Soft-tissue fungal infections: surgical management of 12 immunocompromised patients.

Published

Journal Article

Isolated fungal soft-tissue infections are uncommon but may cause severe morbidity or mortality among transplant recipients and other immunosuppressed patients. Twelve immunocompromised patients illustrating three patterns of infection were treated recently at the Duke University Medical Center. These groups comprised (I) locally aggressive infections, (II) indolent infections, and (III) cutaneous manifestations of systemic infection. Patient diagnoses included organ transplant, leukemia, prematurity, chronic obstructive pulmonary disease, and rheumatoid arthritis. Time from immunosuppression to biopsy ranged from 5.5 to 31 weeks. Organisms included Aspergillus, Rhizopus, Fusarium, Paecilomyces, Exophiala, and Curvularia. Patients presented with necrotic ulcerations or nodules. Surgical treatment ranged from radical debridement to excisional biopsy to none. Antifungal chemotherapy also was employed in some cases. The mortality rate was 33 percent, two patients dying without evidence of fungal infection. Six of the eight survivors cleared their infections. Necrotic skin lesions with surrounding erythema in this population call for prompt examination, biopsy, and culture. Group I lesions mandate radical excision with rapid intraoperative microscopic control and systemic antifungal medication. Group II requires surgical control with or without antifungal therapy. Group III requires systemic antifungal therapy for metastatic infection. In our opinion, treatment of fungal soft-tissue infection should be tailored to infection type and requires a team approach of surgeon and expert infectious disease consultation.

Full Text

Duke Authors

Cited Authors

  • Heinz, T; Perfect, J; Schell, W; Ritter, E; Ruff, G; Serafin, D

Published Date

  • June 1996

Published In

Volume / Issue

  • 97 / 7

Start / End Page

  • 1391 - 1399

PubMed ID

  • 8643722

Pubmed Central ID

  • 8643722

Electronic International Standard Serial Number (EISSN)

  • 1529-4242

International Standard Serial Number (ISSN)

  • 0032-1052

Digital Object Identifier (DOI)

  • 10.1097/00006534-199606000-00011

Language

  • eng