Combat-Related Pythium aphanidermatum Invasive Wound Infection: Case Report and Discussion of Utility of Molecular Diagnostics

Abstract

We describe a 22-year-old soldier with 19% total body surface area burns, polytrauma, and sequence- and culture-confirmed Pythium aphanidermatum wound infection. Antemortem histopathology suggested disseminated Pythium infection, including brain involvement; however, postmortem PCR revealed Cunninghamella elegans, Lichtheimia corymbifera, and Saksenaea vasiformis coinfection. The utility of molecular diagnostics in invasive fungal infections is discussed.

FIG 1

(A) Pythium aphanidermatum UTHSC DI 14-349 colony on cornmeal/irradiated carnation leaf agar at 48 h in ambient air at 25°C; (B) toruloid sporangium; (C) oogonium (white arrow), oospores (black arrow), and antheridium (gray arrow).

FIG 2

(A) Tissue taken from the cortex of the right occipital lobe reveals brain parenchyma with patchy infiltration by broad, aseptate fungal hyphae (arrows) and robust acute encephalitis, as noted by the large number of neutrophils (arrowhead). No other foci of necrosis or inflammation were noted in the brain. (B) Hematoxylin-and-eosin-stained right testis and soft tissue (PDOI 42/autopsy) with acute and chronic inflammation with hemorrhage. Broad, aseptate hyphae are seen interspersed with the inflammatory cells.