Fungal Infections

February 26, 2012

Fungal super-infections turn killer in burns cases

Fungal super-infections turn killer in burns cases

Jan 2012

NEW DELHI: Fungal infections have been found to be a significant cause of death in burns cases, a new study has revealed. Ironically, these infections result from the use of powerful third-generation antibiotics that destroy all bacteria while allowing fungi present in the environment and the gastrointestinal tract to grow unchecked.

A study by doctors at Safdarjung Hospital, published in the medical journal ‘Burns’, shows 12 out of 100 burn injury patients included in the research had fungal infection. The mortality rate among the infected patients was found to be 66.7%. Most of the patients found positive for fungal infection were on three or more higher antibiotics, given either as a combination or over a period of 10 days. “Of this, the commonest were carbapenems and monobactums followed by Piperacillin and Tazobactum,” states the report. Safdarjung Hospital has the largest dedicated burns unit in Asia with an average of 2000 admissions every year.

One of the lead authors of the study, who did not want to be named, said the ubiquity of fungi in the environment along with the suppression of normal bacteria causes the fungal super-infection in burns. “The broad spectrum antibiotics destroy bacteria which grow on the dead tissues in the wound area. But the fungi, which are present in the system, get a chance to proliferate. They turn pathogenic, leading to infection and even death,” he said. Extreme age groups – children and the elderly – diabetes, inhalation injury, prolonged hospital stay and other risk factors increase the chances of fungal infection in the wound.

Experts say that till a few years ago, the burnt surface was considered to be a suitable site for opportunistic colonization and invasion by bacteria which could be checked by early wound excision and skin grafting and the use of antibiotic therapy. But now, anti-fungal therapy is being mulled in view of the increasing incidence of fungal infection in patients.

A senior doctor said, “A lot of effort has been put into treating life threatening bacterial septicemia in burns but often the bacterial culture is negative yet the patient’s condition deteriorates. Fever, sepsis and even death occur as a consequence. No attention was paid towards the cause of this increasing mortality for a long time. Our investigations suggest that all such patients are usually suffering from fungal infection, and this was confirmed with positive biopsy results. Early closure of wound can be effective in fighting this and decreasing the risk.”

Times of India

September 17, 2009

Clinical presentation of zygomycosis.

Clinical presentation of zygomycosis.

Clin Microbiol Infect. 2009 Oct

Mantadakis E, Samonis G.

Department of Paediatrics, Democritus University of Thrace and General District Hospital of Alexandroupolis, Thrace, Greece.

Zygomycetes are filamentous fungi with a worldwide distribution. This class of fungi encompasses two orders, i.e. the Mucorales and the Entomophthorales. Members of the latter are associated with chronic cutaneous and subcutaneous infections that are limited to the tropics and rarely disseminate to internal organs. The order Mucorales includes several species involved in rhinocerebral, pulmonary, cutaneous, gastrointestinal and other less frequent infections in immunocompetent and immunocompromised individuals, and is characterized by a tendency to disseminate. Portals of entry of zygomycetes are usually the lungs, skin, and gastrointestinal tract. A characteristic property of zygomycetes is their tendency to invade blood vessels and to cause thrombosis-processes that result in subsequent necrosis of involved tissues. Risk factors associated with zygomycosis include prolonged neutropenia and use of corticosteroids, solid organ or haematopoietic stem cell transplantation, AIDS, poorly controlled diabetes mellitus, iron chelation with deferoxamine, burns, wounds, malnutrition, extremes of age, and intravenous drug abuse. Recently, the widespread use of voriconazole for prophylaxis or treatment of aspergillosis in patients with haematological malignancies has been linked with a rise in the numbers of cases of invasive zygomycosis. As the symptoms, clinical signs and imaging findings of these infections are non-specific, a high index of suspicion is required for timely diagnosis. Early diagnosis, correction of the underlying predisposing factors, aggressive surgical debridement of all infected tissues and lengthy administration of antifungals are the only potentially curative options for this rare but emerging invasive fungal infection.



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