation not an uncommon scenario. Infection may still progress, despite these aggressive measures. Treated patients with localized cutaneous zygomycosis still have a mortality rate of 31%. Cutaneous zygomycosis is an exceedingly difficult disease to manage with limited evidence to guide management. This review offers some insight to burns surgeons and other health professionals to help provide best practice for patients in the future.