David R Tribble1, Anuradha Ganesan1,2,3, Carlos J Rodriguez4. 1. Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814. 2. Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda MD 20817. 3. Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889. 4. John Peter Smith Hospital, 1500 S Main Street, Fort Worth, TX 76104.
Abstract
PURPOSE OF REVIEW: This review highlights research from the past five years on combat trauma-related invasive fungal wound infections (IFIs) with a focus on risk stratification to aid patient management, microbiology, and diagnostics. RECENT FINDINGS: A revised classification scheme stratifies wounds into three risk groups: IFI, High Suspicion of IFI, and Low Suspicion of IFI. This stratification is based on persistence of wound necrosis and laboratory fungal evidence, presence of signs/symptoms of deep soft-tissue infections, and the need for antifungals. Use of this classification could allow for prioritization of antifungal therapy. Further, IFIs delay wound healing, particularly when caused by fungi of the order Mucorales. Lastly, molecular sequencing offers promising and complimentary results to the gold standard histopathology. SUMMARY: Optimal management of combat-related IFIs depends on early tissue-based diagnosis with aggressive surgical debridement and concomitant dual antifungal therapy. Further research on clinical decision support tools and rapid diagnostics are needed.
PURPOSE OF REVIEW: This review highlights research from the past five years on combat trauma-related invasive fungal wound infections (IFIs) with a focus on risk stratification to aid patient management, microbiology, and diagnostics. RECENT FINDINGS: A revised classification scheme stratifies wounds into three risk groups: IFI, High Suspicion of IFI, and Low Suspicion of IFI. This stratification is based on persistence of wound necrosis and laboratory fungal evidence, presence of signs/symptoms of deep soft-tissue infections, and the need for antifungals. Use of this classification could allow for prioritization of antifungal therapy. Further, IFIs delay wound healing, particularly when caused by fungi of the order Mucorales. Lastly, molecular sequencing offers promising and complimentary results to the gold standard histopathology. SUMMARY: Optimal management of combat-related IFIs depends on early tissue-based diagnosis with aggressive surgical debridement and concomitant dual antifungal therapy. Further research on clinical decision support tools and rapid diagnostics are needed.
Authors: Aaron R Farmer; Clinton K Murray; Ian R Driscoll; Brian L Wickes; Nathan Wiederhold; Deanna A Sutton; Carmita Sanders; Katrin Mende; Brent Enniss; James Feig; Anuradha Ganesan; Elizabeth A Rini; Todd J Vento Journal: J Clin Microbiol Date: 2015-04-01 Impact factor: 5.948
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Authors: Carlos J Rodriguez; Amy C Weintrob; Jinesh Shah; Debra Malone; James R Dunne; Allison B Weisbrod; Bradley A Lloyd; Tyler E Warkentien; Clinton K Murray; Kenneth Wilkins; Faraz Shaikh; M Leigh Carson; Deepak Aggarwal; David R Tribble Journal: Surg Infect (Larchmt) Date: 2014-05-12 Impact factor: 2.150
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