G Vithiya, T Rajendran, A Ramesh, A Sathesini Priya
Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, India.
J Orthop. 2023 Jun 21;42:13-16. doi: 10.1016/j.jor.2023.06.008. eCollection 2023 Aug.
Apophysomyces species are emerging as the second most common agent of mucormycosis in India. It is worrisome as it affects predominantly immunocompetent host unlike other Mucorales. Unfortunately, the most common presentation is necrotising fasciitis which can be overlooked as bacterial infection.
Seven cases of mucormycosis due to Apophysomyces species were detected in our hospital between January 2019 and September 2022. Mean age was 55 years and all were males. Six patients presented with necrotising soft tissue infection following accidental or iatrogenic trauma. In four cases, multiple fractures over the body were observed. Median days between admission to laboratory diagnosis was 9 days. All isolates were phenotypically identified as . Multiple wound debridements, on an average two, was performed in all the cases and amputation performed in two patients. Three patients recovered, two could not be treated due to financial constraints and lost to followup and two patients died.
Through this series, we anticipate to upheave awareness among the orthopedician community about this emerging infection and contemplate it in appropriate case settings. All patients with necrotising soft tissue infection following trauma and significant degree of wound contamination with soil should be suspected for traumatic mucormycosis at the time of wound assessment.
在印度，阿波菲霉属正成为毛霉病的第二大常见病原体。令人担忧的是，与其他毛霉目真菌不同，它主要感染免疫功能正常的宿主。不幸的是，最常见的表现是坏死性筋膜炎，可能会被误诊为细菌感染而被忽视。
2019年1月至2022年9月期间，我院共检测到7例由阿波菲霉属引起的毛霉病。平均年龄为55岁，均为男性。6例患者在意外或医源性创伤后出现坏死性软组织感染。4例患者全身多处骨折。从入院到实验室诊断的中位天数为9天。所有分离株均通过表型鉴定为 。所有病例均平均进行了两次多次伤口清创术，两名患者接受了截肢手术。3例患者康复，2例因经济困难无法治疗而失访，2例患者死亡。
通过本系列研究，我们期望提高骨科医生群体对这种新出现感染的认识，并在适当的病例中加以考虑。所有创伤后出现坏死性软组织感染且伤口被土壤严重污染的患者，在伤口评估时均应怀疑有创伤性毛霉病。
