Posttraumatic Mucormycosis

Data on clinical, mycologic characteristics, and outcome of posttraumatic mucormycosis are scarce and often limited to case reports. From the French nationwide ‘‘RetroZygo’’ study, we compared posttraumatic mucormycosis cases with other forms of mucormycosis. We also reviewed reports of posttraumatic mucormycosis in the English-language literature from 1993 to 2013. We included all proven or probable cases for which underlying condition, route of infection, surgical and antifungal treatments, and outcome were detailed. From our cohort, posttraumatic mucormycosis (n 1⁄4 16) differed significantly from other forms (n1⁄4 85) by rarity of underlying disease (31.2% vs 81%, p< 0.0001), frequency of cutaneous localization (87% vs 7%, p< 0.0001), short time before diagnosis (4.5 vs 21 d, p1⁄4 0.0002), species involved (Apophysomyces elegans complex and Saksenaea vasiformis), surgical requirement (93.7% vs 47%, p1⁄4 0.0006) and better survival (87.5% vs 47.6% at day 90, p1⁄4 0.03). We studied 122 cases of posttraumatic mucormycosis through our literature review. Most frequently reported traumas were traffic (37%), domestic accidents (15.1%), or natural disasters (13.4%). Mucormycosis occurred after extensive soft-tissue damage in 47.5% cases, with symptoms occurring a median of 9.5 days after trauma with necrosis being reported in 76.2% cases. Dissemination was found in 9% of patients, and bacterial coinercent of cases occurred in the Middle East or myces elegans complex was the predominant reness of mucormycosis as a cause of r-Enfants malades, Department of Infectious M, OL, FL), Assistance Publique Hôpitaux de ie Necker-Pasteur, University Paris Descartes, DGH, OL), Paris; Institut Pasteur, Unité de DGH, OL), Centre National de Référence ntifongiques, Paris; Hôpital Necker-Enfants iostatistic (HA), Assistance Publique Hôpitaux Descartes, Paris; Hôpital Européen Georges Plastic and Reconstructive Surgery (MH, L. blique-Hôpitaux de Paris, University Paris aison Blanche, Mycology-Parasitology Laboraer Universitaire de Reims; Unité MEDyC, FRE rsité de Reims Champagne Ardenne; Centre Amiens, Université de Picardie Jules Verne, mycologie médicales (TC), Amiens, France. anternier, MD, PhD, Centre d’Infectiologie l Necker-Enfants malades, IHU Imagine, 149, aris Cedex 15, France (e-mail: fanny.lanternier