RESUMO
We describe 6 cases of severe filamentous fungal infections after widespread tissue damage due to traumatic injury in previously healthy people. Additionally, we report 69 cases from an exhaustive 20-y review of the literature to investigate the epidemiological and clinical features, the prognosis and the therapeutic management of these post-traumatic severe filamentous fungal infections. Traffic (41%) and farm accidents (25%) were the main causes of injury, which involved either the limbs only (41%) or multiple sites (41%). Necrosis was the main symptom (60%) and Mucorales (72%) and Aspergillus (11%) were the 2 most frequent fungi causing infection. These infections required substantial surgical debridement or amputation (96%) associated with aggressive antifungal therapy (81%), depending on the responsible fungi. This study underlines the need for early, repeated and systematic mycological wound samples to guide and adapt surgical and antifungal management in these filamentous fungal infections.
Assuntos
Fungos/isolamento & purificação , Micoses/etiologia , Ferimentos e Lesões/microbiologia , Acidentes de Trânsito , Adolescente , Adulto , Aspergillus fumigatus/isolamento & purificação , Criança , Pré-Escolar , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mucor/isolamento & purificação , Micoses/epidemiologia , Micoses/microbiologia , Necrose , Prognóstico , Solo , Ferimentos e Lesões/epidemiologiaAssuntos
Varicela , Herpes Simples , Herpes Zoster , Complicações Infecciosas na Gravidez , Acetaminofen/uso terapêutico , Aciclovir/administração & dosagem , Aciclovir/análogos & derivados , Aciclovir/uso terapêutico , Administração Oral , Adulto , Idoso , Analgésicos não Narcóticos/uso terapêutico , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Varicela/diagnóstico , Varicela/epidemiologia , Varicela/transmissão , Pré-Escolar , Feminino , Herpes Simples/tratamento farmacológico , Herpes Simples/epidemiologia , Herpes Simples/transmissão , Herpes Zoster/diagnóstico , Herpes Zoster/terapia , Herpes Zoster Oftálmico/diagnóstico , Humanos , Imunocompetência , Recém-Nascido , Gravidez , Prognóstico , Recidiva , Estudos Soroepidemiológicos , Valaciclovir , Valina/administração & dosagem , Valina/análogos & derivados , Valina/uso terapêuticoRESUMO
OBJECTIVES: This study aims at describing the evolution of the epidemiology of invasive aspergillosis (IA) in a French University Hospital focussing on nosocomial cases, in order to assess the efficiency of the environmental preventive measures which were implemented. METHODS: From 2003 to 2009, IA cases were reviewed monthly and classified according to the EORTC/MSG criteria and the origin of contamination. RESULTS: Five proven and 65 probable IA cases were diagnosed. Most of the cases (74.3%) occurred in patients with haematological malignancies. Incidences of IA and nosocomial IA (NIA) were 0.106 and 0.032 cases per 1000 admissions, respectively. All the 21 NIA cases occurred in the absence of air treatment (laminar air flow facilities or Plasmair decontamination units) and/or during construction works. The 3-month and 1-year overall survival rates were 50.6% [38.2-61.7] and 31.1% [20-42.9] respectively, and did not differ according to the origin of contamination. CONCLUSION: Nosocomial IA still accounted for a third of all IA cases diagnosed from 2003 to 2009 and mainly occurred in the absence of environmental protective measures, which were confirmed to be effective when applied. Our results show that extension and/or reinforcement of these measures is needed, especially in the haematology unit and during construction works.