Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun;14(2):186-196.
doi: 10.1007/s12281-020-00385-4. Epub 2020 Apr 16.

Combat trauma-related invasive fungal wound infections

David R Tribble  1 , Anuradha Ganesan  1   2   3 , Carlos J Rodriguez  4
Affiliations

Combat trauma-related invasive fungal wound infections

David R Tribble et al. Curr Fungal Infect Rep. 2020 Jun.

Abstract

Purpose of review: This review highlights research from the past five years on combat trauma-related invasive fungal wound infections (IFIs) with a focus on risk stratification to aid patient management, microbiology, and diagnostics.

Recent findings: A revised classification scheme stratifies wounds into three risk groups: IFI, High Suspicion of IFI, and Low Suspicion of IFI. This stratification is based on persistence of wound necrosis and laboratory fungal evidence, presence of signs/symptoms of deep soft-tissue infections, and the need for antifungals. Use of this classification could allow for prioritization of antifungal therapy. Further, IFIs delay wound healing, particularly when caused by fungi of the order Mucorales. Lastly, molecular sequencing offers promising and complimentary results to the gold standard histopathology.

Summary: Optimal management of combat-related IFIs depends on early tissue-based diagnosis with aggressive surgical debridement and concomitant dual antifungal therapy. Further research on clinical decision support tools and rapid diagnostics are needed.

Keywords: combat-related; invasive fungal infections; mucormycosis; trauma-related; wound infections.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Wound culture mycology distribution by group classification (modified from Ganesan et al., 2019) [16]. Due to wounds being polymicrobial, organisms are not mutually exclusive for a classification type. Other fungi is restricted to filamentous fungi other than order Mucorales, Aspergillus spp., and Fusarium spp. IFI – invasive fungal wound infection.
See this image and copyright information in PMC

References

    1. Kronen R, Liang SY, Bochicchio G, Bochicchio K, Powderly WG, Spec A. Invasive fungal infections secondary to traumatic injury. Int J Infect Dis. 2017;62:102–11. doi: 10.1016/j.ijid.2017.07.002. - DOI - PubMed
    1. Jeong W, Keighley C, Wolfe R, Leng Lee W, Slavin MA, Kong DCM, et al. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect. 2018;25(1):26–34. doi: 10.1016/j.cmi.2018.07.011. - DOI - PubMed
    1. Lelievre L, Garcia-Hermoso D, Abdoul H, Hivelin M, Chouaki T, Toubas D, et al. Posttraumatic mucormycosis: a nationwide study in france and review of the literature. Medicine. 2014;93(24):395–404. doi: 10.1097/MD.0000000000000221. - DOI - PMC - PubMed
    1. Walsh TJ, Hospenthal DR, Petraitis V, Kontoyiannis DP. Necrotizing mucormycosis of wounds following combat injuries, natural disasters, burns, and other trauma. J Fungi (Basel). 2019;5(3):E57. doi: 10.3390/jof5030057. - DOI - PMC - PubMed
    1. Neblett Fanfair R, Benedict K, Bos J, Bennett SD, Lo Y-C, Adebanjo T, et al. Necrotizing cutaneous mucormycosis after a tornado in Joplin, Missouri, in 2011. N Engl J Med. 2012;367(23):2214–25. doi: 10.1056/NEJMoa1204781. - DOI - PubMed

LinkOut - more resources