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J. Fungi 2019, 5(1), 25; https://doi.org/10.3390/jof5010025

Mucormycosis in Burn Patients

1
CHU Lille, Centre des Brûlés, F-59000 Lille, France
2
Univ. Lille, Inserm, CHU Lille, CIC 1403-Centre d’Investigation Clinique, F-59000 Lille, France
3
CHU Lille, Laboratoire de Parasitologie-Mycologie, F-59000 Lille, France
4
Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019–UMR8204-CIIL-Center for Infection and Immunity of Lille, F-59000 Lille, France
*
Author to whom correspondence should be addressed.
Received: 7 February 2019 / Revised: 19 March 2019 / Accepted: 20 March 2019 / Published: 21 March 2019
(This article belongs to the Special Issue Mucorales and Mucormycosis)
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PDF [241 KB, uploaded 21 March 2019]

Abstract

Patients with extensive burns are an important group at risk for cutaneous mucormycosis. This study aimed to perform a systematic review of all reported mucormycosis cases in burn patients from 1990 onward. A Medline search yielded identification of 7 case series, 3 outbreaks, and 25 individual cases reports. The prevalence reached 0.04%–0.6%. The median age was 42–48 in the case series and outbreaks, except for the studies from military centers (23.5–32.5) and in individual reports (29.5). The median total body surface area reached 42.5%–65%. Various skin lesions were described, none being pathognomonic: the diagnosis was mainly reached because of extensive necrotic lesions sometimes associated with sepsis. Most patients were treated with systemic amphotericin B or liposomal amphotericin B, and all underwent debridement and/or amputation. Mortality reached 33%–100% in the case series, 29%–62% during outbreaks, and 40% in individual cases. Most patients were diagnosed using histopathology and/or culture. Mucorales qPCR showed detection of circulating DNA 2–24 days before the standard diagnosis. Species included the main clinically relevant mucorales (i.e., Mucor, Rhizopus, Absidia/Lichtheimia, Rhizomucor) but also more uncommon mucorales such as Saksenaea or Apophysomyces. Contact with soil was reported in most individual cases. Bandages were identified as the source of contamination in two nosocomial outbreaks. View Full-Text
Keywords: mucormycosis; burn; cutaneous; qPCR; outbreak; molecular typing; environmental source; nosocomial; Saksenaea; Apophysomyces mucormycosis; burn; cutaneous; qPCR; outbreak; molecular typing; environmental source; nosocomial; Saksenaea; Apophysomyces
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Devauchelle, P.; Jeanne, M.; Fréalle, E. Mucormycosis in Burn Patients. J. Fungi 2019, 5, 25.

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