Tribble David R, Rodriguez Carlos J
Infectious Disease Clinical Research Program, Preventive Medicine and Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-5119, USA.
Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
Curr Fungal Infect Rep. 2014 Dec 1;8(4):277-286. doi: 10.1007/s12281-014-0205-y.
Combat-related invasive fungal (mold) wound infections (IFIs) have emerged as an important and morbid complication following explosive blast injuries among military personnel. Similar to trauma-associated IFI cases among civilian populations, as in agricultural accidents and natural disasters, these infections occur in the setting of penetrating wounds contaminated by environmental debris. Specific risk factors for combat-related IFI include dismounted (patrolling on foot) blast injuries occurring mostly in southern Afghanistan, resulting in above knee amputations requiring resuscitation with large-volume blood transfusions. Diagnosis of IFI is based upon early identification of a recurrently necrotic wound following serial debridement and tissue-based histopathology examination with special stains to detect invasive disease. Fungal culture of affected tissue also provides supportive information. Aggressive surgical debridement of affected tissue is the primary therapy. Empiric antifungal therapy should be considered when there is a strong suspicion for IFI. Both liposomal amphotericin B and voriconazole should be considered initially for treatment since many of the cases involve not only Mucorales species but also or spp., with narrowing of regimen based upon clinical mycology findings.
与战斗相关的侵袭性真菌（霉菌）伤口感染（IFI）已成为军事人员爆炸伤后一种重要且致命的并发症。与平民群体中与创伤相关的IFI病例类似，如在农业事故和自然灾害中，这些感染发生在被环境碎片污染的穿透性伤口情况下。与战斗相关的IFI的特定风险因素包括主要发生在阿富汗南部的下车（徒步巡逻）爆炸伤，导致需要大量输血复苏的膝上截肢。IFI的诊断基于在连续清创后早期识别反复坏死的伤口以及基于组织的组织病理学检查，并使用特殊染色来检测侵袭性疾病。受影响组织的真菌培养也提供支持性信息。对受影响组织进行积极的手术清创是主要治疗方法。当高度怀疑IFI时应考虑经验性抗真菌治疗。最初应考虑使用脂质体两性霉素B和伏立康唑进行治疗，因为许多病例不仅涉及毛霉目菌种，还涉及其他菌种，治疗方案会根据临床真菌学结果进行调整。
