Combat Trauma–Related Invasive Fungal Wound Infections

Abstract

Purpose of Review

This review highlights research from the past 5 years on combat trauma-related invasive fungal wound infections (IFIs) with a focus on risk stratification to aid patient management, microbiology, and diagnostics.

Recent Findings

A revised classification scheme stratifies wounds into three risk groups: IFI, high suspicion of IFI, and low suspicion of IFI. This stratification is based on persistence of wound necrosis and laboratory fungal evidence, presence of signs/symptoms of deep soft-tissue infections, and the need for antifungals. Use of this classification could allow for prioritization of antifungal therapy. Further, IFIs delay wound healing, particularly when caused by fungi of the order Mucorales. Lastly, molecular sequencing offers promising and complimentary results to the gold standard histopathology.

Summary

Optimal management of combat-related IFIs depends on early tissue-based diagnosis with aggressive surgical debridement and concomitant dual antifungal therapy. Further research on clinical decision support tools and rapid diagnostics is needed.

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Acknowledgments

We are indebted to the Infectious Disease Clinical Research Program Trauma Infectious Disease Outcomes Study (TIDOS) study team of clinical coordinators, microbiology technicians, data managers, clinical site managers, and administrative support personnel for their tireless hours to ensure the success of this project.

Funding

Support for this work (IDCRP-024) was provided by the Infectious Disease Clinical Research Program (IDCRP), a Department of Defense program executed through the Uniformed Services University of the Health Sciences, Department of Preventive Medicine and Biostatistics. This project has been funded by the National Institute of Allergy and Infectious Diseases, National Institute of Health, under Inter-Agency Agreement Y1-AI-5072, the Defense Health Program, U.S. DoD, under award HU0001190002, the Department of the Navy under the Wounded, Ill, and Injured Program, the Defense Medical Research and Development Program, and Military Infectious Diseases Research Program.

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Correspondence to David R. Tribble.

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Conflict of Interest

David Tribble reports grants from NIAID, grants from Navy Bureau of Medicine - Wounded Ill and Injured Program, grants from Defense Medical Research and Development Program, grants from Military Infectious Diseases Research Program, and grants from Defense Health Program during the conduct of the study. Anuradha Ganesan reports grants from NIAID, grants from Navy Bureau of Medicine - Wounded Ill and Injured Program, grants from Defense Medical Research and Development Program, grants from Military Infectious Diseases Research Program, and grants from Defense Health Program during the conduct of the study. Carlos Rodriguez declares no conflicts of interest relevant to this manuscript.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Tribble, D.R., Ganesan, A. & Rodriguez, C.J. Combat Trauma–Related Invasive Fungal Wound Infections. Curr Fungal Infect Rep 14, 186–196 (2020). https://doi.org/10.1007/s12281-020-00385-4

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Keywords

  • Mucormycosis
  • Combat-related
  • Trauma-related
  • Invasive fungal infections
  • Wound infections