amphotericin-b and Abdominal-Injuries

Mucormycosis is a deadly angioinvasive fungal infection that is increasing in incidence. Gastrointestinal and abdominal involvement is rare, has higher mortality rates, and is frequently diagnosed late.. We report a patient who sustained multiple gunshot wounds to the chest and abdomen and subsequently developed omental and hepatic mucormycosis. He underwent 14 abdominal washouts and several liver debridements, and he received combination therapy with amphotericin B and micafungin.. The patient survived the disease, with negative cultures and pathology at the last washout, and underwent skin grafting. He is clinically improved and remains on oral antifungals as an outpatient.. Mucormycosis should be considered in trauma patients with persistent signs of infection after lavage and antibiotics, especially when necrosis or atypical wound presentations are noted. Approaches such as ours using aggressive surgical management and intensive antifungal administration should be instituted once the diagnosis is suspected.

Topics: Abdominal Injuries; Adult; Amphotericin B; Antifungal Agents; Drug Therapy, Combination; Echinocandins; Humans; Lipopeptides; Male; Micafungin; Mucormycosis; Rhizopus; Wounds, Gunshot

We report a case of mucormycosis in a healthy 17-year-old accident victim with multiple abdominal injuries which was caused by infection with Absidia Corymbifera, a ubiquitous saphrophyte in the ground.. The patient was admitted to hospital with massive abdominal trauma. During an 8-hour emergency operation he received transfusions of compacted red blood cells, plasma, platelets and hemagel. He developed a crush syndrome with acute renal failure, resolved with extra-corporeal dialysis and had to undergo splenectomy because of spleen hematoma. As wound secretion and central venous catheter (CVC) blood cultures and drainage fluid were positive for Enterococcus Faecium, Providentia Rettgeri, Hafnia Alvei and Candida Albicans, tecoplanin, metronidazole, imipenem, and flucanozole were administered. Although the CVC was changed high fever persisted and discharge continued from the large abdominal wound. Repeated tampons in different sections and wound secretion smears were positive for A. corymbifera. Flucanozole was stopped and liposomal amphotericin (Ambisome; 5 mg/Kg i.v.) given for over 3 months. The patient improved; fever gradually disappeared. After 8 days, tampons and wound secretion smears were negative for A. corymbifera. No other fungal infections developed. Drainage fluid was later positive for tecoplanin-resistant E. faecium and Pseudomonas Aeroginosa responding only to meropenem and ciprofloxacin. Abdominal computerized tomography visualized fluid accumulation around the iliac-femoral bypass. Abcess was ruled out when scintigraphy showed no tracer uptake. The lesion was drained. Drainage fluid cultures were negative for bacteria and fungi. Fluid accumulation gradually disappeared with prolonged antibiotic and antifungal therapy. One year after the accident the patient is in good health, with normal quality of life.. Successful outcome was due to early, specific antifungal therapy, at sufficiently high dosage which was prolonged for an adequate period of time. Early diagnosis of mucormycosis is essential for efficacious anti-fungal treatment and prevention of irreversible spread of mucormycosis to vital organs. It presupposes awareness that A. corymbifera infection can develop in healthy individuals who are stressed and traumatized through skin-ground contact in accidents.

Topics: Abdominal Injuries; Absidia; Accidents, Occupational; Adolescent; Amphotericin B; Antifungal Agents; Catheterization, Central Venous; Catheters, Indwelling; Crush Syndrome; Humans; Male; Mucormycosis

Infection due to farm machinery injuries may be caused by microorganisms found in soil or decaying vegetable material. A case of injury due to entrapment of a young boy in a silage wagon is reported here. His injuries were complicated by infection with Aspergillus species, Absidia species, Rhizopus species (the latter two are members of the Mucorales order), and Pseudomonas maltophilia. Successful treatment of his infection followed aggressive surgical debridement of the anterior abdominal wall, amphotericin B, hyperbaric oxygen therapy, and surgical closure utilizing delayed placement of split-thickness skin grafts.

Topics: Abdominal Injuries; Accidents; Agricultural Workers' Diseases; Amphotericin B; Aspergillus; Child; Colostomy; Combined Modality Therapy; Debridement; Humans; Male; Mucormycosis; Rhizopus; Wound Infection