title: The use of dilute Dakin's solution for the treatment of angioinvasive fungal infection in the combat wounded: a case series.
abstract: Disseminated fungal infections are normally opportunistic infections in the immunocompromised population. Current literature has documented a high mortality rate with these infections in civilian trauma or as complications of severe burns. There is only one published case of fungal infection in a combat-injured individual to date, which resulted in mortality despite aggressive debridement and appropriate antifungal agents. We present here three patients in whom aggressive debridement, antifungals, and the addition of dilute Dakin's solution with negative pressure wound therapy was used to treat angioinvasive mold. Angioinvasive fungal infection continue to be one of the most aggressive and devastating infections that our combat-injured patients face. With the addition of dilute Dakin's solution, we successfully managed three critically ill patients. Previous literature had shown close to 30% mortality associated with cutaneous mucormycosis and the mortality rate approaches 100% with disseminated angioinvasive fungal infections. These results provide hope not only for the combat-injured patients being treated for both local and disseminated angioinvasive fungal infections, but also for the civilian trauma and immunocompromised patients.
authors.affiliation: Integrated Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
authors.forename: Louis
authors.initials: L
authors.lastname: Lewandowski
authors.forename: Richard
authors.initials: R
authors.lastname: Purcell
authors.forename: Mark
authors.initials: M
authors.lastname: Fleming
authors.forename: Wade T
authors.initials: WT
authors.lastname: Gordon
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000627:therapeutic use*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy*; D014946:Wound Infection / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; D000935:Antifungal Agents