title: Cutaneous mucormycosis and motor vehicle accidents: Findings from an Australian case series.
abstract: Cutaneous disease is the third most frequent manifestation of mucormycosis. The clinical manifestations of and subsequent mortality due to cutaneous mucormycosis are dependent on the mode of acquisition and the host immune status. Here, we describe the epidemiology, clinical presentation, microbiology, and outcomes of 16 cutaneous mucormycosis infections managed in an Australian tertiary hospital over a 15-year period. The proportion with localized (56%), deep (38%), and disseminated (6%) cutaneous disease as well as the overall mortality (25%) were consistent with findings reported in the published literature. Two novel forms of hospital-acquired infection were reported following a sacral pressure sore and insertion of a foreign body during a bone graft procedure. The majority of patients were immunocompetent (75%) and/or suffered trauma (56%) with associated environmental contamination. A novel finding was that motor vehicle accidents (MVAs) accounted for 78% of all trauma-related cases, suggesting MVAs should receive greater recognition as a potential precipitant of cutaneous mucormycosis. Aggressive decontamination and debridement of devitalized tissue following trauma is therefore likely to play an important role in the prevention of this rare but potentially devastating infection.
authors.affiliation: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Australia School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia paul.ingram@health.wa.gov.au.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Ingram
authors.affiliation: Department of General Surgery, Royal Perth Hospital, Perth, Australia.
authors.forename: Arul E
authors.initials: AE
authors.lastname: Suthananthan
authors.affiliation: Department of General Surgery, Royal Perth Hospital, Perth, Australia.
authors.forename: Ruben
authors.initials: R
authors.lastname: Rajan
authors.affiliation: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Australia.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Pryce
authors.affiliation: Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia.
authors.forename: Kishore
authors.initials: K
authors.lastname: Sieunarine
authors.affiliation: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Australia.
authors.forename: Dianne J
authors.initials: DJ
authors.lastname: Gardam
authors.affiliation: Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, Australia School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Heath
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D003881:Dermatomycoses / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Australia; motor vehicle accident; mucormycosis