Cutaneous Zygomycosis – A Poor Prognostic Indicator in Burn Patients
Jeremy Bishay1, Isobel Yeap1, Aruna Wijewardana1, Archie Darbar1, Bishoy Soliman1, Rowan Gillies1, John Vandervord1, 1Royal North Shore Hospital, St Leonards, NSW, Australia
Abstract
Purpose:
Cutaneous zygomycosis is a rare opportunistic fungal infection that is challenging to treat and is associated with a high mortality in burn patients. We describe a case series of two patients with severe burns complicated by cutaneous zygomycosis, both of which resulted in death: first, a 52-year-old female with 17% TBSA flame burns and second a 48-year-old male with 70% TBSA burns from an aircraft explosion. Both patients were initially improving, then deteriorated between days 20-30 at which point cutaneous zygomycosis was diagnosed. Both presented as necrotic patches with underlying caseous necrosis on previously debrided tissue. Aggressive debridement was trialed for both patients but unfortunately the infection continued to penetrate deeper tissue planes and they both passed away of sepsis. We hope this presentation will help burns surgeons recognise cutaneous zygomycosis early, allowing for prompt diagnosis and timely management which could save a patient’s life.
Methodology:
Case series and literature review.
Results and conclusion
Cutaneous zygomycosis in burns remains challenging to diagnose and treat. The treatment relies on prompt diagnosis, extensive surgical debridements and intravenous amphotericin B (1). A literature review reveals that contamination with zygomycosis is associated with a 31% mortality in burn patients (1). It is apparent that cutaneous mucormycosis is a poor prognostic indicator in burn patients and a high index of clinical suspicion is required to facilitate early debridement. Cutaneous mucormycosis restricted to a single limb often results in amputation. In patients diagnosed with systemic cutaneous mucormycosis, palliation may need to be considered.
References:
(1) Palackic, A, Popp, D, Tapking, C, Houschyar, K, Branski, L 2021, ‘Fungal Infections in Burn Patients’, Surgical Infections, vol. 22, no. 1, pp. 83-87
Biography
Jeremy Bishay is a Burns Senior Resident Medical Officer at Royal North Shore Hospital with an interest in Plastic and Reconstructive Surgery.