Angioinvasive Mold in the Surgical and Burn Intensive Care Unit: A Case Series and Review of the Literature

Background: Angioinvasive mold infections (AMIs) are among the most serious infections a patient can acquire. These infections carry high mortality and are difficult to cure. Methods: Report of case series of five patients with AMIs and review of pertinent English-language literature. Results: Five cases of AMIs developed in the surgical and burn intensive care units (ICUs) of a single center over a three-year period; four patients were female. The mean age was 48 y. One patient had advanced breast cancer and four had large total body surface area (TBSA; average 59%) burns. Among the burn patients, AMIs developed on average 25 d after burn injury (range, 18–35 d). Four of the AMIs reported here were polymicrobial; four patients had Candida spp., three had Aspergillus spp., two had Fusarium spp., two had Trichosporon asahii , two had Mucor spp., and one had Purpureocillium lilacinus . Four patients were treated with intravenous voriconazole, two with intravenous amphotericin B (amB), and one was treated with enteral posaconazole. Adjunctive topical anti-fungal therapy consisted of silver nitrate solution (n=4), 0.5% sodium hypochlorite (Dakin) solution (n=3), and topical amB (n=1). Conclusion: Three patients were cured of their infections (one of whom succumbed to a bacterial infection later in the hospitalization) and two died of the AMI, for an overall mortality rate of 60%. A majority of AMIs were polymicrobial, which has not been reported previously. To our knowledge, this is the first case report of P. lilacinus AMI in a burn patient.