Soft-tissue fungal infections

Surgical management of 12 immunocompromised patients

Tad Heinz, John Perfect, Wylie Schell, Edmond F Ritter, Gregory Ruff, Donald Serafin

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

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 (1) locally aggressive infections, (II) indolent infections, and (III) cutaneous manifestations of systemic infection. Patients 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, Phizopus, fusarium, Paecilomuces, 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 calls 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 anti 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 infections disease consultation.

Original languageEnglish (US)
Pages (from-to)1391-1399
Number of pages9
JournalPlastic and Reconstructive Surgery
Volume97
Issue number7
DOIs
StatePublished - Jun 1 1996
Externally publishedYes

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Soft Tissue Infections
Mycoses
Immunocompromised Host
Infection
Biopsy
Exophiala
Skin Manifestations
Mortality
Fusarium
Debridement
Aspergillus
Therapeutics
Erythema
Immunosuppression
Chronic Obstructive Pulmonary Disease
Survivors
Rheumatoid Arthritis
Leukemia
Referral and Consultation
Morbidity

ASJC Scopus subject areas

  • Surgery

Cite this

Soft-tissue fungal infections : Surgical management of 12 immunocompromised patients. / Heinz, Tad; Perfect, John; Schell, Wylie; Ritter, Edmond F; Ruff, Gregory; Serafin, Donald.

In: Plastic and Reconstructive Surgery, Vol. 97, No. 7, 01.06.1996, p. 1391-1399.

Research output: Contribution to journalArticle

Heinz, Tad ; Perfect, John ; Schell, Wylie ; Ritter, Edmond F ; Ruff, Gregory ; Serafin, Donald. / Soft-tissue fungal infections : Surgical management of 12 immunocompromised patients. In: Plastic and Reconstructive Surgery. 1996 ; Vol. 97, No. 7. pp. 1391-1399.
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