Cutaneous mucormycosis and motor vehicle accidents: Findings from an Australian case series

• Published in: Medical mycology (Oxford) Vol. 52; no. 8; pp. 819 - 825
• Main Authors: Ingram, Paul R., Suthananthan, Arul E., Rajan, Ruben, Pryce, Todd M., Sieunarine, Kishore, Gardam, Dianne J., Heath, Christopher H.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.11.2014
• Subjects: Accidents, Traffic; Adolescent; Adult; Aged; Australia - epidemiology; Dermatomycoses - diagnosis; Dermatomycoses - drug therapy; Dermatomycoses - epidemiology; Dermatomycoses - microbiology; Female; Humans; Male; Middle Aged; Mucormycosis - diagnosis; Mucormycosis - drug therapy; Mucormycosis - epidemiology; Mucormycosis - microbiology; Retrospective Studies; Young Adult; Australia; motor vehicle accident; Australia; mucormycosis
• ISSN: 0004-6264; 1460-2709
• DOI: 10.1093/mmy/myu054

Cutaneous disease is the third most frequent manifestation of mucormycosis. The clinical manifestations of and subsequent mortality due to cutaneous mucormycosis are dependent on the mode of acquisition and the host immune status. Here, we describe the epidemiology, clinical presentation, microbiology, and outcomes of 16 cutaneous mucormycosis infections managed in an Australian tertiary hospital over a 15-year period. The proportion with localized (56%), deep (38%), and disseminated (6%) cutaneous disease as well as the overall mortality (25%) were consistent with findings reported in the published literature. Two novel forms of hospital-acquired infection were reported following a sacral pressure sore and insertion of a foreign body during a bone graft procedure. The majority of patients were immunocompetent (75%) and/or suffered trauma (56%) with associated environmental contamination. A novel finding was that motor vehicle accidents (MVAs) accounted for 78% of all trauma-related cases, suggesting MVAs should receive greater recognition as a potential precipitant of cutaneous mucormycosis. Aggressive decontamination and debridement of devitalized tissue following trauma is therefore likely to play an important role in the prevention of this rare but potentially devastating infection.