Gonte Madeleine R, Ranganathan Kavitha L, Helliwell Lydia A
Harvard T.H. Chan School of Public Health, Boston, Mass.
Brigham and Women's Hospital, Boston, Mass.
Plast Reconstr Surg Glob Open. 2022 Nov 16;10(11):e4568. doi: 10.1097/GOX.0000000000004568. eCollection 2022 Nov.
The majority of invasive fungal infections arise in immunocompromised patients; however, there exist many clinical interventions and physiologic phenomena in the setting of traumatic injury that induce immunosuppressant states. Enhanced clinical suspicion and early detection of invasive fungal infections has played an increasingly pertinent role in clinical management of patients admitted for traumatic injury, given its substantial morbidity and mortality rates. In this case report, we discuss a case of trauma-related invasive fungal infection by a rare pathogen in a previously immunocompetent patient. We present this case in hopes of instilling a high index of clinical suspicion for trauma-related invasive fungal infections. We also discuss the role of negative pressure wound therapy and aggressive surgical management, including debridement and various levels of amputation to optimize patient outcomes. Clinical management of trauma-related IFI has adopted increasingly aggressive approaches with respect to its formidable morbidity and mortality rates. Multidisciplinary discussions and patient-centered care are essential when making surgical decisions that impact quality of life such as amputation level.
大多数侵袭性真菌感染发生在免疫功能低下的患者中;然而,在创伤性损伤的情况下,存在许多诱导免疫抑制状态的临床干预措施和生理现象。鉴于侵袭性真菌感染的高发病率和死亡率,提高临床怀疑度并早期发现此类感染在创伤性损伤患者的临床管理中发挥着越来越重要的作用。在本病例报告中,我们讨论了一例既往免疫功能正常的患者因罕见病原体引起的创伤相关侵袭性真菌感染病例。我们呈现此病例是希望能提高对创伤相关侵袭性真菌感染的临床怀疑度。我们还讨论了负压伤口治疗和积极手术管理的作用,包括清创和不同程度的截肢,以优化患者预后。鉴于创伤相关侵袭性真菌感染的高发病率和死亡率,其临床管理已采取越来越积极的方法。在做出影响生活质量的手术决策(如截肢水平)时,多学科讨论和以患者为中心的护理至关重要。