Carter J Elliot, Ulusarac Ozlem
Department of Pathology, University of South Alabama Medical Center, 2451 Fillingim St, Mobile, AL 36617, USA.
Cutis. 2003 Sep;72(3):221-4, 227-8.
Invasive infections in humans with organisms from the fungal subclass Zygomycetes are most commonly seen in immunocompromised and diabetic patients. Rarely, such fungal infections may be seen in immunocompetent, nondiabetic individuals. In these cases, cutaneous trauma with direct implantation of fungal organisms into the wound from soil contamination is the frequent scenario. We present the case of a 31-year-old gravid woman involved in a single-vehicle automobile accident who presented to our institution with severe head trauma. On admission, a small ecchymotic area on her right forearm was noted. The lesion eventually expanded and ulcerated. Culture and histologic examination of tissue from the site revealed fungal organisms consistent with Zygomycetes. Subsequent studies confirmed the fungal organism as Apophysomyces elegans. Antifungal therapy was initiated, and multiple debridements were performed. Amputation of the right arm above the elbow was eventually necessary, but aggressive surgical intervention and antifungal therapy were unsuccessful in preventing the spread of the infection. The patient died 2 weeks after admission from polymicrobial sepsis. This case illustrates the dangerously invasive nature of A elegans, even in immunocompetent individuals.
人类感染来自真菌接合菌亚纲的病原体所引发的侵袭性感染，最常见于免疫功能低下和糖尿病患者。在免疫功能正常的非糖尿病个体中，此类真菌感染较为罕见。在这些病例中，因土壤污染导致真菌病原体直接植入伤口的皮肤创伤是常见情况。我们报告一例31岁的孕妇，她遭遇单车车祸，因严重头部创伤被送至我院。入院时，发现其右前臂有一小片瘀斑区域。该病变最终扩大并溃疡。对该部位组织进行培养和组织学检查，发现了与接合菌相符的真菌病原体。后续研究证实该真菌病原体为雅致鳞质霉。开始进行抗真菌治疗，并多次进行清创术。最终不得不将右臂在肘部以上截肢，但积极的手术干预和抗真菌治疗未能阻止感染扩散。患者在入院2周后死于多重微生物败血症。该病例表明，即使在免疫功能正常的个体中，雅致鳞质霉也具有危险的侵袭性。
