Abstract
Invasive fungal wound infection (FWI) after burn injury, while uncommon, is associated with significant morbidity and mortality. There are numerous risk factors for FWI, including large burn size and incomplete excision of burn wounds. FWI can be challenging to diagnose. Close attention to changes in the physical examination and, in particular, to the appearance of burn wounds leads the burn team to be suspicious of FWI. Once FWI is suspected, histopathological evaluation of an incisional biopsy provides definitive diagnosis, while tissue culture enables identification of the causative organism to the species level and facilitates targeted antifungal therapy. Management of FWI focuses largely on aggressive surgical intervention, in addition to adjunctive systemic and topical antifungals and nonpharmacologic therapies. Treatment of FWI involves a multifaceted approach, which requires expertise from the entire multidisciplinary burn team.
Highlights
Invasive fungal wound infection (FWI) after burn injury, while uncommon, is associated with significant morbidity and mortality
Clinicians must remain vigilant for the occurrence of opportunistic fungal infection in burn wounds that may originate from any etiology: blast, thermal, chemical, electrical, or friction mechanisms
Amphotericin B has activity against Mucorales and Fusarium, which, as previously mentioned, are common organisms seen in FWI after burn injury
Summary
Invasive fungal wound infection (FWI) after burn injury, while uncommon, is associated with significant morbidity and mortality. Clinicians must remain vigilant for the occurrence of opportunistic fungal infection in burn wounds that may originate from any etiology: blast, thermal, chemical, electrical, or friction mechanisms. Contamination by fungi at the point of injury likely led to an increased incidence of FWI in blast-injured casualties from recent combat operations in Iraq and Afghanistan [7]. FWIs in burn patients are a continued threat, in large part because of increased survival secondary to burnshock resuscitation, topical antibacterial therapy, and improvements in general critical care. Patients with larger burn sizes are surviving past the resuscitation period and are hospitalized for longer periods of time. Sarabahi et al found that FWIs in their unit often emerged late in a burn patient’s clinical course and that non-albicans species were common [9]
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