amphotericin-b and Wounds--Penetrating

Mucormycosis is a rare but serious sequelae of penetrating trauma [1-5]. In spite of aggressive management, mortality remains high due to dissemination of infection. We completed a review of literature to determine the most optimal treatment of cutaneous mucormycosis which occurs secondary to penetrating trauma.. We completed a review regarding the management of mucormycosis in trauma patients. We selected a total of 36 reports, of which 18 were case-based, for review.. Surgical debridement is a primary predictor of improved outcomes in the treatment of mucormycosis [3,6,7]. Anti-fungal therapy, especially lipid soluble formulation of Amphotericin B, is helpful as an adjunct or when surgical debridement has been maximally achieved. Further research is needed to fully evaluate the impact of topical dressings; negative pressure wound therapy is helpful.. An aggressive and early surgical approach, even at the expense of disfigurement, is necessary to reduce mortality in the setting of cutaneous mucormycosis that results from penetrating trauma [4,8,9]. Anti-fungal therapy and negative pressure wound therapy are formidable adjuncts.

Topics: Amphotericin B; Antifungal Agents; Australia; Combined Modality Therapy; Debridement; Humans; Mucormycosis; Negative-Pressure Wound Therapy; Treatment Outcome; Wound Healing; Wounds, Penetrating

Survivors of combat trauma can have long and challenging recoveries, which may be complicated by infection. Invasive fungal infections are a rare but serious complication with limited treatment options. Currently, aggressive surgical debridement is the standard of care, with antifungal agents used adjunctively with uncertain efficacy. Anecdotal evidence suggests that antifungal agents may be ineffective in the absence of surgical debridement, and studies have yet to correlate antifungal concentrations in plasma and wounds.. Here we report the systemic pharmacokinetics and wound effluent antifungal concentrations of five wounds from two male patients, aged 28 and 30 years old who sustained combat-related blast injuries in southern Afghanistan, with proven or possible invasive fungal infection. Our data demonstrate that while voriconazole sufficiently penetrated the wound resulting in detectable effluent levels, free amphotericin B (unbound to plasma) was not present in wound effluent despite sufficient concentrations in circulating plasma. In addition, considerable between-patient and within-patient variability was observed in antifungal pharmacokinetic parameters.. These data highlight the need for further studies evaluating wound penetration of commonly used antifungals and the role for therapeutic drug monitoring in providing optimal care for critically ill and injured war fighters.

Topics: Adult; Amphotericin B; Amputation, Surgical; Antifungal Agents; Aspergillosis; Blast Injuries; Burns; Critical Illness; Debridement; Drug Monitoring; Fusariosis; Humans; Male; Mucormycosis; Mycoses; Voriconazole; War-Related Injuries; Wounds, Penetrating

Composite tissue allograft recipients require intensive immunosuppression and are therefore at risk of infections. Filamentous fungal infections are among the complications most difficult to manage in organ transplant recipients.. Case report and literature review.. Two years after bilateral forearm transplantation, a 35-year-old patient presented with a tumor-like lesion on his thigh after a penetrating injury caused by a sliver acquired during hiking. The lesion was excised completely, and microscopic examination revealed a filamentous fungal infection. Alternaria alternata was identified as the causative agent. Induction therapy with liposomal amphotericin B for one week followed by oral itraconazole maintenance therapy for eight weeks was successful, with no signs of recurrence or side effects at 18 months' follow-up.. This is the first reported case of invasive A. alternata infection in a composite tissue allograft recipient. The infection was managed successfully with local excision and systemic antifungal treatment.

Topics: Adult; Alternaria; Amphotericin B; Antifungal Agents; Arm; Drug Therapy, Combination; Forearm; Humans; Itraconazole; Male; Mycoses; Transplantation; Wound Infection; Wounds, Penetrating

Invasive zygomycosis rarely complicates trauma. We describe the first recorded case of invasive infection of the anterior abdominal wall and omentum with the zygomycete Syncephalastrum racemosum, which was successfully treated with partial surgical debridement and amphotericin B lipid complex.

Topics: Adult; Amphotericin B; Antifungal Agents; Debridement; Drug Combinations; Humans; Male; Mucorales; Mucormycosis; Phosphatidylcholines; Phosphatidylglycerols; Wounds, Penetrating