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. 2022 Apr 8;10(4):e4230.
doi: 10.1097/GOX.0000000000004230. eCollection 2022 Apr.

Cutaneous Invasive Fungal Infections with Saksenaea Species in Immunocompetent Patients in Europe: A Systematic Review and Case Report

Andrea Planegger  1 , Semra Uyulmaz  1 , Audrius Poskevicius  2 , Andrea Zbinden  3 , Nicolas J Müller  4 , Maurizio Calcagni  1
Affiliations

Cutaneous Invasive Fungal Infections with Saksenaea Species in Immunocompetent Patients in Europe: A Systematic Review and Case Report

Andrea Planegger et al. Plast Reconstr Surg Glob Open. .

Abstract

Invasive fungal infections from Saksenaea, a fungus belonging to the Mucorales, have been rarely reported in central European climate zones. This study aims to raise awareness of invasive cutaneous infections with Saksenaea species. The first case of a cutaneous infection was diagnosed in Switzerland in an immunocompetent 79-year-old patient. A minor skin trauma of her left lower leg led to a fulminant infection causing necrosis and extensive loss of tissue. The combination of surgical debridement and administration of antifungal agents averted a prolonged course with a possible worse outcome. A pedicled hemisoleus muscle flap was used to reconstruct the defect and treatment was continued for 63 days.

Methods: A systematic review in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis guidelines was conducted to identify all European cases of infection with Saksenaea species in immunocompetent hosts. The epidemiology, clinical presentation, microbiological diagnosis, and management of cases reported in Europe were summarized and analyzed.

Conclusions: The prognosis of soft tissue infections with Saksenaea species. depends on early diagnosis and appropriate antifungal and surgical treatment. Reconstruction can be successful under ongoing antifungal treatment.

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Figures

Fig. 1.
Fig. 1.
Preoperative (magnified) view of the wound showing necrotizing panniculitis on the left lower leg (taken on day 8).
Fig. 2.
Fig. 2.
Photograph showing the extent of the wound of the left lower leg defect (taken on day 8).
Fig. 3.
Fig. 3.
Defect on left lower leg demonstrating necrosis (photographs taken on day 12, before debridement).
Fig. 4.
Fig. 4.
Defect on left lower leg demonstrating necrosis (photographs taken on day 12, after debridement).
Fig. 5.
Fig. 5.
Photograph of left lower leg defect after eight debridements, 6 weeks after initial presentation at regional hospital.
Fig. 6.
Fig. 6.
Photograph taken 12 months postoperative of left lower leg, following a medial hemi soleus flap coverage (anterior view/left leg).
Fig. 7.
Fig. 7.
Photograph taken 12 months postoperative of lower legs bilaterally, following a medial hemisoleus flap coverage (posterior view).
Fig. 8.
Fig. 8.
Preferred Reporting Items for Systematic review and Meta-Analysis Protocols flow chart.
See this image and copyright information in PMC

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