Invasive Curvularia Infections in Burn Patients: A Case Series

Abstract

Background:Curvularia is a black mold that resides primarily in the soil of warm tropical environments and infects plant species. Reports of human disease and infection caused by this organism are rare, primarily occur in immunocompromised patients, and have a high incidence of mortality. To date, there has only been one case report of Curvularia infection published in burn patients. Case Presentation: We describe a case series of two early, invasive Curvularia infections in burn patients treated at the Regional Burn Center in Mobile, Alabama. Both patients were Caucasian males between 50 and 60 years of age, married, insured, with 50%–60% total body surface area (TBSA) second- and third-degree burns. Flames were reportedly extinguished using stagnant water and mud, respectively. Both patients presented from the Gulf Coast, one from Florida and the other from Mississippi, over a span of 15 months. No patients were excluded from this study or have been lost to follow-up. A review of the literature related to the treatment of this uncommon infection was also conducted. Results: After suffering Curvularia infections, both patients included in this study survived. We believe morbidity was improved by early identification of cutaneous manifestations and clinical symptoms of invasive fungal infection. Identification lead to urgent surgical debridement and use of intravenous (IV) and topical antifungal agents that aided in the complete resolution of disease resulting in limited morbidity. Both patients were discharged to rehabilitation centers before returning home. Conclusions: Aggressive wound surveillance, routine quantitative tissue cultures, and early excision and closure are imperative in the prevention of invasive, life-threatening fungal colonization. Upon suspicion of fungal infection, urgent treatment with IV antifungal agents, topical antifungal soaks, and excision is imperative. Best practices regarding prophylaxis with stagnant water and environmental exposures are unknown.