Current Fungal Infection Reports

, Volume 8, Issue 4, pp 277–286

Combat-Related Invasive Fungal Wound Infections

Epidemiological Aspects of Fungal Infection (T Chiller and JA Baddley, Section Editors)

DOI: 10.1007/s12281-014-0205-y

Cite this article as:
Tribble, D.R. & Rodriguez, C.J. Curr Fungal Infect Rep (2014) 8: 277. doi:10.1007/s12281-014-0205-y

Abstract

Combat-related invasive fungal (mold) wound infections (IFIs) have emerged as an important and morbid complication following explosive blast injuries among military personnel. Similar to trauma-associated IFI cases among civilian populations, as in agricultural accidents and natural disasters, these infections occur in the setting of penetrating wounds contaminated by environmental debris. Specific risk factors for combat-related IFI include dismounted (patrolling on foot) blast injuries occurring mostly in southern Afghanistan, resulting in above knee amputations requiring resuscitation with large-volume blood transfusions. Diagnosis of IFI is based upon early identification of a recurrently necrotic wound following serial debridement and tissue-based histopathology examination with special stains to detect invasive disease. Fungal culture of affected tissue also provides supportive information. Aggressive surgical debridement of affected tissue is the primary therapy. Empiric antifungal therapy should be considered when there is a strong suspicion for IFI. Both liposomal amphotericin B and voriconazole should be considered initially for treatment since many of the cases involve not only Mucorales species but also Aspergillus or Fusarium spp., with narrowing of regimen based upon clinical mycology findings.

Keywords

Invasive fungal infections Combat-related trauma Invasive mold infections Wound infections Invasive mucormycosis 

Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  1. 1.Infectious Disease Clinical Research Program, Preventive Medicine and Biometrics DepartmentUniformed Services University of the Health SciencesBethesdaUSA
  2. 2.Walter Reed National Military Medical CenterBethesdaUSA

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