1378. Fungal infections in burn patients during Northern California wildfires

Abstract

Abstract Background Wildfires are an increasing human health concern. In 2020 there were nearly 10,000 fires in California including 5 of the 6 largest wildfires recorded in the state, burning 4.1million acres. In addition to the known risks of direct burn and inhalation injury, extreme heat exposure, and psychological stress, there are unrecognized infection risks associated with smoke exposure. Fungal elements travel great distances in the air, and smoke significantly alters the number and diversity of fungal particles in affected geographical regions. Aims: To analyze the incidence and contributing factors for mould infections in hospitalized burn patients in the fall of 2020, during the peak of wildfire season. Methods We reviewed the electronic medical records for all patients admitted with burns in the fall of 2020 and recorded demographics, treatment, and outcomes. Data was stored in a secure electronic database. Results Of the 10 patients admitted with wildfire related burns, 4 developed mould infections. Two additional cases were diagnosed in patients burned in a plane crash and one in a house fire. Five of the 7 patients (71%) were men; patients had a mean age of 37.7 years (range 24-56 years); mechanism in 4 of the 7 was direct wildfire exposure (57.1%); mean total body surface area (TBSA) burned was 69% (range 44-90%). Mould infection was identified on or after hospital day 14 in all patients. A total of 5 mould genera were isolated, with Aspergillus mould genus isolated from 6 patients (85.7%). All 7 patients (100%) were treated with at least 2 days of antibacterials before identification of mould infection; 4 (57.1%) of the patients died before leaving the hospital. Following this period, mould cases decreased to baseline low levels of < 10% for all burn sizes. Conclusion Wildfires in the western United States have had a devastating effect on the ecosystem and human health. We suspect that wildfires may increase the risk of invasive mold infections in burn patients with ambient wildfire smoke exposure. We observed a disproportionate number of invasive mould infections in hospitalized burn patients during large wildfires, which may have a significant impact on the seasonal treatment of burn patients. The relationship between wildfires and fungal infection warrants future investigation. Disclosures All Authors: No reported disclosures.