Mucormycosis in Burns: A Review

Abstract

Mucormycosis is a rare fungal infection with a high mortality rate. It presents with scattered black/necrotic ulcers, white fungal elements, and progression of wounds despite seemingly adequate debridement. Diagnosis is confirmed on wound histology; however, this is often delayed. There is currently no comprehensive review of burn-related mucormycosis within the literature, making this the first article to provide evidence-based treatment guidance. We performed a review of publications from 1946 to the present. There were 151 cases of mucormycosis complicating burns. The mortality rate was 54.5%, and there was a significant increase in mortality with axial body site involvement compared with isolated peripheral involvement. The standard treatment was prompt and radical debridement. Utilization of frozen section to guide debridement aided in clinical decision making. No systemic treatment reached statistical significance; however, amphotericin B trended toward significance. Although there is no strong evidence for topical amphotericin B or hyperbaric oxygen, there may be benefit in some cases. This study recommends early radical debridement in conjunction with the European Confederation of Medical Mycology guidelines of IV liposomal/lipid complex amphotericin B more than 5mg/kg/day, with posaconazole 800 mg daily in divided doses as a salvage or oral step-down.