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2014 ; 8
(4
): 277-286
Nephropedia Template TP
Curr Fungal Infect Rep
2014[Dec]; 8
(4
): 277-286
PMID25530825
show ga
Combat-related invasive fungal (mold) wound infections (IFIs) have emerged as an
important and morbid complication following explosive blast injuries among
military personnel. Similar to trauma-associated IFI cases among civilian
populations, as in agricultural accidents and natural disasters, these infections
occur in the setting of penetrating wounds contaminated by environmental debris.
Specific risk factors for combat-related IFI include dismounted (patrolling on
foot) blast injuries occurring mostly in southern Afghanistan, resulting in above
knee amputations requiring resuscitation with large-volume blood transfusions.
Diagnosis of IFI is based upon early identification of a recurrently necrotic
wound following serial debridement and tissue-based histopathology examination
with special stains to detect invasive disease. Fungal culture of affected tissue
also provides supportive information. Aggressive surgical debridement of affected
tissue is the primary therapy. Empiric antifungal therapy should be considered
when there is a strong suspicion for IFI. Both liposomal amphotericin B and
voriconazole should be considered initially for treatment since many of the cases
involve not only Mucorales species but also Aspergillus or Fusarium spp., with
narrowing of regimen based upon clinical mycology findings.
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