Abstract
Patients with extensive burns are an important group at risk for cutaneous mucormycosis. This study aimed to perform a systematic review of all reported mucormycosis cases in burn patients from 1990 onward. A Medline search yielded identification of 7 case series, 3 outbreaks, and 25 individual cases reports. The prevalence reached 0.04%–0.6%. The median age was 42–48 in the case series and outbreaks, except for the studies from military centers (23.5–32.5) and in individual reports (29.5). The median total body surface area reached 42.5%–65%. Various skin lesions were described, none being pathognomonic: the diagnosis was mainly reached because of extensive necrotic lesions sometimes associated with sepsis. Most patients were treated with systemic amphotericin B or liposomal amphotericin B, and all underwent debridement and/or amputation. Mortality reached 33%–100% in the case series, 29%–62% during outbreaks, and 40% in individual cases. Most patients were diagnosed using histopathology and/or culture. Mucorales qPCR showed detection of circulating DNA 2–24 days before the standard diagnosis. Species included the main clinically relevant mucorales (i.e., Mucor, Rhizopus, Absidia/Lichtheimia, Rhizomucor) but also more uncommon mucorales such as Saksenaea or Apophysomyces. Contact with soil was reported in most individual cases. Bandages were identified as the source of contamination in two nosocomial outbreaks.
Highlights
Patients with extensive burns are an important group at risk for cutaneous mucormycosis
When analyzing data from the 25 individual cases retrieved using Medline, we found a median age of 29.5 (10–63), which was lower than that in case series and outbreaks (Table 2)
Mucormycosis is a rare disease in burn patients but remains difficult to treat and is often lethal
Summary
Patients with extensive burns are an important group at risk for cutaneous mucormycosis. Clinical presentation is characterized by rapid progression to necrosis and a better prognosis than other clinical forms of mucormycosis (31% mortality). These reviews include burn patients, none is focused on them. In 2005, Roden et al identified 11 cases of cutaneous mucormycosis in burns among 176 patients (6%) before 2004 [2]. Ledgard et al reviewed all published cutaneous mucormycosis cases from 1966 to 2006 and found that burns were amongst the most commonly reported factors, representing 19 out of 145 cases (13%) [3]. In 2009, Skiada and Petrikkos analyzed seven case reports published from 2004 and 2008 [4], and, in 2012, Skiada et al, identified two supplementary cases in 2009–2010 [5]
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