Traumatic mucormycosis caused by Apophysomyces species - A case series

• Published in: Journal of orthopaedics 2023-08, Vol.42, p.13-16
• Main Authors: Vithiya, G., Rajendran, T., Ramesh, A., Sathesini Priya, A.
• Format: Article
• Language: English
• Subjects: Apophysomyces; Case report; Necrotising fasciitis; Trauma
• ISSN: 0972-978X; 0972-978X
• DOI: 10.1016/j.jor.2023.06.008

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 Apophysomyces variabilis. 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.