title: Posttraumatic mucormycosis: a nationwide study in France and review of the literature.
abstract: Data on clinical, mycologic characteristics, and outcome of posttraumatic mucormycosis are scarce and often limited to case reports. From the French nationwide "RetroZygo" study, we compared posttraumatic mucormycosis cases with other forms of mucormycosis. We also reviewed reports of posttraumatic mucormycosis in the English-language literature from 1993 to 2013. We included all proven or probable cases for which underlying condition, route of infection, surgical and antifungal treatments, and outcome were detailed. From our cohort, posttraumatic mucormycosis (n = 16) differed significantly from other forms (n = 85) by rarity of underlying disease (31.2% vs 81%, p < 0.0001), frequency of cutaneous localization (87% vs 7%, p < 0.0001), short time before diagnosis (4.5 vs 21 d, p = 0.0002), species involved (Apophysomyces elegans complex and Saksenaea vasiformis), surgical requirement (93.7% vs 47%, p = 0.0006) and better survival (87.5% vs 47.6% at day 90, p = 0.03). We studied 122 cases of posttraumatic mucormycosis through our literature review. Most frequently reported traumas were traffic (37%), domestic accidents (15.1%), or natural disasters (13.4%). Mucormycosis occurred after extensive soft-tissue damage in 47.5% cases, with symptoms occurring a median of 9.5 days after trauma with necrosis being reported in 76.2% cases. Dissemination was found in 9% of patients, and bacterial coinfection in 41%. Nineteen percent of cases occurred in the Middle East or in India where Apophysomyces elegans complex was the predominant species recovered. Awareness of mucormycosis as a cause of posttrauma soft-tissue infection is warranted, especially in cases of soil-contaminated wounds. Survival is higher than in other forms of mucormycosis, but morbidity remains high.
authors.affiliation: From the Hôpital Necker-Enfants malades, Department of Infectious Diseases (L. Lelièvre, ACM, OL, FL), Assistance Publique Hôpitaux de Paris, Centre d'Infectiologie Necker-Pasteur, University Paris Descartes, Paris; CNRS URA3012 (DGH, OL), Paris; Institut Pasteur, Unité de Mycologie Moléculaire (DGH, OL), Centre National de Référence Mycoses Invasives et Antifongiques, Paris; Hôpital Necker-Enfants malades, Department of Biostatistic (HA), Assistance Publique Hôpitaux de Paris, University Paris Descartes, Paris; Hôpital Européen Georges Pompidou, Department of Plastic and Reconstructive Surgery (MH, L. Lantieri), Assistance Publique-Hôpitaux de Paris, University Paris Descartes, Paris; Hôpital Maison Blanche, Mycology-Parasitology Laboratory (DT), Centre Hospitalier Universitaire de Reims; Unité MEDyC, FRE CNRS 3481 (DT), Université de Reims Champagne Ardenne; Centre Hospitalo-Universitaire d'Amiens, Université de Picardie Jules Verne, Service de parasitologie et mycologie médicales (TC), Amiens, France. Members are listed in the Appendix.
authors.forename: Lucie
authors.initials: L
authors.lastname: Lelievre
authors.forename: Dea
authors.initials: D
authors.lastname: Garcia-Hermoso
authors.forename: Hendy
authors.initials: H
authors.lastname: Abdoul
authors.forename: Mickael
authors.initials: M
authors.lastname: Hivelin
authors.forename: Taieb
authors.initials: T
authors.lastname: Chouaki
authors.forename: Dominique
authors.initials: D
authors.lastname: Toubas
authors.forename: Anne-Claire
authors.initials: AC
authors.lastname: Mamez
authors.forename: Laurent
authors.initials: L
authors.lastname: Lantieri
authors.forename: Olivier
authors.initials: O
authors.lastname: Lortholary
authors.forename: Fanny
authors.initials: F
authors.lastname: Lanternier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009090:Mucorales; D009091:Mucormycosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D014947:Wounds and Injuries / Q000150:complications* / Q000382:microbiology; D055815:Young Adult