title: Upper-extremity mucormycosis infections in immunocompetent patients.
abstract: OBJECTIVE
  Mucormycosis can produce an aggressive and sometimes fatal soft tissue infection seen most commonly in immunocompromised individuals. Eradication consists of surgical resection and antifungal chemotherapy. Knowledge regarding infectious mucormycosis in the upper extremity has been limited to case reports involving mainly immunocompromised individuals. The purpose of this study was to identify risk factors for the development of mucormycosis infections within the upper extremity in immunocompetent individuals and to evaluate the effectiveness of the present therapies.
  
  
  METHODS
  A 12-year retrospective review of all fungal infections involving the upper extremity was conducted in our institution. Seven immunocompetent patients with infectious cutaneous mucormycosis of the upper extremity were identified from 223 primary upper-extremity fungal infections.
  
  
  RESULTS
  In the 7 patients 3 infections resulted from heavy soil contamination after motor vehicle collisions and 4 resulted from conveyor belt injuries in agricultural facilities. All patients had considerable upper-extremity soft tissue loss and 6 of the 7 patients had upper-extremity fractures or dislocations. Patients had an average of 10 surgical debridements. Four infections resulted in amputations: 1 partial hand amputation, 1 below the elbow, 1 above the elbow, and 1 at the glenohumeral joint.
  
  
  CONCLUSIONS
  Mucormycosis can produce limb-threatening infections in an immunocompetent host. Hand surgeons must have suspicion of such infections in patients with grossly contaminated open wounds.
authors.affiliation: Division of Plastic Surgery, Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN 55905, USA. moran.steven@mayo.edu
authors.forename: Steven L
authors.initials: SL
authors.lastname: Moran
authors.forename: Justin
authors.initials: J
authors.lastname: Strickland
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Shin
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000671:Amputation, Surgical; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D003646:Debridement; D005260:Female; D006801:Humans; D007121:Immunocompetence; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D034941:Upper Extremity / Q000293:injuries* / Q000382:microbiology* / Q000601:surgery
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B