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Review
. 2014 Nov;93(24):395-404.
doi: 10.1097/MD.0000000000000221.

Posttraumatic mucormycosis: a nationwide study in France and review of the literature

Lucie Lelievre  1 , Dea Garcia-Hermoso, Hendy Abdoul, Mickael Hivelin, Taieb Chouaki, Dominique Toubas, Anne-Claire Mamez, Laurent Lantieri, Olivier Lortholary, Fanny Lanternier; and the French Mycosis Study Group
Affiliations
Review

Posttraumatic mucormycosis: a nationwide study in France and review of the literature

Lucie Lelievre et al. Medicine (Baltimore). 2014 Nov.

Erratum in

  • Medicine (Baltimore). 2014 Nov;93(24):414

Abstract

Data on clinical, mycologic characteristics, and outcome of posttraumatic mucormycosis are scarce and often limited to case reports. From the French nationwide "RetroZygo" study, we compared posttraumatic mucormycosis cases with other forms of mucormycosis. We also reviewed reports of posttraumatic mucormycosis in the English-language literature from 1993 to 2013. We included all proven or probable cases for which underlying condition, route of infection, surgical and antifungal treatments, and outcome were detailed. From our cohort, posttraumatic mucormycosis (n = 16) differed significantly from other forms (n = 85) by rarity of underlying disease (31.2% vs 81%, p < 0.0001), frequency of cutaneous localization (87% vs 7%, p < 0.0001), short time before diagnosis (4.5 vs 21 d, p = 0.0002), species involved (Apophysomyces elegans complex and Saksenaea vasiformis), surgical requirement (93.7% vs 47%, p = 0.0006) and better survival (87.5% vs 47.6% at day 90, p = 0.03). We studied 122 cases of posttraumatic mucormycosis through our literature review. Most frequently reported traumas were traffic (37%), domestic accidents (15.1%), or natural disasters (13.4%). Mucormycosis occurred after extensive soft-tissue damage in 47.5% cases, with symptoms occurring a median of 9.5 days after trauma with necrosis being reported in 76.2% cases. Dissemination was found in 9% of patients, and bacterial coinfection in 41%. Nineteen percent of cases occurred in the Middle East or in India where Apophysomyces elegans complex was the predominant species recovered. Awareness of mucormycosis as a cause of posttrauma soft-tissue infection is warranted, especially in cases of soil-contaminated wounds. Survival is higher than in other forms of mucormycosis, but morbidity remains high.

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Conflict of interest statement

Financial support and conflicts of interest: The authors have no financial support to declare for this work. F.L. has received travel grants or speaker's fees from MSD and Gilead Science. O.L. has been a consultant for Gilead Sciences, and has received grants or speaker's fees from Astellas, Pfizer, Merck, and Gilead Sciences. All other authors report no potential conflicts.

Figures

FIGURE 1
FIGURE 1
Right leg wound 7 days after a traffic accident in a young girl. The presence of subcutaneous necrosis suggested a Mucorale infection, thereafter confirmed by mycologic culture.
FIGURE 2
FIGURE 2
Histologic and mycologic results obtained in 16 proven or probable cases of posttraumatic mucormycosis from the RetroZygo study. ∗Negative or not done.
FIGURE 3
FIGURE 3
Survival of posttraumatic (dotted line) versus other forms of mucormycosis (blue line) in the RetroZygo study.
FIGURE 4
FIGURE 4
Distribution of 122 published cases of posttraumatic mucormycosis, 1993–2013. Each bar represents a 5-year period except for the last, which represents 6 years.
FIGURE 5
FIGURE 5
Distribution of Mucorales species according to the geographical origin in the literature review.
FIGURE 6
FIGURE 6
Traumas responsible for 122 mucormycosis in the literature.
See this image and copyright information in PMC

References

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