title: Primary Gangrenous Cutaneous Mold Infections in a Patient With Cancer and Neutropenia.
abstract: BACKGROUND
  Opportunistic fungal infections caused by Aspergillus and Candida followed by infections with Fusarium, Rhizopus, Mucor, and Alternaria species are an important cause of morbidity and mortality in patients with hematological malignancies. Cutaneous mucormycosis infections are rare, and the incidence, outcomes, and factors associated with survival in the setting of hematological malignancies are not clear.
  
  
  METHODS
  A literature search was conducted for all cases of primary cutaneous mold infections in patients with hematological malignancy, of which 50 cases were found. Our case of a patient with a hematological malignancy who sustained a cat bite that in turn caused a primary cutaneous mold infection is also included.
  
  
  RESULTS
  In the 51 cases identified, 66.7% were neutropenic upon presentation, and 54.9% were male with an average age of 32 years. Aspergillus species (33.3%) was the most cited followed by Rhizopus species (19.6%). Overall mortality rate was 29.4% and was observed more frequently in patients with neutropenia (60.0%) and without surgical intervention (73.3%). Survival rate was higher (35.3%) for cases utilizing both antifungal and surgical intervention. The antifungal agent with the highest survival rate was amphotericin B and its formulations (58.8%).
  
  
  CONCLUSIONS
  Neutropenia within hematological malignancies demonstrate a risk for developing severe cutaneous fungal infections, of which primary cutaneous mucormycosis can carry significant mortality. Combination antifungal therapy and surgical debridement appears to be associated with higher survival outcomes and warrants further investigation.
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, Moffitt Cancer Center, Tampa, FL 33612, USA. John.Greene@Moffitt.org.
authors.forename: Abraham
authors.initials: A
authors.lastname: Yacoub
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Soni
authors.forename: Lysenia
authors.initials: L
authors.lastname: Mojica
authors.forename: Jane
authors.initials: J
authors.lastname: Mai
authors.forename: Jamie
authors.initials: J
authors.lastname: Morano
authors.forename: C Wayne
authors.initials: CW
authors.lastname: Cruse
authors.forename: Ramon L
authors.initials: RL
authors.lastname: Sandin
authors.forename: Sowmya
authors.initials: S
authors.lastname: Nanjappa
authors.forename: Chandrashekar
authors.initials: C
authors.lastname: Bohra
authors.forename: Ganesh
authors.initials: G
authors.lastname: Gajanan
authors.forename: John N
authors.initials: JN
authors.lastname: Greene
mesh_terms: D000368:Aged; D005260:Female; D005658:Fungi / Q000472:pathogenicity*; D005734:Gangrene / Q000209:etiology*; D006801:Humans; D009369:Neoplasms / Q000150:complications*; D009503:Neutropenia / Q000209:etiology*; D015996:Survival Rate